Pharyngoesophageal spasm after total laryngectomy: A clinically guided technique for injection

Vocal restoration after total laryngectomy is an essential part of patient care. The most successful voice rehabilitation method available is prosthetic tracheoesophageal speech. In patients without dysphagia, pharyngoesophageal spasm is the most common cause of speech failure. Botox® is an accepted, non-invasive therapy for this disorder and it is associated with lower morbidity compared to open or endoscopic laser techniques. The gold standard for diagnosis is fluoroscopy. However, fluoroscopy and/or its adjuncts are not readily available in many developing countries. This is the first reported clinically guided technique in the English literature for pharyngoesophageal spasm. It offers a safe, timely and cost-effective solution in resource-limited settings.