Pharyngeal Constrictor Botulinum Toxin Injection Therapy For Aphonia and Dysphagia Following Total Laryngectomy

Presentation: C056
Topic: Pharynx / Larynx Cancer
Type: Poster
Date: Thursday, April 19, 2018
Session: 9:00 AM - 7:00 PM
Authors: Shannon D Fayson, Laura Matrka, MD, Brad W deSilva, MD
Institution(s): The Ohio State University

Objective:  Describe the utility of botulinum toxin injection to pharyngeal constrictors for treatment of aphonia and dysphagia in the setting of constrictor spasm following total laryngectomy (TL).

Study Design:  Retrospective case series

Setting:  Tertiary Academic Medical Center Voice and Swallowing Disorders Clinic

Subjects and Methods:  Retrospective review of patients undergoing botulinum toxin injection to pharyngeal constrictors for constrictor spasm in the setting of aphonia and dysphagia following TL.  Outcomes measured included voice improvement, intelligibility, swallowing quality using VHI-10 and EAT-10 scores following botulinum toxin injection, dosage and frequency of botulinum toxin injection, and comparison of outcomes in patients that had previous chemoradiation therapy, with or without pharyngeal flap reconstruction.

Results:  35 subjects underwent botulinum toxin injection to the pharyngeal constrictors for constrictor spasm, resulting in aphonia and/or dysphagia following TL and tracheoesophageal voice prosthesis placement.  22/35 subjects (63%) had substantial voice and swallow improvement with ability to perform tracheoesophageal speech following botulinum toxin injection.  Subjects received 25-117.5 units of botulinum toxin with a median of 75 units.  The average number of repeat injections was 3.68 with a median of 2. 18/35 subjects had been irradiated, 1/35 subjects underwent primary or adjuvant chemotherapy, 10/35 subjects received chemoradiation therapy, and 16/35 subjects underwent pharyngeal flap reconstruction concurrently with TL. The average post-injection VHI-10 and EAT-10 scores were 21 and 16.5, respectively.  There was no statistical difference in voice and swallowing improvement following botulinum toxin injection when comparing subjects with aphonia and dysphagia that had not received chemoradiation therapy or pharyngeal flap reconstruction versus those subjects that had received chemoradiation or flap reconstruction.

Conclusion:  Botulinum toxin injection to pharyngeal constrictors following TL improves voice and swallowing quality in most patients that are unable to achieve tracheoesophageal speech and experience dysphagia, regardless of previous chemoradiation therapy or pharyngeal flap reconstruction.