纤维鼻咽镜下经环甲膜声带肉毒毒素注射治疗喉痉挛性构音障碍的应用效果OA

Objective To explore the clinical efficacy of botulinum toxin injection through the cricothyroid membrane and vocal cords under fiberoptic nasopharyngoscopy in the treatment of spasmodic dysarthria(SD).Methods A retrospective analysis was conducted on the clinical data of 17 patients with SD from December 2022 to December 2024.Observe the type A botulinum toxin injection situation and the occurrence of complications in patients.Results When the fiberoptic nasopharyngoscopy was inserted into the nasal cavity,2 cases(11.8%)found that one nasal cavity was severely narrowed.After switching to the opposite nasal cavity,the insertion was successful.Under the guidance of fiberoptic nasopharyngoscopy,the injection needle was punctured through the cricothyroid membrane into the laryngeal cavity,and 2 u of type A botulinum toxin was injected into both vocal cords respectively.During the injection process,3 cases(17.6%)of patients experienced severe choking cough,which was relieved after repeated surface anesthesia with tetracaine.In 2 cases(11.8%),due to coughing and vocal cord activity,the injection needle fell off and part of the liquid medicine leaked.After adjusting the needle angle,the remaining liquid medicine was injected into the vocal cords.The overall operation time ranged from 0.43～0.68 h,with an average of 0.58 h.1～12 d after injection,with an average of 3.5 d,the patients'pronunciation returned to normal.Three patients had choking cough when drinking water and three patients had hoarseness,which were relieved after 3 to 4 d.Conclusion Injection of botulinum toxin through cricothyroid membrane guided by fiberoptic nasopharyngoscopy is convenient and has a good clinical efficacy in the treatment of SD.It is worthy of clinical promotion and application.