A Preliminary Study on the Effect of Botulinum Toxin in the Prevention of Glottic Web Reformation

Ab s t r Ac t Introduction: The risk of recurrence is associated with all currently available surgical modalities for the treatment of congenital anterior glottic webs. Physical separation of the raw mucosal surfaces is essential until complete healing. Botulinum toxin injected into the thyroarytenoid muscle of a vocal fold for achieving separation between healing tissues has successfully prevented further synechiae formation. Aim: To compare and evaluate the effect of intraoperative botulinum toxin injection for prevention of recurrence in endoscopically treated congenital anterior glottic webs. Materials and methods: A prospective comparative analytical study of six cases was carried out over 1 year. Cases with a thin Cohen’s grade I or II congenital anterior glottic web were included and randomized into two groups. Group I underwent endoscopic cold knife web division with keel placement, and Group II subjects additionally received botulinum toxin injection intraoperatively. Patients were followed up after 6 weeks and the degree of residual/recurrent web was recorded. Results: The preoperative mean percentage of anterior glottic web in both groups was 46.67 ± 2.36. The postoperative mean percentage of anterior glottic web was 26.67 ± 6.24 in Group I and 13.33 ± 4.71 in Group II. The mean percentage of the length of the glottis involved by web improved in both groups postoperatively, i.e., by 20.0 in Group I (p = 0.00065; significant) and by 33.34 in Group II (p = 0.0004; significant). The difference in improvement between both the groups postoperatively was 13.34% (p = 0.0417; significant). Conclusion: Botulinum toxin due to its paralytic effect on the thyroarytenoid muscle decreases web reformation and can therefore be used along with the established techniques in the treatment of anterior glottic webs.