Reabilitação fonatória do laringectomizado total: utilização de toxina botulínica na voz tráqueo-esofágica com prótese fonatória

Abstract

In tracheo esophageal puncture (TEP), we carry out a myotomy of the pharynx constrictor muscle; however, about 9 to 79% of patients need such procedure. The consequence of such procedure is an increase in salivary fistula rates in the postoperative. Botulin toxin is used in an outpatient basis. Aim: analyzing the efficacy of botulin toxin (BT) use in the rehabilitation of totally laryngectomized patients with tracheoesophageal voice (TEV) with spasms (S) of the pharyngoesophageal segment (PES) without myotomy. Materials and Methods: We analyzed eight patients submitted to total laryngectomy (TL), rehabilitated with TEV, with speech prosthesis (SP) and struggle to utter voice because of PES spasms. They were all submitted to treatment of such motor alteration with the injection of 100 units of BT in the PES. The evaluation was based on perceptive voice analysis, video fluoroscopy (VF) of the PES, acoustic voice analysis and computerized manometry (CM) of the PES, all before and after BT injection. Study design: prospective. Results: There was a reduction in PES CM pressure after BT injection. Acoustic analysis showed an improvement in harmonics quality after treatment. There was smoother voice utterance and spasm improvement after BT. Conclusion: all patients with PES spasms presented vocal improvement after BT injection in the PES.

The applicability of high resolution manometry in total laryngectomy

“…Regarding myotomy, some authors have observed that there is a decrease in the peak of pharyngeal pressure and a decrease in spasms and hypertonicity in total laryngectomy patients (16,17,18,19) . In our study, none of the patients underwent these procedures.…”

Tratamento do câncer de laringe: revisão da literatura publicada nos últimos dez anos

“…Many studies [5][6][7][8][9][10][11][12][13][14][15][16][17][18][19][20][21] have been done with the aim to investigate the efficiency of different surgical methods with a view to the most satisfactory possible prognostic in these patients affected by cancer.…”