Novel Therapeutic Approach to Relieve Pharyngoesophageal Spasm after Total Laryngectomy
| Autor: | Alexander A. Dekovich, Hak N. Kim, Jodi K. Knott, Jan S. Lewin, Katherine A. Hutcheson |
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| Jazyk: | angličtina |
| Rok vydání: | 2012 |
| Předmět: |
Male
medicine.medical_specialty Spasm medicine.medical_treatment Neurotoxins Laryngectomy Injections Intramuscular Article Endoscopy Gastrointestinal Pharyngeal muscles Stoma Alaryngeal speech Swallowing otorhinolaryngologic diseases medicine Humans Radiology Nuclear Medicine and imaging Phonation Esophagus Botulinum Toxins Type A Aged business.industry Gastroenterology Pharyngeal Diseases Surgery Esophageal Spasm Diffuse medicine.anatomical_structure Pharyngeal Muscles Female Speech-Language Pathology business |
| Popis: | Total laryngectomy results in a variety of functional changes including the loss of normal laryngeal voice and alterations in swallowing physiology [1]. Current literature recognizes tracheoesophageal (TE) voice restoration as the preferred alaryngeal speech alternative in most patients with total laryngectomy. The method depends on the use of a unidirectional valved prosthesis that maintains the TE puncture and also allows pulmonary air flow into the esophagus for phonation while preventing aspiration during swallowing. Although total laryngectomy disrupts the neurophysiology of the oropharynx, patients who have undergone total laryngectomy rarely complain of significant swallowing impairments. The most common reason for TE speech failure after total laryngectomy is constrictor muscle hypertonicity or what has been referred to as pharyngoesophageal spasm (PES). PES is known to increase peak intraesophageal pressure measurements during phonation and is correlated with levels of TE speech fluency [2]. PES has also been shown to impede cricopharyngeal functioning resulting in problems with food transit during swallowing as well as preventing the superior egress of airflow for sound production [3]. Although several methods have been employed with variable success to relieve PES, chemical denervation of the PE segment using Clostridium Botulinum Toxin A (BTA) that acts on the presynaptic cholinergic nerve fibers to prevent the release of acetylcholine at the neuromuscular junction, has become the treatment of choice to facilitate TE speech and swallowing after total laryngectomy. Currently, BTA is injected percutaneously into the pharyngeal constrictor muscles along one side of the neopharynx just superior and lateral to the stoma. The optimal technique uses electromyographic (EMG) guidance into the site of injection that has been previously marked by the speech pathologist during videofluoroscopic recording. However, percutaneous injection is not always possible particularly in patients with significantly distorted cervical anatomy, severe post-radiation fibrosis, postural difficulties that prevent accurate injection, or anxiety or inability to tolerate the procedure. Therefore, the purpose of this case series is to assess the efficacy of the BTA injection through the EGD in patients with PES. |
| Databáze: | OpenAIRE |
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