Uso da Toxina Botulínica em Pacientes Laringectomizados Totais para Controle do Espasmo do Segmento Faringo-esofágico e aquisição de voz esofágica.

Introduction: Total laryngectomy is an often-used treatment in patients with laryngeal cancer, mainly because of the security offered by their surgical margin. But with the removal of the vocal cords the patient has impaired their quality of life, the loss of their most important means of communication. The main methods of rehabilitation are the electronic larynx, the tracheoesophageal and esophageal voice (EV). One of the advantages of esophageal voice in relation to other methods is its low cost by not requiring device or prosthesis. In Brazil, the EV is the primary means of vocal rehabilitation after total laryngectomy, but it has success rate of 31%, mainly due to spasm and hypertonicity of the pharyngoesophageal segment (PES). For the treatment of hypertonia of the PES can be done surgical myotomy, or injection of neurotoxin (botulinum toxin). Botulinum toxin is produced by Clostridia botulinnum causing blockage preventing the presynaptic release of acetylcholine at the neuromuscular junction. There are studies showing positive results with patients who use tracheoesophageal prosthesis by injecton of neurotoxin. Virtually all research related to the applicability of the toxin in patients using tracheoesophageal prostheses, and no studies were found in the same direction in patients with esophageal voice as a means of communication. objective: Aim of this study is to evaluate the relaxing effect of botulinum toxin in patient’s submited to total laryngectomy with hypertonia of the pharyngoesophageal segment. methods: The study sample consists of ten patients who underwent total laryngectomy seen at the Head and Neck Surgery and Speech Therapy group of Santa Casa de Sao Paulo who were diagnosed with hypertonia of the PES (eight did not develop EV and two patients using tracheoesophageal protesis and do not emit voice), which were evaluated by spech therapists and tested for insufflation of SFE, percutaneous injection of local anesthetic and video assisted fluoroscopy to identify and locate the hypertonic PES and predict whether the neurotoxin has a relaxing effect on muscles . Was performed recording the voices of patients prior to application of neurotoxin that was evaluated by five speech therapists. Was injected into each patient 66 units of Botox ® diluted in 3 mL of saline divided into three points along the PES hypertonic