Abstract
Introduction
Spasmodic dysphonia (SD), a form of focal dystonia, has been defined as a neurogenic, task-specific disorder characterized by abrupt spasms of intrinsic laryngeal muscles that result in phonatory breaks. There are three classic types of SD: adductor SD, abductor (ABSD) and mixed SD. Compared with the more common adductor form, treatment of ABSD with botulinum toxin injection is related to a shorter efficacy and improvement in only about 70% of patients [Blitzer et al. in Laryngoscope 108:1435–1441, 1998]. Moreover, due to the possible loss of efficacy over time or patient refusal for repeated injections, surgical solutions for permanent or at least long-term results must be considered.
Method
The surgical technique we propose is based on transoral bilateral posterior cricoarytenoid muscle (PCA) coagulation by radiofrequency (Celon, pro surg 250-T30, Olympus, Germany, 10 W, in 3 spots, each side) under a microscope or rigid scope control. The procedure is performed in two sessions distant of 2–3 weeks to avoid the risk of bilateral vocal fold temporary paralysis in adduction. A 52-year-old female patient with no audible voicing, resistant to botulinum toxin and after failure of relaxation thyroplasty type III according to lssihki [Saito et al. in Case Rep Otolaryngol 2018:4280381, 2018] showed an improvement of the Voice Handicap Index (VHI-10) from 35/40 to 19/40. The patient was rated G2R3B2A1S2 according to GRABS scale.
Conclusion
PCA coagulation for ABSD is a safe and reusable surgical option. It is less invasive than other techniques described before. To the best of our knowledge, this technique was never reported before in this type of SD.
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References
Blitzer A, Brin MF, Stewart CF (1998) Botulinum toxin management of spasmodic dysphonia (laryngeal dystonia): a 12-year experience in more than 900 patients. Laryngoscope 108:1435–1441
Saito Y, Nakamura K, Itani S, Tsukahara K (2018) Type 3 thyroplasty for a patient with female-to-male gender identity disorder. Case Rep Otolaryngol 2018:4280381
Blitzer A, Brin MF, Fahn S et al (1988) Clinical and laboratory characteristics of focal laryngeal dystonia: study of 110 cases. Laryngoscope 98:636–640
Hintze JM, Ludlow CL, Bansberg SF, Adler CH, Lott DG (2017) Spasmodic dysphonia: a review. Part 1: pathogenic factors. Otolaryngol Head Neck Surg 157(4):551–557. https://doi.org/10.1177/0194599817728521
Simonyan K, Berman BD, Herscovitch P, Hallett M (2013) Abnormal striatal dopaminergic neurotransmission during rest and task production in spasmodic dysphonia. J Neurosci 33:14705–14714
Postma GN, Blalock PD, Koufman JA (1998) Bilateral medialization laryngoplasty. Laryngoscope 108:1429–1434
Shaw GY, Sechtem PR, Rideout B (2003) Posterior cricoarytenoid myoplasty with medialization thyroplasty in the management of refractory abductor spasmodic dysphonia. Ann Otol Rhinol Laryngol 112:303–306
Koufman JA (1998) Management of abductor spasmodic dysphonia by endoscopic partial posterior cricoarytenoid myectomy. Phonoscope 2:159–164
Benito DA, Ferster APO, Sataloff RT (2020) Bilateral Posterior Cricoarytenoid Myoneurectomy for Abductor Spasmodic Dysphonia. J Voice 34(1):127–129. https://doi.org/10.1016/j.jvoice.2018.07.028
Remacle M, Plouin-Gaudon I, Lawson G, Abitbol J (2005) Bipolar radiofrequency-induced thermotherapy (rfitt) for the treatment of spasmodic dysphonia. A report of three cases. Eur Arch Otorhinolaryngol 262:871–874
Wang L, Xu D, Yang Y, Li M, Zheng C, Qiu X, Huang B (2019) Safety and efficacy of ultrasound-guided percutaneous thermal ablation in treating low-risk papillary thyroid microcarcinoma: a pilot and feasibility study. J Cancer Res Ther 15(7):1522–1529
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We do not have any conflict of interest. Our surgical method includes a human participant who has given his informed consent.
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Samaha, M., Remacle, M. Coagulation of posterior cricoarytenoid muscles for abduction spasmodic dysphonia. Eur Arch Otorhinolaryngol 278, 839–841 (2021). https://doi.org/10.1007/s00405-020-06485-8
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DOI: https://doi.org/10.1007/s00405-020-06485-8