Technical Description:
6 patients were treated over the last year using this method. General
anaesthesia was given to these patients and they were ventilated through
an armoured tube inserted through the laryngeal stoma. Patients were
positioned with their neck flexed and head extended, though the
extension was limited in these patients due to post-radiotherapy
fibrosis. A GlideScope was inserted through the oral cavity along the
tongue and the top of the scope was used to lift the base of the tongue
(figure 1). This provided a good view of the neopharynx in all the
cases. Botox was kept ready pre-loaded on a syringe with a 22-gauge
needle. The needle was inserted through the neck and under the direct
vision of the GlideScope, Botox was injected into the PE
segment/posterior pharyngeal wall at the level of the neopharynx down to
the level of the valve (figure 2). It was feasible to inject Botox in
all the patients using this technique and in none of them did we have to
resort to any other technique. All of them had improvements in their
voice outcomes.