Botulinum toxin: Adjunctive treatment for posterior glottic synechiae

Introduction: Synechiae formation of the posterior glottis can result in tr acheostomy dependence secondary to airway obstruction. Stenosis is caused b y total or partial fixation of the vocal folds in adduction resulting from scar contracture. The treatment poses a management dilemma because of recur rent scar formation, made worse by mobility of the vocal folds. Although va rious treatment options from conservative endoscopic repair to open procedu res have been proposed, the results are not satisfactory and patients often require multiple procedures. Methods: We present the trial of a conservati ve approach that includes microscopic CO2 laser resection of the scar with concomitant botulinum toxin injection of the interarytenoid and thyroaryten oid muscles of the more mobile cord. This results in a temporary paresis of the adductor muscles and hence prevents overadduction in the posterior com missure during the postoperative healing period. Study Design: We present t he surgical technique and results in three patients who underwent the proce dure. Results: Treatment in all three patients was successful, Conclusions: The appropriate use of botulinum toxin may help improve the treatment outc ome of posterior synechiae of the larynx without sacrificing any laryngeal components.