International Journal of Head and Neck Surgery

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VOLUME 1 , ISSUE 3 ( September-December, 2010 ) > List of Articles

RESEARCH ARTICLE

Clinical Localization of the Spasmodic Segment in Voice Limiting Pharyngoesophageal Spasm

Rao Vishal, Anil K D'Cruz, Mandar Deshpande, Devendra Chaukar, Prathamesh Pai

Citation Information : Vishal R, D'Cruz AK, Deshpande M, Chaukar D, Pai P. Clinical Localization of the Spasmodic Segment in Voice Limiting Pharyngoesophageal Spasm. Int J Head Neck Surg 2010; 1 (3):189-192.

DOI: 10.5005/jp-journals-10001-1038

Published Online: 00-12-2010

Copyright Statement:  Copyright © 2010; Jaypee Brothers Medical Publishers (P) Ltd.


Abstract

Background

Primary tracheoesophageal prosthetic speech is the gold standard for speech rehabilitation in patients undergoing total laryngectomy. However, despite a high success rate, the speech outcome can be suboptimal in 5-15% of these patients. The most frequent cause being hypertonicity of the pharyngoesophageal segment. We elaborate a simple clinical technique that can be performed in an outpatient clinic to identify the hypertonic pharyngoesophageal segment in patients with PES.

Methods

All these patients (13 males and 1 female) had undergone total laryngectomy and primary tracheoesophageal puncture followed by postoperative radiotherapy. Even after rigorous speech therapy, these patients had failed to develop fluent speech. The mean duration following surgery was 8 months (range 4-20 months). A simple clinical technique is elaborated utilizing the dermal ballooning effect observed in the cervical region to ascertain the site of pharyngo esophageal spasmodic segment.

Results

Using this technique we have been able to identify the hypertonic segment successfully in 13 of the 14 patients with PES. In these patients the trial lignocaine block was injected specifically at these points medial to the carotid vessels. Improvement in speech following the block was observed, and was further confirming using a videofluroscopy.

Conclusion

This technique serves as a simple and useful clinical tool to map the spasmodic segment and to guide the injection site for trial lignocaine block and as well for botulinum a toxin. In addition, it also prevents inadvertent injection to the normal segments.


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