Botulinum neurotoxin injection after total laryngectomy

Background: One of several causes of tracheoesophageal puncture (TEP) speech failure after total laryngectomy is disturbance in relaxation of the pharyngoesophageal (PE) segment. We introduce the use of chemical denervation of the PE segment through botulinum neurotoxin (Botox(R)) injection to improve TEP speech. Methods: An analysis was performed on eight patients who received Botox(R) injections for TEP speech problems after total laryngectomy at the University of Iowa between June 4, 1991 and August 8, 1994. Retrospective chart review identified the evolution of pretreatment evaluation and injection technique which became standardized in April 1992. Prospective evaluation of results was recorded by a single speech pathologist who subjectively identified the response to Botox(R) in all patients and recorded pressure readings at the tracheostoma site during speech in 6 patients. Results: Seven of the eight patients were noted to have improved TEP speech following injection. Five of these seven patients experienced substantially improved speech, three of whom had no ability to produce speech prior to the Botox(R) injection. Conclusion: Botox(R) injection is a safe and effective method of improving TEP speech in selected patients with disturbed relaxation of pharyngoesophageal segment. (C) 1997 John Wiley & Sons, Inc.