Eugene Rontal, MD Michael Rontal, MD

A clear understanding of the "balanced force" concept of normal laryngeal musculature function has greatly aided the laryngologist in the endoscopic management of a wide range of laryngeal problems. The authors have demonstrated the validity of this principle in previous work, utilizing selective surgical tenotomy to correct bilateral vocal cord fixation. Botulinum toxin, in effect, causes these same changes in a chemically reversible manner. Without extensive surgical procedures, the surgeon can endoscopically utilize this toxin as a chemical tenotomy, to alter the position of the arytenoid cartilage and thus treat a variety of problems, including arytenoid subluxation, posterior glottic inflammation, and laryngeal stenosis. This paper discusses our experience managing these difficult laryngeal problems.