Laryngeal and Extralaryngeal Botulinum Toxin Injections

  • William Z. Gao
  • Michael M. JohnsIIIEmail author


This chapter reviews the use of different laryngeal and extralaryngeal botulinum toxin injections to help treat various neurologic conditions affecting the larynx. Basics of botulinum toxin are first reviewed including the historical context for its introduction into medicine, the mechanism of action for its clinical effect, and an overview of different commercial formulations. We discuss the diverse array of clinical indications within the scope of this book, which include adductor/abductor spasmodic dysphonia, essential voice tremor, bilateral vocal fold paresis/paralysis, respiratory dystonia, paradoxical vocal fold motion disorder, neurogenic cough, and cricopharyngeal dysfunction. The initial focus is on procedural technique/approaches to achieve therapeutic injection of end organ muscle targets: the thyroarytenoid-lateral cricoarytenoid complex, posterior cricoarytenoid, false vocal folds, and cricopharyngeus. Potential complications are briefly examined. Within the context of the aforementioned conditions, we delve into optimal dosing strategies as well as expected outcomes. The understanding gained from this chapter should help the reader incorporate botulinum toxin injections into their practice and treat clinical phenomenology arising from numerous neurologic diseases that affect the larynx.


Botulinum toxin Botox MyoBloc Spasmodic dysphonia Dystonia Essential voice tremor Bilateral vocal fold paralysis Paradoxical vocal fold motion Neurogenic cough Cricopharyngeal dysfunction 


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Copyright information

© Springer Nature Switzerland AG 2020

Authors and Affiliations

  1. 1.USC Tina and Rick Caruso Department of Otolaryngology–Head & Neck Surgery, Keck School of MedicineUniversity of Southern CaliforniaLos AngelesUSA
  2. 2.USC Tina and Rick Caruso Department of Otolaryngology–Head & Neck SurgeryKeck School of Medicine, University of Southern CaliforniaLos AngelesUSA
  3. 3.USC Voice Center, Division of LaryngologyUniversity of Southern CaliforniaLos AngelesUSA

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