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November 1987

Botulinum Toxin for Relief of Spasmodic Dysphonia

Author Affiliations

Syracuse, NY

Arch Otolaryngol Head Neck Surg. 1987;113(11):1240. doi:10.1001/archotol.1987.01860110106025

To the Editor.—The preliminary report by Miller and coworkers,1 and two other presentations at our national meetings, have demonstrated the temporary effectiveness of botulinum toxin (BT) for the relief of spasmodic dysphonia. The use of a myoneural blocking agent such as BT is logical, and has the advantage that different adductor muscles can be paralyzed selectively or in combination. The injection of this toxic substance, however, should be carefully controlled and appropriately placed so as to produce a maximal effect on the motor end-plate junctions. A knowledge of the distribution of the motor end plates in the adductor muscles of the human larynx is, therefore, an important prerequisite for the accurate injection of BT. For example, in a muscle such as the thyroarytenoid muscle, where the motor end plates are diffusely distributed throughout the muscle, multiple small injections of BT should effectively block most of the motor end

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