Swallowing disorders following free jejunal flap reconstruction of circumferential pharyngeal defect: Does Botox help?

Abstract

Free jejunal flap for circumferential pharyngeal reconstruction is associated with late-onset dysphagia, regurgitation and prolonged transit time. This study aims to assess the feasibility and efficacy of Botulinum toxin A (Botox) in alleviating such swallowing dysfunction. Twenty-six consecutive patients underwent free jejunal flap for circumferential pharyngeal reconstruction between January 2012 and December 2018. Outcomes were compared at 6, 12 and 24months. In the non-Botox group (n=13), video-fluoroscopic and manometry studies demonstrated asynchronous contractions and retrograde propulsion. All patients complained of nasal regurgitation on thin fluids at 6, 12 and 24months. Bolus residue accumulation along jejunal mucosal folds resulted in prolonged transit time. In the Botox group (n=13), amplitude of asynchronous contractions were lower: 25.4mmHg vs. 52.1mmHg (p=0.037) for thin fluids at 12months. Three patients complained of nasal regurgitation on thin fluids at 6months. All 3 were asymptomatic at 12months. Transit time was shortened overall. Functional Oral Intake Scale was higher. MD Anderson Dysphagia Inventory global (72.5% vs 45.7%, p=0.003) and functional (62.0% vs 40.6%, p=0.012) subscales were significantly improved at 24months. Botox safely and effectively alleviates swallowing dysfunction associated with free jejunal flap for circumferential pharyngeal reconstruction.