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Anatomic considerations in botulinum toxin type A therapy for spasmodic dysphonia
P F Castellanos1, G A Gates, G Esselman
1Department of Otolaryngology, Washington University School of Medicine, St. Louis, Mo.
The Laryngoscope
|June 1, 1994
Summary
Botulinum toxin type A injections effectively treat adductor spasmodic dysphonia via a transcutaneous vocal fold approach. Temporary side effects like breathiness are common but resolve, suggesting neural adaptation.
Area of Science:
- Otolaryngology
- Neurology
- Pharmacology
Background:
- Adductor spasmodic dysphonia (ADSD) is a neurological voice disorder.
- Chemodenervation with botulinum toxin type A is a primary treatment for ADSD.
- Injection can be performed perorally or transcutaneously.
Purpose of the Study:
- To evaluate the efficacy and safety of transcutaneous transcricothyroid membrane injection of botulinum toxin type A for ADSD.
- To investigate the optimal injection site and potential mechanisms for side effects.
Main Methods:
- Transcutaneous transcricothyroid membrane injection of botulinum toxin type A.
- Performed in over 50 patients with ADSD.
- Utilized indirect laryngoscopy to guide injection site selection.
Main Results:
- Satisfactory results achieved in over 50 patients.
- Temporary breathiness and aspiration were common side effects.
- Injection site was identified as below and posterior to the midpoint of the vibrating vocal fold.
Conclusions:
- Transcutaneous botulinum toxin type A injection is an effective treatment for ADSD.
- Side effects may be related to toxin spread to the lateral cricoarytenoid muscle or thyroarytenoid muscle paresis.
- Rapid symptom resolution suggests adaptive neural responses like axonal sprouting warrant further investigation.