Botulinum Toxin Injection of the Larynx

Botulinum Toxin injection of the larynx is a frequent and very fruitful treatment for many patients with movement disorders of the larynx especially laryngeal dystonia (formerly known as spasmodic dysphonia) and essential tremor of the vocal tract (also known as vocal tremor). The most common and effective injection method is a percutaneous electromyography guided injection into the thyroarytenoid-lateral cricoarytenoid (TA-LCA) muscle complex or the posterior cricoarytenoid (PCA) muscle. There is a steep learning curve to these injections, but they are highly successful and provide profound benefit to patients suffering from movement disorders of the larynx. This chapter provides detailed information on patient selection, botulinum toxin dosing and step-by-step technique information on performing this procedure. Information is provided on methods to inject the TA-LCA muscle complex for adductor laryngeal dystonia or essential tremor of the vocal tract, and the PCA muscle for abductor laryngeal dystonia. Instruction is included on the approach to injection of the supraglottis. Management of postinjection care and complications are covered as well.