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Botulinum Toxin Injection to Cricopharyngeus after Total Laryngectomy (In Clinic Transnasal Laryngoscopy)

last modified on: Mon, 09/11/2023 - 10:34

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return to: Botulinum Toxin Protocols; Tracheoesophageal Puncture; Botulinum Neurotoxin A Injection; Head and Neck Cancer Symposium MCOW September 23 2011

Modified Operative Note

PREOPERATIVE DIAGNOSIS: 
Dysphagia status post total laryngectomy and cricopharyngeal constriction refractory to myotomy responding to Botox injection. 
POSTOPERATIVE DIAGNOSIS: 
Dysphagia status post total laryngectomy and cricopharyngeal constriction refractory to myotomy responding to Botox injection. 
PROCEDURE PERFORMED: 
Transnasal fiberoptic pharyngoscopy with Botox injection to the cricopharyngeus with a total of 75 units delivered (2 different sites). 
ANESTHESIA: 
Nasal decongestion with topical lidocaine and Afrin as well as spray into the oropharynx. 
DESCRIPTION OF PROCEDURE: 
Following identification of the patient informed consent initial inspection with the distal chip flexible endoscope of the trachea tracheal stoma down at the carina showed no lesion with a well-seated PE puncture the scope was placed through the right nostril with ready injection of the right cricopharyngeus with 25-gauge sclerotherapy needle preloaded with Botox at 2.5 units or 0.1 cc administered to a volume of 1.5 cc (37.5 units). An identical procedure was done the contralateral left side with initial 0.5 cc administered followed by "chasing it" with 1 cc of saline total of 1.5 cc (37.5 units) instilled after the instillation inspection showed no bleeding the scope was passed down through the upper esophagus with no lesion seen and he was discharged home with followup as needed. Despite our planning to cover with oral antibiotics, the patient related he had not used antibiotics in the past and does not feel he needs him for this either. 

6 month f/u reported smilar benefit to swallowing with a series of identical procedures done over a 5 year period at 6 month intervals 

References

Hoffman HT, Fischer H, VanDenmark D, Peterson KL, McCulloch TM, Karnell LH, Funk GF. Botulinum neurotoxin injection after total laryngectomy. Head Neck. 1997 Mar;19(2):92-7. doi: 10.1002/(sici)1097-0347(199703)19:2<92::aid-hed2>3.0.co;2-p. PMID: 9059865.