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General Rehabilitation

Impact of Botulinum Toxin on Dysphagia in Head and Neck Cancer Patients: A Case Report

Thursday, November 16, 2023

    Primary Author(s)

  • Ekta Gupta, MD

    Assistant Professor
    UT MD Anderson Cancer Center
    Houston, Texas

    • Co-Author(s)

  • An Ngo-Huang, DO

    Associate Professor
    University of Texas MD Anderson Cancer Center
    Houston, Texas

  • Jack B. Fu, MD

    Professor
    UT MD Anderson Cancer Center
    Houston, Texas

  • Ashish Khanna, MD

    Director of Oncology Rehabilitation
    Emory University Winship Cancer Center
    Atlanta, Georgia

Case Diagnosis: 59 year old male with right tonsillar squamous cell cancer treated with radiation therapy and concurrent cisplatin in 2012, complicated by severe dysphagia and radiation induced fibrosis causing cervical dystonia.

Case Description: Due to severe dysphagia, a feeding tube was placed in 2012 and removed in 2013 as was tolerating a regular diet. In 2014, he had progressive right neck spasms, without significant improvement with physical therapy, and received botulinum toxin injections to his sternocleidomastoid muscle by Neurology. His spasms progressed, and he developed severe dysphagia with aspiration pneumonia; his gastric tube was replaced in 2022. His modified barium swallow (MBS) in June 2022 revealed mild oral dysphagia and severe pharyngeal dysphagia, and he continued working with speech language pathology. Upon evaluation by PM&R, he had spasms with right greater than left torticollis. After botulinum toxin to the platysma, sternocleidomastoid, trapezius and scalene complex in May and August, he reported improvement in his dysphagia. By August, he was on a dysphagia one diet with thin liquids and repeat MBS in September improved to moderate to severe pharyngeal dysphagia.

Discussion: The use of botulinum toxin to impact dysphagia has been documented in case reports in patients with myositis and other muscular and neuromuscular diseases causing cervical dystonia, but it has not been well studies in patients with radiation fibrosis from head and neck cancer that is not related to trismus. In this case report, we show the impact of use of botulinum toxin on neck muscles with speech pathology strategies that decreased spasms and improved the patient’s ability to swallow.

Setting: Outpatient Clinic

Assessment/Results: Botulinum toxin injections to the platysma, sternocleidomastoid, trapezius and scalene complex concurrent with speech pathology improved this patient’s dysphagia from severe to moderate-severe.

Conclusion: The synergy of botulinum toxin with speech therapy improved dysphagia for this patient with radiation fibrosis and cervical dystonia.