Biomaterial Database

Spasmodic dysphonia: botulinum toxin injection after recurrent nerve surgery. 1990

C L Ludlow, and R F Naunton, and M Fujita, and S E Sedory

Speech and Voice Unit, National Institute on Deafness and Other Communication Disorders, NIH, Bethesda, MD 20892.

The purpose of this study was to determine if botulinum toxin injections into the thyroarytenoid muscle would reduce symptoms in adductor spasmodic dysphonic patients who had experienced symptom recurrence after recurrent laryngeal nerve surgery. Five patients were seen between 3 to 10 years after surgery with a return of speech symptoms and persistent unilateral vocal fold paralysis. Before injection, comparisons with controls on spectrographic measures of pitch and voice breaks, aperiodicity, and sentence length demonstrated significant symptoms of spasmodic dysphonia (p less than or equal to 0.02). Electromyographic measures demonstrated equal levels of thyroarytenoid muscle activation on the operated and non-operated sides with bipolar needle electrodes, and heightened activity in both muscles relative to normal. Therefore, symptom return was associated with thyroarytenoid innervation after recurrent nerve surgery. In all patients, the thyroarytenoid muscle on the side operated on was injected with type A botulinum toxin. In two patients, toxin was also injected on the side not operated on. Significant (p less than or equal to 0.002) reductions in all speech symptoms occurred after injection. Electromyographic measures demonstrated significant reductions in the percent activation levels of both the injected muscle and noninjected muscles (p less than or equal to 0.01). Botulinum toxin injections were an effective treatment of post-surgical symptom recurrence in adductor spasmodic dysphonia.

UI	MeSH Term	Description	Entries
D007273	Injections, Intramuscular	Forceful administration into a muscle of liquid medication, nutrient, or other fluid through a hollow needle piercing the muscle and any tissue covering it.	Intramuscular Injections,Injection, Intramuscular,Intramuscular Injection
D007821	Laryngeal Muscles	The striated muscle groups which move the LARYNX as a whole or its parts, such as altering tension of the VOCAL CORDS, or size of the slit (RIMA GLOTTIDIS).	Cricothyroid Muscles,Aryepiglottic Muscle,Arytenoid Muscle,Cricoarytenoid Muscles,Thyroarytenoid Muscles,Thyroepiglottic Muscle,Vocal Muscle,Vocalis Muscle,Aryepiglottic Muscles,Arytenoid Muscles,Cricoarytenoid Muscle,Cricothyroid Muscle,Laryngeal Muscle,Muscle, Aryepiglottic,Muscle, Arytenoid,Muscle, Cricoarytenoid,Muscle, Cricothyroid,Muscle, Laryngeal,Muscle, Thyroarytenoid,Muscle, Thyroepiglottic,Muscle, Vocal,Muscle, Vocalis,Muscles, Aryepiglottic,Muscles, Arytenoid,Muscles, Cricoarytenoid,Muscles, Cricothyroid,Muscles, Laryngeal,Muscles, Thyroarytenoid,Muscles, Thyroepiglottic,Muscles, Vocal,Muscles, Vocalis,Thyroarytenoid Muscle,Thyroepiglottic Muscles,Vocal Muscles,Vocalis Muscles
D007823	Laryngeal Nerves	Branches of the VAGUS NERVE. The superior laryngeal nerves originate near the nodose ganglion and separate into external branches, which supply motor fibers to the cricothyroid muscles, and internal branches, which carry sensory fibers. The RECURRENT LARYNGEAL NERVE originates more caudally and carries efferents to all muscles of the larynx except the cricothyroid. The laryngeal nerves and their various branches also carry sensory and autonomic fibers to the laryngeal, pharyngeal, tracheal, and cardiac regions.	Laryngeal Nerve, Superior,Laryngeal Nerve,Laryngeal Nerves, Superior,Nerve, Laryngeal,Nerve, Superior Laryngeal,Nerves, Laryngeal,Nerves, Superior Laryngeal,Superior Laryngeal Nerve,Superior Laryngeal Nerves
D008297	Male		Males
D008875	Middle Aged	An adult aged 45 - 64 years.	Middle Age
D012009	Recurrent Laryngeal Nerve	Branches of the vagus (tenth cranial) nerve. The recurrent laryngeal nerves originate more caudally than the superior laryngeal nerves and follow different paths on the right and left sides. They carry efferents to all muscles of the larynx except the cricothyroid and carry sensory and autonomic fibers to the laryngeal, pharyngeal, tracheal, and cardiac regions.	Laryngeal Nerve, Inferior,Inferior Laryngeal Nerve,Inferior Laryngeal Nerves,Laryngeal Nerve, Recurrent,Laryngeal Nerves, Inferior,Laryngeal Nerves, Recurrent,Nerve, Inferior Laryngeal,Nerve, Recurrent Laryngeal,Nerves, Inferior Laryngeal,Nerves, Recurrent Laryngeal,Recurrent Laryngeal Nerves
D001905	Botulinum Toxins	Toxic proteins produced from the species CLOSTRIDIUM BOTULINUM. The toxins are synthesized as a single peptide chain which is processed into a mature protein consisting of a heavy chain and light chain joined via a disulfide bond. The botulinum toxin light chain is a zinc-dependent protease which is released from the heavy chain upon ENDOCYTOSIS into PRESYNAPTIC NERVE ENDINGS. Once inside the cell the botulinum toxin light chain cleaves specific SNARE proteins which are essential for secretion of ACETYLCHOLINE by SYNAPTIC VESICLES. This inhibition of acetylcholine release results in muscular PARALYSIS.	Botulin,Botulinum Neurotoxin,Botulinum Neurotoxins,Clostridium botulinum Toxins,Botulinum Toxin,Neurotoxin, Botulinum,Neurotoxins, Botulinum,Toxin, Botulinum,Toxins, Botulinum,Toxins, Clostridium botulinum
D003131	Combined Modality Therapy	The treatment of a disease or condition by several different means simultaneously or sequentially. Chemoimmunotherapy, RADIOIMMUNOTHERAPY, chemoradiotherapy, cryochemotherapy, and SALVAGE THERAPY are seen most frequently, but their combinations with each other and surgery are also used.	Multimodal Treatment,Therapy, Combined Modality,Combined Modality Therapies,Modality Therapies, Combined,Modality Therapy, Combined,Multimodal Treatments,Therapies, Combined Modality,Treatment, Multimodal,Treatments, Multimodal
D004576	Electromyography	Recording of the changes in electric potential of muscle by means of surface or needle electrodes.	Electromyogram,Surface Electromyography,Electromyograms,Electromyographies,Electromyographies, Surface,Electromyography, Surface,Surface Electromyographies
D005260	Female		Females