109: Cricothyroid Botulinum Toxin Injection to Avert Tracheostomy in Bilateral Vocal Cord Paralysis

Abstract

Up to 59 percent of children with bilateral vocal cord paralysis require a tracheostomy for airway management. While the recurrent laryngeal nerve is usually compromised, the cricothyroid muscle, a tensor of the vocal cords has a separate innervation. We report an innovative approach whereby a tracheostomy is averted by injecting Onabotulinum Toxin into the cricothyroid muscles in patients with bilateral vocal cord paralysis. The goal is to denervate the cricothyroid muscles thereby decreasing vocal fold tension and a subsequent increase in the glottic space. We review pediatric cases of bilateral vocal paralysis managed with Onabotulinum Toxin A injections by the senior author. Medical charts were retrospectively reviewed; the clinical manifestation, injection dosage and outcomes are reported. Six patients were included. Five were female and one male infants, ranging from three weeks old to four years old. The clinical presentations included stridor and respiratory distress. We used Onabotulinum toxin to paralyze the cricothyroid muscles of five patients who would have undergone a tracheostomy for airway obstruction secondary bilateral vocal cord paralysis. We had a successful decanulation of an additional patient with a long-term tracheostomy for the same pathology. No complications were reported. Onabotulinum toxin injection in the cricothyroid muscles provides a safe, fast, effective and successful option for patients suffering with vocal cord paralysis.