Cricothyroid Muscle Botulinum Toxin Injection to Improve Airway for Bilateral Recurrent Laryngeal Nerve Paralysis, A Case Series

Benninger, Michael S.; Hanick, Andrea; Hicks, Douglas M.

doi:10.1016/j.jvoice.2015.02.008

Cited by 14 publications

(15 citation statements)

References 8 publications

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“…Laryngeal BTX applications could be performed transcutaneously under EMG, with the help of transnasal fibreoptic endoscopy, or with direct vision under general anaesthesia [9,11]. In this study, BTX injection was performed under EMG in all patients without anesthesia, with no complications being observed during the injections or at subsequent follow-up.…”

Section: Discussionmentioning

confidence: 99%

“…In paralytic VF, endogenous abductor power may result in more manifest adductor effects of the CT muscle. As the paralysis proceeds, the unopposed effect of the CT muscle may result in more severe airway problems [8,9]. In an animal study by Cohen et al [22], chemical CT muscle denervation with BTX for bilateral VF paralysis was reported to produce VF lateralization without any complications or histological damage in muscles.…”

Section: Discussionmentioning

confidence: 99%

“…In time, the balance of adductor/abductor muscle powers with especially chronic unopposed activity of intact cricothyroid (CT) muscles which has the function of stretching VFs to the anteromedially could potentially result in gradual more medial positioning of the VFs in BVFAP [9]. Unbalanced adductor powers reinforce gradual narrowing of the airway results in an escalation in respiratory distress with a relative improvement in voice quality [9,10]. The typical mid-line position of the resting VFs’ tonus has been attributed to the development of a synkinesis with adductor dominancy [1,9,10].…”

Section: Introductionmentioning

confidence: 99%

“…Unbalanced adductor powers reinforce gradual narrowing of the airway results in an escalation in respiratory distress with a relative improvement in voice quality [9,10]. The typical mid-line position of the resting VFs’ tonus has been attributed to the development of a synkinesis with adductor dominancy [1,9,10]. Neuromuscular blockade of synkynetic reinnervated adductor muscles may be beneficial in some patients with BVFAP.…”

Section: Introductionmentioning

confidence: 99%

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Electromyography-Guided Botulinum Toxin Injection Into the Cricothyroid Muscles in Bilateral Vocal Fold Abductor Paralysis

Şahin

Aydoğdu

Akyıldız

et al. 2017

Clin Exp Otorhinolaryngol

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ObjectivesBilateral vocal fold abductor paralysis (BVFAP) both deteriorates quality of life and may cause life-threatening respiratory problems. The aim of this study was to reduce respiratory symptoms in BVFAP patients using cricothyroid (CT) botulinum toxin (BTX) injection.MethodsBefore and 2 weeks and 4 months after bilateral BTX injection into the CT muscles under electromyography; alterations in respiratory, acoustic, aerodynamic and quality of life parameters were evaluated in BVFAP patients with respiratory distress. For the respiratory evaluation modified Borg scale and spirometry, for the voice and aerodynamic evaluations Voice Handicap Index-30 (VHI-30), GRBAS, acoustic analysis (sound pressure level, F0, jitter%, shimmer%, noise-to-harmonic ratio) and maximum phonation time and for the quality of life assessment Short Form-36 (SF-36) form were used.ResultsAll patients were female with a mean age of 47±8.1 years. There was a mean time of 11.8±5.5 (minimum 2, maximum 23) months between BVFAP development and BTX injection. In all cases, other than one case with unknown aetiology, the cause of vocal fold paralysis was prior thyroid surgery. In total 18.6±3.1 units of BTX were applied to the CTs. In the preinjection period, and the 2nd week and 4th month after injection, the Borg dyspnea scale was 7.3/5.3/5.0, FIV1 (forced inspiratory volume in one second) was 1.7/1.7/1.8 L, peak expiratory flow (PEF) was 1.4/1.7/2.1 L/sec, maximum phonation time was 7.0/6.4/6.2 seconds and VHI-30 was 63.2/52.2/61.7 respectively. There was no significant alteration in acoustic analysis parameters. Many of the patients reported transient dysphagia within the first week. There were insignificant increases in SF-36 sub-scale values.ConclusionAfter BTX injection, improvements in the mean Borg score, PEF and FIV1 values and SF-36 sub-scale scores showed the restricted success of this approach. This modality may be kept in mind as a transient treatment option for patients refused persistent tracheotomy or ablative airway surgeries.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Electromyography-Guided Botulinum Toxin Injection Into the Cricothyroid Muscles in Bilateral Vocal Fold Abductor Paralysis

Şahin

Aydoğdu

Akyıldız

et al. 2017

Clin Exp Otorhinolaryngol

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“…Lastly, the possibility of a paresis because of botulinum neuro-toxin injection whether intentional or because of diffusion of injection into the strap musculature, cricopharyngeus should also be considered in the initial assessment [42,46,47].…”

Section: Differential Diagnosismentioning

confidence: 99%

Vocal fold paresis

Benninger

2016

Current Opinion in Otolaryngology & Head and Neck Surgery

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Decision-Making in Patients with Bilateral Vocal Fold Paralysis with Glottal Insufficiency: Balancing Voice Versus Airway

Woo

2019

Decision Making in Vocal Fold Paralysis

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Cricothyroid Muscle Botulinum Toxin Injection to Improve Airway for Bilateral Recurrent Laryngeal Nerve Paralysis, A Case Series

Cited by 14 publications

References 8 publications

Electromyography-Guided Botulinum Toxin Injection Into the Cricothyroid Muscles in Bilateral Vocal Fold Abductor Paralysis

Electromyography-Guided Botulinum Toxin Injection Into the Cricothyroid Muscles in Bilateral Vocal Fold Abductor Paralysis

Vocal fold paresis

Decision-Making in Patients with Bilateral Vocal Fold Paralysis with Glottal Insufficiency: Balancing Voice Versus Airway

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