Abstract：
OBJECTIVE: The tracheoesophageal puncture for the voice prosthesis (VP) placement is the recognized gold standard in post-laryngectomy voice rehabilitation. Despite the development of specific intraoperative techniques, a subset of patients will suffer from poor functional outcomes due to pharyngoesophageal spasms (PES). This paper evaluates the functional outcomes after transcutaneous botulinum toxin type A (BTX-A) infiltration for PES with a videofluoroscopy-guided technique.
METHODS: Since 2022, eight consecutive patients with VP and affected by PES were treated with BTX-A injection by a standard videofluoroscopic guided technique at the European Institute of Oncology, IRCCS (IEO) in Milan. A lidocaine test was performed pre-operatively to evaluate the potential effect of chemical neurectomy. All patients with positive lidocaine tests were injected with 50 IU of BTX-A (Allergan, Irvine, CA) according to the sites marked during the videofluoroscopy. Reported symptoms (VHI, SECEL), perceptual (INFVo), aerodynamic (MPT) and manometric parameters were collected before and after treatment.
RESULTS: In all cases, BTX-A was performed as an outpatient procedure without complications. For seven patients, only one BTX-A injection was needed, while one patient required a re-injection. Subjective and perceptive improvement after BTX-A was significant for VHI, SECEL and INFVo. MPT showed significant improvement after a chemical neurectomy. After a mean follow-up of 6 months, all patients maintained a good TES quality.
CONCLUSIONS: The videofluoroscopic guided BTX-A injection of the pharyngoesophageal tract showed to be a feasible and reproducible technique in all cases. The pharyngoesophageal videofluoroscopy allows defining of patients\' anatomical landmarks that help the surgeon to perform a homogeneous injection, empowered by post-injection massage.
METHODS: Since 2022, eight consecutive patients with VP and affected by PES were treated with BTX-A injection by a standard videofluoroscopic guided technique at the European Institute of Oncology, IRCCS (IEO) in Milan. A lidocaine test was performed pre-operatively to evaluate the potential effect of chemical neurectomy. All patients with positive lidocaine tests were injected with 50 IU of BTX-A (Allergan, Irvine, CA) according to the sites marked during the videofluoroscopy. Reported symptoms (VHI, SECEL), perceptual (INFVo), aerodynamic (MPT) and manometric parameters were collected before and after treatment.
RESULTS: In all cases, BTX-A was performed as an outpatient procedure without complications. For seven patients, only one BTX-A injection was needed, while one patient required a re-injection. Subjective and perceptive improvement after BTX-A was significant for VHI, SECEL and INFVo. MPT showed significant improvement after a chemical neurectomy. After a mean follow-up of 6 months, all patients maintained a good TES quality.
CONCLUSIONS: The videofluoroscopic guided BTX-A injection of the pharyngoesophageal tract showed to be a feasible and reproducible technique in all cases. The pharyngoesophageal videofluoroscopy allows defining of patients\' anatomical landmarks that help the surgeon to perform a homogeneous injection, empowered by post-injection massage.
摘要：
目的：气管食管穿刺放置语音假体（VP）是喉切除术后语音康复的公认金标准。尽管特定术中技术的发展，一部分患者会因咽食管痉挛(PES)而出现不良的功能结局.本文使用视频透视引导技术评估了经皮A型肉毒杆菌毒素（BTX-A）浸润PES后的功能结果。
方法：自2022年以来，在欧洲肿瘤学研究所，通过标准的视频透视引导技术，对八名连续患有VP并受PES影响的患者进行了BTX-A注射治疗。IRCCS（IEO）在米兰。术前进行利多卡因试验以评估化学神经切除术的潜在效果。所有利多卡因试验阳性的患者均注射50IU的BTX-A（Allergan，Irvine,CA）根据视频透视检查期间标记的部位。报告的症状（VHI，SECEL),感知（INFVo），收集治疗前后的空气动力学（MPT）和测压参数。
结果：在所有情况下，BTX-A作为门诊手术进行，没有并发症。对于七个病人来说，只需要注射一次BTX-A,而一名患者需要重新注射。BTX-A后主观和感知的改善对VHI显著，SECEL和INFVo。化学神经切除术后MPT显着改善。经过6个月的平均随访，所有患者均保持良好的TES质量。
结论：视频透视引导下BTX-A在所有病例中都是可行且可重复的技术。咽食管透视检查允许定义患者的解剖标志，帮助外科医生进行均匀注射，注射后按摩。
方法：自2022年以来，在欧洲肿瘤学研究所，通过标准的视频透视引导技术，对八名连续患有VP并受PES影响的患者进行了BTX-A注射治疗。IRCCS（IEO）在米兰。术前进行利多卡因试验以评估化学神经切除术的潜在效果。所有利多卡因试验阳性的患者均注射50IU的BTX-A（Allergan，Irvine,CA）根据视频透视检查期间标记的部位。报告的症状（VHI，SECEL),感知（INFVo），收集治疗前后的空气动力学（MPT）和测压参数。
结果：在所有情况下，BTX-A作为门诊手术进行，没有并发症。对于七个病人来说，只需要注射一次BTX-A,而一名患者需要重新注射。BTX-A后主观和感知的改善对VHI显著，SECEL和INFVo。化学神经切除术后MPT显着改善。经过6个月的平均随访，所有患者均保持良好的TES质量。
结论：视频透视引导下BTX-A在所有病例中都是可行且可重复的技术。咽食管透视检查允许定义患者的解剖标志，帮助外科医生进行均匀注射，注射后按摩。
