The Mayo Clinic Spasmodic Dysphonia Experience: A Demographic Analysis of 686 Patients

Objectives:

(1) Review demographic data collected over a 23-year experience of 686 patients with spasmodic dysphonia (SD) who have been treated with onabotulinum toxinA (onaBTX-A). (2) Compare demographic trends surrounding SD with previously published data.

Methods:

A retrospective chart review was conducted. A total of 686 patients with SD were treated with 6345 onaBTX-A injections at Mayo Clinic Arizona between 1989 and 2013. Demographic data were compiled and analyzed. Patients were subdivided based on type of SD, presence of vocal tremor (VT), and presence of neurologic disorders. Family history of neurological disorders was also recorded.

Results:

In 686 patients, 432 patients were female (63.0%) and 254 patients were male (37.0%). A total of 630 patients (91.8%) were of the adductor type (AdSD) and 56 patients (8.2%) were of the abductor type (AbSD). AdSD patients noted symptom onset and began injections at an older age than AbSD patients (52.5; 60.6 years vs 43.7 years; 50.0 years, respectively). A total of 374 patients (54.5%) had VT, with 355 AdSD patients and 19 AbSD patients. A total of 45 patients (6.6%) had other movement disorders, such as blepharospasm (1.5%), torticollis (2.3%), limb dystonia (1.0%), or oromandibular dystonia (1.8%). Family history of SD was positive in 4 patients (0.6%) and of other dystonias in 9 patients (1.3%).

Conclusions:

Spasmodic dysphonia is a chronic and potentially disabling laryngeal dystonia resulting from disrupted motor control of the laryngeal musculature during phonation. This large series adds new insight and contributes to the current literature regarding the clinical scope and nature of SD.

Temporalis Tendon Transposition for Dynamic Facial Reanimation following Radical Oncologic Resection

Objectives:

Report a patient series in which a temporalis tendon transposition was performed for facial paralysis following radical oncologic resection. 1) Describe the modifications in technique of temporalis tendon transfer associated with concurrent cancer resection. 2) Evaluate the effect of complex defects and their reconstruction on facial reanimation outcomes.

Methods:

Retrospective review of 10 patients who underwent orthodromic temporalis tendon transposition for dynamic facial reanimation of their facial paralysis following radical cancer resection from January 2010 through February 2013. Data was collected for parotid malignancy, defect composition, reconstructive details, postoperative course, complications, and outcomes.

Results:

All patients underwent radical parotidectomy with facial nerve sacrifice and resection of adjacent soft and/or bony tissue for parotid malignancy. Complex defects included cutaneous loss necessitating concurrent flap reconstruction (n=5), partial or total temporal bone resection (n=6), and mandibulectomy (n=2). All patients underwent dynamic reanimation with temporalis tendon transposition through a nasolabial incision. Facial reanimation was performed at the same time as the resection in 6 cases and in a delayed setting in 4 cases. There was no difference in outcomes in these two patient groups. Due to tumor involvement, six resections included sacrifice of the internal maxillary artery without resultant compromise of the temporalis transfer. During the follow-up period, all patients had improved facial symmetry at rest and developed voluntary motion with post-procedure facial training therapy.

Conclusions:

Temporalis tendon transposition is a reliable, straightforward option for dynamic facial reanimation in the oncologic patient. Radical resection does not prohibit using this technique.