Botulinum toxin is a neurotoxin produced from Clostridium botulinum, an anaerobic, gram-positive bacteria. Injection of botulinum toxin into a muscle temporarily denervates the targeted muscle. It also reduces secretory function when injected into a gland. Although botulinum toxin has traditionally been utilized in facial cosmetics/aesthetics to address rhytids, it is also a useful tool in addressing laryngeal pathology. Before introducing botulinum toxin, laryngeal dystonia was historically treated with psychotherapy and speech therapy, both of which were significantly limited in their effectiveness for this disorder.
The use of botulinum toxin has been described in the management of both adductor and abductor laryngeal dystonia/spasmodic dysphonia (SD), vocal tremor, vocal process granuloma, and cricopharyngeal muscle dysfunction. By selectively denervating targeted laryngeal musculature, the surgeon can strategically address these pathologies.
The vast majority (65%) of SD patients are female, with an average age of onset of 45 years. The prevalence of SD is 1 per 100,000. In adductor spasmodic dysphonia (ADSD), the thyroarytenoid (TA) muscle is targeted for chemodenervation. Botulinum toxin chemodenervation, initiated in the 1980s by Blitzer and colleagues, is now considered the gold standard for the treatment of ADSD.
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