Expanded Uses for Botulinum Toxin Benefit Head and Neck Patients

Botulinum toxin (Botox) therapy – perhaps most widely known for its ability to freeze superficial facial wrinkles – has, for the past 25 years, proven to be  a safe and effective treatment for a growing number of medical conditions. Occurring naturally as a potent neurotoxin produced by the bacterium Clostridium botulinum, botulinum toxin causes food poisoning. When small amounts of pure toxin are injected into muscle, however, the toxin has been found to be a safe and very effective method of decreasing muscle overactivity and spasm.

"The toxin blocks the transmission of nerve impulses to the muscle by binding to the neuromuscular endplate,” explains John Price, MD, Otolaryngology–Head and Neck Surgery. “It literally blocks the ability of nerves to conduct into the muscle so you get a paralysis or relaxation. We, of course, use a very diluted amount (several billionths of a gram of toxin in an injection), whereas a teaspoon of spoiled beans, for example, would be lethal.”

At GBMC’s Milton J. Dance, Jr. Head and Neck Rehabilitation Center, botulinum toxin is used as an adjunct treatment for a variety of rehabilitation issues. Dr. Price has pioneered the use of the toxin at the Dance Center, after becoming interested in using it through the work of a colleague, Andrew Blitzer, MD, Head and Neck Surgical Group, New York.
In the early 1980s, Dr. Blitzer brought the use of botulinum toxin to the head and neck clinical arena when he gave the world’s first laryngeal injection of botulinum toxin for spasmodic dysphonia (spasm of the vocal cords that causes sudden disruption of speech). Otolaryngologists Dario Kunar, MD, and Andrew Goldstone, MD, of Ear, Nose and Throat Associates, have used botulinum toxin to treat GBMC patients with spasmodic dysphonia since 1990.

For the past several years at the Dance Center, Dr. Price has used botulinum toxin to treat laryngeal spasm in cancer patients who have had a laryngectomy. “For this surgery, we interrupt a lot of the nerves and remodel the muscles in the back of the throat; sometimes, some of the patterns of renewed nerve growth into these muscles result in chronic spasm of the throat muscles. These spasms are a barrier to successful speech rehabilitation, whether it is with a tracheoesophageal prosthesis (TEP) or esophageal speech,” explains Dr. Price.

Physicians tried to cope with TEP failures due to laryngeal spasms by doing additional surgery, but they were not very successful. “We have found, however, that using Botox injections allows us to significantly relieve the spasms so that people can become much more fluent with their speech,” adds Dr. Price. “It takes much less effort for them to talk, and they get a better production of the voice. The effect of the toxin usually lasts three to six months, and then the injections have to be repeated. This new application for Botox has been successfully used on about one dozen laryngectomy patients.”

In addition to the laryngeal rehab patients, Dr. Price has found three other conditions for which botulinum toxin injections are effective in head and neck cancer patients. They include:

• Frey’s syndrome or gustatory sweating.  This condition occurs in people whose salivary glands have been removed due to the presence of tumors. As a result of the surgery, cut secretory salivary fibers grow back, but into the sweat glands, causing redness and sweating of the cheek when the person eats. “These nerve endings are truly pathologic,” says Dr. Price. “I have treated 10-12 patients during the past three years, and all but one patient have had long-lasting relief with one series of injections.”
• Neuromas (abnormal tissue growth derived from nerve tissue). While treating Frey’s syndrome with the botulinum toxin, Dr. Price observed that a couple of his patients who also had neuromas experienced relief from the neuroma pain. He has directly injected botulinum toxin into three other patients’ neuromas, providing “considerable pain relief,” he says. “In fact, I was very surprised to find that, in the first patient, the neuroma actually disappeared.”
• Excessive drooling. The removal of significant amounts of tissue from the mouth and lips is often one of the direct consequences of head and neck surgery. “The combination of numbness in the cheek from cutting the nerves, poor jaw motion, and inadequate reconstruction inside the mouth often produces hypersecretion and a lot of drooling,” says Dr. Price. “The first time I used the botulinum toxin for excessive drooling was for a Parkinson’s patient, and we got a superb result. Subsequently, I have treated two more Parkinson’s patients and one head and neck cancer patient, and have had ‘decent’ to ‘excellent’ responses.”

 For further information about the use of botulinum toxin,
please contact the Dance Center at 443-847-2087.