The role of botulinum toxin in the management of airway compromise due to bilateral vocal fold paralysis.

Abstract:

PURPOSE OF REVIEW:The management of a patient with bilateral vocal fold motion impairment (BVFMI) can be challenging for the otolaryngologist. The treatment traditionally involves tracheotomy, which can be very distressful for some patients. Alternatively, there are endoscopic procedures, which irreversibly sacrifice voice in order to improve airway. The optimal treatment of BVFMI still eludes us. The purpose of this review is to highlight an alternate management strategy for bilateral vocal fold paralysis using botulinum toxin (BTX). This procedure is predicated on the premise that vocal fold immobility is related to synkinetic reinnervation of the vocal fold. Eliminating any thyroarytenoid/lateral cricoarytenoid (LCA) activity during respiratory gestures should allow greater unopposed posterior cricoarytenoid abduction. RECENT FINDINGS:There have been several case reports and series, the largest of which involved 11 patients, describing the successful use of BTX for this application. SUMMARY:The best candidates for this adductor chemical denervation are those patients who have undergone trauma to the recurrent laryngeal nerve without evidence of cricoarytenoid joint fixation. Patients should have evidence of voluntary thyroarytenoid/LCA laryngeal electromyography activity, though true synkinesis cannot always be reliably identified. The procedure can be another management option for patients with BVFMI.

authors

Ongkasuwan J,Courey M

doi

10.1097/MOO.0b013e32834c1e4f

subject

Has Abstract

pub_date

2011-12-01 00:00:00

pages

444-8

issue

6

eissn

1068-9508

issn

1531-6998

journal_volume

19

pub_type

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