Visualisation of pharyngo-esophageal spasm while performing botulinum therapy in patients with tracheo-esophageal prostheses

Aims: By using different methods to visualise pharyngospasm, to achieve the clinical effect of botulinum therapy and to reduce the dose of the drug.

Materials and methods: We observed 6 patients with voice prosthesis dysfunction who underwent total laryngectomy with tracheo-oesophageal puncture (TEP). Two of the patients underwent intraoperative TEP, while the other four underwent delayed TEP (3 to 6 months). All six patients received radiotherapy after surgery.

One of the patients was diagnosed with a recurrence of the disease, the other two had severe pharyngeal stricture. The remaining three patients were diagnosed with pharyngospasm using real-time MRI with oral contrast.

The treatment of choice was chemical denervation with botulinotoxin A.

Results and discussion: Botulinum toxin A injection was performed in all three patients under ultrasound guidance to visualise the localisation of the spasm. The dose of the drug used was 40 OG, which is 10 points less than the usual minimum dose. The clinical effect was assessed by the speech therapist 72 hours later. A real-time MRI control was performed, which showed adequate dilatation of the pharyngo-esophageal segment. After 6 months of follow-up, all patients had significant improvement of tracheo-oesophageal speech.

Conclusions: The use of real-time MRI in the diagnosis of spasm of the pharyngo-esophageal segment, together with ultrasound-guided botulotoxin injection precisely at the site of the spasm, gives the possibility to achieve a stable clinical effect and to reduce the dose of the toxin.

The authors declare that there is no conflict of interest