Treatment of Adductor-Type Spasmodic Dysphonia by Surgical Myectomy: A Preliminary Report

Abstract

Objectives:

Despite the belief that it represents a central neurologic dysfunctional process, adductor-type spasmodic dysphonia without tremor is usually effectively treated by injection of botulinum toxin A; however, in most cases such injections must be repeated every few months. A promising new surgical procedure is herein reported.

Methods:

Under local anesthesia with intravenous sedation, a large laryngoplasty window is created, and under direct vision with intraoperative voice monitoring, fibers from the thyroarytenoid and lateral cricoarytenoid muscles are removed until breathiness occurs. The two sides are staged; that is, one side is done at a time, with surgery on the second side being performed 3 to 6 months after that on the first side, if needed.

Results:

This was a retrospective, unblinded study of 5 patients who underwent myectomy of the thyroarytenoid and lateral cricoarytenoid muscles. The preliminary results show improved voice fluency in all patients at 5 to 19 months of follow-up. There was no period of prolonged breathiness or dysphagia in any of the patients, and there were no surgical complications.

Conclusions:

Myectomy of the thyroarytenoid and lateral cricoarytenoid muscles is a promising new surgical treatment for adductor-type spasmodic dysphonia that may effectively mimic “permanent” botulinum toxin injections.

Keywords

adductor spasmodic dysphonia Botox botulinum toxin A myectomy

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References

Hillel

. The study of laryngeal muscle activity in normal human subjects and in patients with laryngeal dystonia using multiple fine-wire electromyography. Laryngoscope 2001; 111(suppl 97).

Nash

Ludlow

. Laryngeal muscle activity during speech breaks in adductor spasmodic dysphonia. Laryngoscope 1996; 106: 484–9.

Klotz

Maronian

Waugh

Shahinfar

Robinson

Hillel

. Findings of multiple muscle involvement in a study of 214 patients with laryngeal dystonia using fine-wire electromyography. Ann Otol Rhinol Laryngol 2004; 113: 602–12.

Blitzer

Brin

Stewart

. Botulinum toxin management of spasmodic dysphonia (laryngeal dystonia): A 12-year experience in more than 900 patients. Laryngoscope 1998; 108: 1435–41.

Dedo

. Recurrent laryngeal nerve section for spastic dysphonia. Ann Otol Rhinol Laryngol 1976; 85: 451–9.

Chan

Baxter

Oates

Yorston

. Long-term results of type II thyroplasty for adductor spasmodic dysphonia. Laryngoscope 2003; 114: 1604–8.

Berke

Blackwell

Gerratt

Verneil

Jackson

Sercarz

. Selective laryngeal adductor denervation-reinnervation: A new surgical treatment for adductor spasmodic dysphonia. Ann Otol Rhinol Laryngol 1999; 108: 227–31.

Maranillo

Leon

Orus

Quer

Sanudo

. Variability in nerve patterns of the adductor muscle group supplied by the recurrent laryngeal nerve. Laryngoscope 2005; 115: 358–62.

Genack

Woo

Colton

Goyette

. Partial thyroarytenoid myectomy: An animal study investigating a proposed new treatment for adductor spasmodic dysphonia. Otolaryngol Head Neck Surg 1993; 108: 256–64.

10.

Rontal

Rolnick

. The use of spectrograms in the evaluation of vocal cord injection. Laryngoscope 1975; 85: 47–56.

11.

Wolfe

Bacon

. Spectrographic comparison of two types of spasmodic dysphonia. J Speech Hear Disord 1976; 41: 325–32.

12.

Bach

Belafsky

Wasylik

Postma

Koufman

. Validity and reliability of the glottal function index. Arch Otolaryngol Head Neck Surg 2005; 131: 961–4.

13.

Schaefer

Freeman

Finitzo

. Magnetic resonance imaging findings and correlations in spasmodic dysphonia patients. Ann Otol Rhinol Laryngol 1985; 94: 595–601.

14.

Dedo

Townsend

Izdebski

. Current evidence for the organic etiology of spastic dysphonia. Otolaryngology 1978; 86: 875–80.

15.

Carpenter

III Henley-Cohn

Snyder

III . Spastic dysphonia: Treatment by selective section of the recurrent laryngeal nerve. Laryngoscope 1979; 89: 2000–3.

16.

Netterville

Stone

Rainey

Zealear

Ossoff

. Recurrent laryngeal nerve avulsion for treatment of spastic dysphonia. Ann Otol Rhinol Laryngol 1991; 100: 10–4.

17.

Weed

Jewett

Rainey

. Long-term follow-up of recurrent laryngeal nerve avulsion for the treatment of spastic dysphonia. Ann Otol Rhinol Laryngol 1996; 105: 592–601.

18.

Koufman

. Preliminary report. Management of abductor spasmodic dysphonia by endoscopic partial posterior cricoarytenoid myectomy. Phonoscope 1999; 2: 159–64.

19.

Takeda

Thomas

Ludlow

. Aging effects on motor units in the human thyroarytenoid muscle. Laryngoscope 2000; 110: 1018–25.

20.

Malmgren

Fisher

Bookman

Uno

. Age-related changes in muscle fiber types in the human thyroarytenoid muscle: An immunohistochemical and stereological study using confocal laser scanning microscopy. Otolaryngol Head Neck Surg 1999; 121: 441–51.