Laryngectomy FAQ’s

What is this Bo-Tox treatment I keep hearing about?

Bo-Tox has been in the news a lot recently. Bo-Tox is short for Botulinum Toxin, which is the bacterial by-product responsible for the dreaded disease botulism. The substance blocks the activity of skeletal muscle and in large doses causes complete paralysis. Bo-Tox has been used medically in small and well-regulated doses to treat spasms of facial, neck and laryngeal muscles. Cosmetic surgeons have begun using Bo-Tox to get rid of frown lines just above the nose and the “crow’s feet” or squint lines that appear at the outer corners of our eyes with aging.

There may be a new application for Bo-Tox for the laryngectomy patient. As you know, tracheo-esophageal puncture (TEP) with insertion of a speech prosthesis has become a mainstay for voice rehabilitation after laryngectomy. Occasionally patients are unable to produce sound when the TEP is placed. One of the causes of lack of phonation in this situation is spasm of the pharyngeal muscles (cricopharyngeus spasm). The traditional method of dealing with this problem has been a surgical procedure called myotomy. Physicians are beginning to try Bo-Tox injections into the muscle to block the spasm and hopefully avoid surgery. Our colleagues at the University of Iowa have seen encouraging early results with this treatment for a small group of patients. At UAB, we are beginning to use this technique as well. No one knows yet if Bo-Tox for cricopharyngeus spasm will become routine. There will very likely continue to be those patients who require surgical myotomy. We’ll keep you posted as we learn more about the applications of Bo-Tox for laryngectomy patients.