Abstract
Hypertonicity of the pharyngeal constrictor muscles is considered to be a frequent cause of dysphagia as well as tracheo-esophageal puncture (TEP) speech failure following total laryngectomy. Methods to address this problem include pharyngeal plexus neurectomy at the time of laryngectomy, myotomy, and mechanical hypopharyngeal dilation after laryngectomy. We describe the use of electromyographically (EMG) guided needle electrode injection of Botulinum neurotoxin A (Botox) into the pharyngeal musculature following total laryngectomy in patients who were either not suitable candidates for or refused myotomy or dilation. Technique, dosage and results are described.

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