Botulinum toxin injection for failed tracheo-oesophageal voice in laryngectomees: the Sunderland experience

2003 ◽  
Vol 117 (7) ◽  
pp. 544-548 ◽  
Author(s):  
K. Ramachandran ◽  
P. S. Arunachalam ◽  
Anne Hurren ◽  
R. L. Marsh ◽  
P. R. Samuel
Keyword(s):  
Botulinum Toxin ◽  
Botulinum Neurotoxin ◽  
Speech Therapy ◽  
Rating Scale ◽  
Botulinum Toxin Injection ◽  
Voice Restoration ◽  
Early Results ◽  
Pharyngeal Plexus

Spasm of the pharyngo-oesophageal segment is one of the important causes of tracheo-oesophageal voice failure. Traditionally it has been managed by either prolonged speech therapy, surgical pharyngeal myotomy or pharyngeal plexus neurectomy with varying degrees of success. Botulinum neurotoxin has been found to be effective in relieving pharyngo-oesophageal segment spasm. Since 1995, we have used botulinum toxin injection on 10 laryngectomees with either aphonia or hypertonicity due to pharyngo-oesophageal segment spasm. Early results were analysed by the Sunderland Surgical Voice Restoration Rating scale. Seven of the 10 patients, who were previously completely aphonic, developed voice following this therapy and are using their valve choice as their only method of communication. Out of the three patients who were treated for hypertonic voice, two did derive some benefit from the procedure. One patient developed a hypotonic voice, which lasted for a few months.

scholarly journals Spatiotemporal Gait Analysis and Lower Limb Functioning in Foot Dystonia Treated with Botulinum Toxin

Toxins ◽  
2018 ◽  
Vol 10 (12) ◽  
pp. 532 ◽  
Author(s):  
Anupam Datta Gupta ◽  
Graeme Tucker ◽  
Simon Koblar ◽  
Renuka Visvanathan ◽  
Ian Cameron
Keyword(s):  
Botulinum Toxin ◽  
Gait Analysis ◽  
Lower Limb ◽  
Functional Outcomes ◽  
Stride Length ◽  
Rating Scale ◽  
Botulinum Toxin Injection ◽  
Step Length ◽  
Small Sample ◽  
Gait Velocity

Foot dystonia (FD) is a disabling condition causing pain, spasm and difficulty in walking. We treated fourteen (14) adult patients experiencing FD with onabotulinum toxin A injection into the dystonic foot muscles. We analyzed the spatiotemporal gait utilizing the GaitRite system pre- and 3 weeks post-botulinum toxin injection along with measuring dystonia by the Fahn–Marsden Dystonia Scale (FMDS), pain by the Visual Analog Scale (VAS) and other lower limb functional outcomes such as gait velocity, the Berg Balance Scale (BBS), the Unified Parkinson’s Disease Rating Scale–Lower Limb Score (UPDRS–LL), the Timed Up and Go (TUG) test and the Goal Attainment Scale (GAS). We found that stride length increased significantly in both the affected (p = 0.02) and unaffected leg (p = 0.01) after treatment, and the improvement in stride length was roughly the same in each leg. Similar results were found for step length (p = 0.02) with improvement in the step length differential (p = 0.01). The improvements in the lower limb functional outcomes were also significant—FMDS, VAS, TUG, and UPDRS–LL decreased significantly after treatment (all p < 0.001), and BBS (p = 0.001), GAS (p < 0.001) except cadence (p = 0.37). BT injection improved walking in foot dystonia as evidenced through gait analysis, pain and lower limb functional outcomes. Main study limitations were small sample size and lack of control.

Botulinum Toxin Injection of the Cricopharyngeus Muscle for the Treatment of Dysphagia

2000 ◽  
Vol 122 (5) ◽  
pp. 691-695 ◽  
Author(s):  
Syed F. Ahsan ◽  
Robert J. Meleca ◽  
James Paul Dworkin
Keyword(s):  
Botulinum Toxin ◽  
Rating Scale ◽  
Botulinum Toxin Injection ◽  
Retrospective Chart Review ◽  
Muscle Spasm ◽  
Barium Swallow ◽  
Patient Questionnaire ◽  
Therapeutic Effects ◽  
Swallowing Function ◽  
Botox Injection

OBJECTIVE: This study was conducted to evaluate, subjectively and objectively, the diagnostic and therapeutic effects of botulinum toxin (Botox) in patients with dysphagia caused by cricopharyngeus (CP) muscle spasm and/or hypertonicity. METHODS: A retrospective chart review was done of 5 patients with normally functioning larynges treated with CP Botox injection for dysphagia caused by perceived spasm. Subjective measures of swallowing function after injection were obtained with a patient questionnaire. Objective data were obtained both before and after surgery by one or more of the following tests: modified barium swallow study, manometry, videostroboscopy, and fiberoptic endoscopic evaluation of swallowing. Quality-of-life measures were obtained with a swallowing rating scale. RESULTS: Overall, all patients had initial improvement in swallowing after Botox injection. The duration of benefit was from 2 to 14 months. There were no complications. Four of 5 patients had long-term benefits, as evidenced by decreased or eliminated aspiration symptoms, removal of tracheotomy, ability to eat solid foods, and weight gain. One patient continues to have poor swallowing function. CONCLUSION: Botox injection of the CP muscle to treat dysphagia is effective in patients with underlying muscle spasm or hypertonicity. A positive response to Botox can also help confirm the diagnosis of CP muscle spasm.

Dysphagia among patients after total laryngectomy: diagnostic and therapeutic procedures

2020 ◽  
Vol 9 (4) ◽  
pp. 1-5
Author(s):  
Barbara Jamróz ◽  
Joanna Chmielewska-Walczak ◽  
Magdalna Milewska
Keyword(s):  
Total Laryngectomy ◽  
Speech Therapy ◽  
Botulinum Toxin Injection ◽  
Specific Treatment ◽  
Upper Esophageal Sphincter ◽  
Diagnostic Process ◽  
Bolus Transit ◽  
Surgical Methods ◽  
Pharyngeal Plexus ◽  
Esophageal Sphincter

Dysphagia concerns 10–89% patients after total laryngectomy; to a greater extent, it concerns patients receiving complementary radiotherapy. The disease mechanism is associated with anatomical changes after surgery (scope of surgery) or complications of adjuvant therapy (xerostomia, neuropathy, swelling of tissue, etc.). The above changes lead to: decreased mobility of the lateral walls of the pharynx and tongue retraction, the occurrence of lingual pumping, decreased swallowing reflex, weakening of the upper esophageal sphincter opening, contraction of the cricopharyngeal muscle, tissue fibrosis, formation of pharyngeal pseudodiverticulum, etc. As a result: regurgitation of food through the nose and oral cavity, food sticking in middle and lower pharynx, prolongation of bolus transit time. Upon the formation of tracheoesophageal fistula, there may be aspiration of gastric contents. The above changes considerably reduce patients’ quality of life after surgery. The diagnostic protocol includes: medical interview (questionnaires can be helpful such as: EAT 10, SSQ, MDADI, DHI), clinical swallowing assessment and instrumental examinations: primarily videofluoroscopy but also endoscopic evaluation of swallowing. In selected cases, multifrequency manometry is necessary. The treatment options include: surgical methods (e.g. balloon dilatation of the upper esophageal sphincter, cricopharyngeal myotomy, pharyngeal plexus neurectomy, removal of the pharyngeal pseudodiverticulum), conservative methods (e.g. botulinum toxin injection of the upper esophageal sphincter, speech therapy, nutritional treatment) and supportive methods such as consultation with a psychologis physiotherapist, clinical dietitian. The selection of a specific treatment method should be preceded by a diagnostic process in which the mechanism of functional disorders related to voice formation and swallowing will be established.

scholarly journals Intramuscular Neural Distribution of Rhomboid Muscles: Evaluation for Botulinum Toxin Injection Using Modified Sihler’s Method

Toxins ◽  
2020 ◽  
Vol 12 (5) ◽  
pp. 289 ◽  
Author(s):  
Kyu-Ho Yi ◽  
Hyung-Jin Lee ◽  
You-Jin Choi ◽  
Ji-Hyun Lee ◽  
Kyung-Seok Hu ◽  
...  
Keyword(s):  
Botulinum Toxin ◽  
Botulinum Neurotoxin ◽  
Botulinum Toxin Injection ◽  
Entry Point ◽  
Middle Section ◽  
Essential Information ◽  
Spinous Processes ◽  
Intramuscular Nerve ◽  
Improved Performance ◽  
Botulinum Toxin Injections

This study describes the nerve entry point and intramuscular nerve branching of the rhomboid major and minor, providing essential information for improved performance of botulinum toxin injections and electromyography. A modified Sihler method was performed on the rhomboid major and minor muscles (10 specimens each). The nerve entry point and intramuscular arborization areas were identified in terms of the spinous processes and medial and lateral angles of the scapula. The nerve entry point for both the rhomboid major and minor was found in the middle muscular area between levels C7 and T1. The intramuscular neural distribution for the rhomboid minor had the largest arborization patterns in the medial and lateral sections between levels C7 and T1. The rhomboid major muscle had the largest arborization area in the middle section between levels T1 and T5. In conclusion, botulinum neurotoxin injection and electromyography should be administered in the medial and lateral sections of C7−T1 for the rhomboid minor and the middle section of T1−T7 for the rhomboid major. Injections in the middle section of C7−T1 should also be avoided to prevent mechanical injury to the nerve trunk. Clinicians can administer safe and effective treatments with botulinum toxin injections and other types of injections by following the methods in our study.

Reduction of self-mutilating behavior and improved oromotor function in a patient with Lesch-Nyhan syndrome following botulinum toxin injection: A case report

2021 ◽  
Vol 14 (1) ◽  
pp. 133-136
Author(s):  
Courtney Gilbert ◽  
Michelle Sauer ◽  
JenFu Cheng
Keyword(s):  
Patient Safety ◽  
Case Report ◽  
Botulinum Toxin ◽  
Functional Status ◽  
Metabolic Disorder ◽  
Speech Therapy ◽  
Botulinum Toxin Injection ◽  
Optimal Dosing ◽  
Botulinum Toxin Injections ◽  
Masseter Muscles

Lesch-Nyhan syndrome is a genetic metabolic disorder often involving dystonia and self-mutilating behavior. This case report describes a 13-year-old boy with Lesch-Nyhan syndrome and self-mutilating behavior who received botulinum toxin injections to his bilateral masseter muscles after failing multiple other treatments. Following injections, the patient had reduction in self-biting, along with improvements in speech, mastication and feeding observed in speech therapy. Botulinum toxin injections to the masseters may help to improve oromotor function and reduce self-mutilating behaviors in children with Lesch-Nyhan syndrome who have failed more conservative treatments, providing opportunity for improved functional status and patient safety. Further investigation is indicated to establish optimal dosing. Additionally, the mechanism for the reduction of self-mutilating behavior is unclear and justifies additional investigation.

The Effect of Botulinum Toxin Injection into the Common Extensor Tendon in Patients with Chronic Lateral Epicondylitis: A Randomized Trial

Pain Medicine ◽  
2019 ◽  
Vol 21 (9) ◽  
pp. 1971-1976 ◽  
Author(s):  
Sang Hoon Lee ◽  
Hyun Hee Choi ◽  
Min Cheol Chang
Keyword(s):  
Botulinum Toxin ◽  
Pain Relief ◽  
Grip Strength ◽  
Dose Group ◽  
Rating Scale ◽  
Botulinum Toxin Injection ◽  
Botulinum Toxin Type A ◽  
Lateral Epicondylitis ◽  
Extensor Tendon ◽  
The Common

Abstract Background Botulinum toxin (BTX) is widely used for pain control in various musculoskeletal disorders. Objectives We evaluated the analgesic effect of botulinum toxin type A (BTX-A) in chronic lateral epicondylitis and compared the effect between 10 and 50 IU of BTX-A. Methods Sixty subjects with chronic lateral epicondylitis were included and underwent a BTX-A injection in the common extensor tendon. The subjects were randomly allocated into two groups: the small-dose group (SD group; 30 subjects, 10 IU) and large-dose group (LD group; 30 subjects, 50 IU). Treatment outcomes were evaluated by measuring the pain level using the numeric rating scale (NRS) and measuring grip strength before and one, two, three, four, five, and six months after treatment. Results Subjects in both groups showed a significant decrease in NRS scores at all evaluation time points after treatment. The reduction in NRS scores was significantly greater in the LD group at one, two, three, and four months after treatment. Six months after treatment, 19 subjects (63.3%) in the SD group and 21 (70%) in the LD group reported successful pain relief (pain relief ≥50%). The rate of successful pain relief was not significantly different between the two groups. Grip strength was more increased in the LD group at one, two, three, four, and six months after treatment. Conclusions BTX-A injection into the common extensor tendon can be a good treatment option for chronic lateral epicondylitis. The 50-IU BTX-A injection achieved a better outcome than the 10-IU injection.

Office-based Electromyography-guided Botulinum Toxin Injection to the Cricopharyngeus Muscle: Optimal Patient Selection and Technique

2017 ◽  
Vol 126 (5) ◽  
pp. 349-356 ◽  
Author(s):  
Min-Su Kim ◽  
Go-Woon Kim ◽  
Young-Soo Rho ◽  
Kee-Hwan Kwon ◽  
Eun-Jae Chung
Keyword(s):  
Botulinum Toxin ◽  
Cranial Nerve ◽  
Rating Scale ◽  
Botulinum Toxin Injection ◽  
Upper Esophageal Sphincter ◽  
Disability Rating Scale ◽  
Cricopharyngeus Muscle ◽  
Swallowing Rehabilitation ◽  
Disability Rating ◽  
Cricopharyngeal Dysfunction

Objectives: This retrospective study was carried out to investigate the effectiveness and safety of office-based electromyography-guided injection of botulinum toxin in the cricopharyngeus muscle of patients who did not show upper esophageal sphincter passage in a swallowing study in spite of maximal swallowing rehabilitation. Methods: Thirty-six patients who showed no or limited ability to oral feed after maximum swallowing rehabilitation were enrolled. Video fluoroscopic swallowing study, flexible endoscopic evaluation of swallowing, disability rating scale, penetration aspiration score, and National Institutes of Health swallowing safety scale were used in the evaluation of dysphagia. Results: Success was defined as nondependence on gastrostomy for patients who previously were dependent on gastrostomy and improvement in disability rating scale score after botulinum toxin injections. The total success rate was 63.9%. The complication rate was very low, with only 1 patient showing temporary unilateral vocal fold paralysis. Botulinum toxin injection was more effective in patients with cranial nerve IX or X palsy than in those without it ( P = .006). Conclusions: This procedure can be a simple, safe, and effective tool in patients with cricopharyngeal dysfunction after swallowing rehabilitation, especially for cranial nerve IX or X palsy.

Autogenous Fat Transplantation and Botulinum Toxin Injection Into the Masseter Muscle to Create an Ideal Oval Face

2021 ◽  
Author(s):  
Zhifang Zheng ◽  
Yongsheng Hao ◽  
Junfeiyang Yin ◽  
Xiaoxuan Lei ◽  
Biao Cheng ◽  
...  
Keyword(s):  
Patient Satisfaction ◽  
Botulinum Toxin ◽  
Rating Scale ◽  
Botulinum Toxin Injection ◽  
East Asian ◽  
Recovery Period ◽  
Nasolabial Fold ◽  
Temporal Region ◽  
Facial Swelling ◽  
The Face

Abstract Background East Asian faces vary in shape but only oval faces seem to be considered attractive. Many patients with wide faces seek removal of part of the mandibular angle and/or zygoma to achieve an ideal facial contour, but the procedure is high risk and the recovery period is relatively protracted. Objectives We sought to achieve ideal facial contours through the use of autologous fat grafting (AFG) combined with masseter botulinum toxin (BTX) injection for patients with wide faces and masseter hypertrophy. Methods Fourteen patients with wide faces underwent AFG of the forehead, temporal region, cheeks, zygomatic body, nose, nasolabial fold, tear trough, and chin; and BTX injection into the masseter muscles. Each patient was photographed more than 6 months after the operation. The pre- and postoperative ratios pertaining to the facial aesthetics of the face were calculated. The Hollowness Severity Rating Scale (HSRS) and Ricketts’s E-line were used to evaluate the photographs. Patient satisfaction was also investigated. Results All patients received AFG and 1 to 3 BTX injections. The face length:bizygomatic breadth, bigonial breadth:bizygomatic breadth, and lower-face height:middle-face height ratios improved greatly after treatment. The mean HSRS score decreased from 2.214 preoperatively to 1.071 postoperatively. The chin and nose became more prominent than before. Facial swelling persisted for an average of 11.929 days. All patients were satisfied with the treatment outcome. Conclusions A combination of AFG and BTX injection was able to achieve an ideal oval face in East Asian patients with wide faces and masseter hypertrophy, with very few complications. Recovery was rapid and patient satisfaction was high. Level of Evidence: 4

Botulinum toxin injection of the cricopharyngeus muscle for the treatment of dysphagia

2000 ◽  
Vol 122 (5) ◽  
pp. 691-695 ◽  
Author(s):  
Syed F. Ahsan ◽  
Robert J. Meleca ◽  
Paul Dworkin James
Keyword(s):  
Botulinum Toxin ◽  
Rating Scale ◽  
Botulinum Toxin Injection ◽  
Retrospective Chart Review ◽  
Muscle Spasm ◽  
Barium Swallow ◽  
Patient Questionnaire ◽  
Therapeutic Effects ◽  
Swallowing Function ◽  
Botox Injection

OBJECTIVE: This study was conducted to evaluate, subjectively and objectively, the diagnostic and therapeutic effects of botulinum toxin (Botox) in patients with dysphagia caused by cricopharyngeus (CP) muscle spasm and/or hypertonicity. METHODS: A retrospective chart review was done of 5 patients with normally functioning larynges treated with CP Botox injection for dysphagia caused by perceived spasm. Subjective measures of swallowing function after injection were obtained with a patient questionnaire. Objective data were obtained both before and after surgery by one or more of the following tests: modified barium swallow study, manometry, videostroboscopy, and fiberoptic endoscopic evaluation of swallowing. Quality-of-life measures were obtained with a swallowing rating scale. RESULTS: Overall, all patients had initial improvement in swallowing after Botox injection. The duration of benefit was from 2 to 14 months. There were no complications. Four of 5 patients had long-term benefits, as evidenced by decreased or eliminated aspiration symptoms, removal of tracheotomy, ability to eat solid foods, and weight gain. One patient continues to have poor swallowing function. CONCLUSION: Botox injection of the CP muscle to treat dysphagia is effective in patients with underlying muscle spasm or hypertonicity. A positive response to Botox can also help confirm the diagnosis of CP muscle spasm.

Sign in / Sign up

Export Citation Format

Share Document