Cricothyroid Onabotulinum Toxin A Injection to Avert Tracheostomy in Bilateral Vocal Fold Paralysis | Congenital Defects | JAMA Otolaryngology–Head & Neck Surgery | JAMA Network
[Skip to Content]
Access to paid content on this site is currently suspended due to excessive activity being detected from your IP address 34.237.138.69. Please contact the publisher to request reinstatement.
[Skip to Content Landing]
Case Report/Case Series
September 2014

Cricothyroid Onabotulinum Toxin A Injection to Avert Tracheostomy in Bilateral Vocal Fold Paralysis

Author Affiliations
  • 1Department of Otolaryngology–Head and Neck Surgery, Montreal Children’s Hospital, McGill University Health Center, Montreal, Quebec, Canada
JAMA Otolaryngol Head Neck Surg. 2014;140(9):867-869. doi:10.1001/jamaoto.2014.1515
Abstract

Importance  More than half of children with bilateral vocal fold paralysis require a tracheostomy for airway management. We report an innovative, minimally invasive approach consisting of onabotulinum toxin A injection into the cricothyroid muscles.

Observations  Onabotulinum toxin A was injected under direct vision into the cricothyroid muscles of 6 pediatric patients with bilateral abductor vocal fold paralysis. None of the patients had fold fixation on laryngoscopy performed at the time of the injection. All patients had a documented increase in airway patency as visualized on flexible laryngoscopy within days after injection. This procedure successfully averted a tracheostomy in 5 patients and permitted decannulation of the sixth patient.

Conclusions and Relevance  Onabotulinum toxin A injection into the cricothyroid muscles leads to an increase in the glottic space, providing an adequate airway. Onabotulinum toxin A injection in the cricothyroid muscles could be offered as a safe, effective, noninvasive first-line option for patients with bilateral vocal fold paralysis.

×