(0601) A Comprehensive Review and Guide for Botulinum Toxin A Injection for Pharyngoesophageal Segment Dysfunction Post-Laryngectomy

Introduction: Pharyngoesophageal segment (PE) spasm in patients after laryngectomy can severely impact swallowing and tracheoesophageal puncture (TEP) speech fluency. We present our institution’s experience with botulinum toxin A injections and a guide for management of this debilitating problem.

Methods: We performed a retrospective chart review of patients who underwent botulinum toxin A injection into the pharyngoesophageal segment for treatment of PE spasm after laryngectomy at a tertiary care center from 2000 - 2023. Pre and posttreatment patient outcomes are evaluated using chart review, and the severity of symptoms was recorded based on the subjective assessment by the patient, speech language pathologists, and the treating surgeon.

Results: In total, 43 patients were treated for PE spasm with botulinum toxin A injection. Most patients were male (n = 35, 81.4%), underwent primary CP myotomy (n = 36, 83.7%), and 37 (86%) had both dysphagia and speech concerns. Our injection methods included percutaneous injection by videofluoroscopy (n = 19, 44.2%), transnasal esophagoscopy (17, 40.5%), electromyography (n = 3, 7%), ultrasound (n = 1, 2.3%), or in the operating room (n = 3, 7%). We found that 37 (86%) patients had improvement in their symptoms, with 16 (38.1%) improving in both swallow and voice. There was no difference in speech and swallowing outcomes by method of botox injection (p = 0.33).

Conclusions: Botulinum toxin A injection is a safe and effective for treating speech and swallowing dysfunction due to pharyngoesophageal spasm after laryngectomy. Providers should consider performing botox injection in the clinic to save time and cost. We provide an up-to-date guide for the management for PE spasm and describe the methods of botox injection.