Cricothyroid Muscle Botulinum Toxin Injection to Improve Airway for Bilateral Recurrent Laryngeal Nerve Paralysis, A Case Series

J Voice. 2016 Jan;30(1):96-9. doi: 10.1016/j.jvoice.2015.02.008. Epub 2015 Mar 24.

Abstract

Bilateral vocal fold paralysis most commonly results from iatrogenic trauma to the recurrent laryngeal nerve during surgical procedures in the anterior neck. Patients may require tracheostomy because of acute or gradual onset of dyspnea and airway compromise. The intralaryngeal injection of Botox has been considered as a possible therapy for these airway symptoms of bilateral vocal fold paralysis. Chronic unopposed activity of intact cricothyroid muscles could potentially result in gradual medialization of the vocal folds in patients with bilateral recurrent laryngeal nerve paralysis. This case series describes three patients who successfully underwent injections of botulinum toxin into the bilateral cricothyroid muscles to offer sustained relief of dyspnea resulting from bilateral vocal fold paralysis.

Keywords: Bilateral recurrent laryngeal nerve paralysis; Bilateral vocal fold paralysis; Botox; Cricothyroid muscle injection.

Publication types

  • Case Reports

MeSH terms

  • Acetylcholine Release Inhibitors / administration & dosage*
  • Adult
  • Botulinum Toxins, Type A / administration & dosage*
  • Female
  • Humans
  • Injections, Intramuscular
  • Laryngeal Muscles / drug effects*
  • Laryngeal Muscles / physiopathology
  • Laryngoscopy
  • Middle Aged
  • Recovery of Function
  • Recurrent Laryngeal Nerve / drug effects*
  • Recurrent Laryngeal Nerve / physiopathology
  • Treatment Outcome
  • Vocal Cord Paralysis / diagnosis
  • Vocal Cord Paralysis / drug therapy*
  • Vocal Cord Paralysis / physiopathology
  • Vocal Cords / drug effects*
  • Vocal Cords / innervation
  • Voice Quality
  • Young Adult

Substances

  • Acetylcholine Release Inhibitors
  • Botulinum Toxins, Type A