Advertisement

Dysphagia

, Volume 10, Issue 4, pp 255–258 | Cite as

Cricopharyngeal myotomy may be effective treatment for selected patients with neurogenic oropharyngeal dysphagia

  • David W. Buchholz
Article

Abstract

The role of cricopharyngeal (CP) myotomy in the management of neurogenic oropharyngeal dysphagia remains controversial. A review of the literature regarding outcomes of CP myotomy for dysphagia in the setting of a variety of neurological disorders indicates a preponderance of favorable results. There are several potential explanations for reported improvement after CP myotomy for neurogenic dysphagia, including the possibility that it is an effective treatment, at least for selected patients. If this is true, appropriate selection criteria for this treatment of neurogenic dysphagia may include (1) intact voluntary initiation of swallowing, (2) adequate propulsive force generated by the tongue and pharyngeal constrictors, (3) videofluorographic demonstration of obstruction to bolus flow at the CP segment (rather than merely retention in the pharyngeal recesses), (4) manometric evidence of relatively elevated CP pressure in relation to the pharynx, and (5) relatively favorable neurological prognosis. The effectiveness and safety of CP myotomy for patients with neurogenic dysphagia are unlikely to be resolved without a prospective, controlled multicenter study enrolling patients who meet such criteria.

Key words

Cricopharyngeal myotomy Deglutition Deglutition disorders Neurogenic dysphagia 

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. 1.
    Duranceau A, Lafontaine ER, Taillefer R, Jamieson GG: Oropharyngeal dysphagia and operations on the upper esophageal sphincter. Ann Surg 19:317–362, 1987Google Scholar
  2. 2.
    Blakeley WR, Garety EJ, Smith DE: Section of the cricopharyngeus muscle for dysphagia. Arch Surg 96:745–762, 1968Google Scholar
  3. 3.
    Montgomery WW, Lynch JP: Oculopharyngeal muscular dystrophy treated by inferior constrictor myotomy. Trans Am Acad Ophthalmol Otolaryngol 75:986–993, 1971Google Scholar
  4. 4.
    Aki BF, Blakeley WR: Late assessment of results of cricopharyngeal myotomy for cervical dysphagia. Am J Surg 128:818–822, 1974Google Scholar
  5. 5.
    Calcaterra TC, Kadell EM, Ward PH: Dysphagia secondary to cricopharyngeal muscle dysfunction. Arch Otolaryngol 101: 726–729, 1975Google Scholar
  6. 6.
    Lebo CP, Sang ÜK, Norris FH: Cricopharyngeal myotomy in amyotrophic lateral sclerosis. Laryngoscope 86:862–868, 1976Google Scholar
  7. 7.
    Duranceau CA, Letendre J, Clermont RJ, Levesque H-P, Barbeau A: Oropharyngeal dysphagia in patients with oculopharyngeal muscular dystrophy. Can J Surg 21:326–329, 1978Google Scholar
  8. 8.
    Overbeek JJM, Betlem HC: Cricopharyngeal myotomy in pharyngeal paralysis: cineradiographic and manometric indicators. Ann Oto, Rhinol Laryngol 88:596–602, 1979Google Scholar
  9. 9.
    Ross ER, Green R, Auslander MO, Biller HF: Cricopharyngeal myotomy: management of cervical dysphagia. Otolaryngol Head Neck Surg 90:434–441, 1982Google Scholar
  10. 10.
    Lim RY, Venna PL: Cricopharyngeal myotomy for dysphagia with aspiration. WV Med J 80:95–97, 1984Google Scholar
  11. 11.
    Bonavina L, Khan NA, DeMeester TR: Pharyngoesophageal dysfunctions: the role of cricopharyngeal myotomy. Arch Surg 120:541–549, 1985Google Scholar
  12. 12.
    Taillefer R, Duranceau AC: Manometric and radionuclide assessment of pharyngeal emptying before and after cricopharyngeal myotomy in patients with oculopharyngeal muscular dystrophy. J Thorac Cardiovasc Surg 95:868–875, 1988Google Scholar
  13. 13.
    Stein M, Williams AJ, Grossman F, Weinberg AS, Zuckerbraun L: Cricopharyngeal dysfunction in chronic obstructive pulmonary disease. Chest 97:347–352, 1990Google Scholar
  14. 14.
    Lindgren S, Ekberg O: Cricopharyngeal myotomy in the treatment of dysphagia. Clin Otolaryngol 15:221–227, 1990Google Scholar
  15. 15.
    Wilson PS, Bruce-Lockhart FJ, Johnson AP: Videofluoroscopy in motor neuron disease prior to cricopharyngeal myotomy. Ann R Coll Surg Engl 72:375–377, 1990Google Scholar
  16. 16.
    McKenna JA, Dedo HH: Cricopharyngeal myotomy: indications and technique. Ann Otol Rhinol Laryngol 101:216–221, 1992Google Scholar
  17. 17.
    Darrow DH, Hoffman HT, Barnes GJ, Wiley CA: Management of dysphagia in inclusion body myositis. Arch Otolaryngol Head Neck Surg 118:313–317, 1992Google Scholar
  18. 18.
    Johnson ER, McKenzie SW: Kinematic pharyngeal transit times in myopathy: evaluation for dysphagia. Dysphagia 8:35–40, 1993Google Scholar
  19. 19.
    Buchholz DW: Oropharyngeal dysphagia due to iatrogenic neurological dysfunction. Dysphagia 10:248–254, 1995Google Scholar
  20. 20.
    Schneider I, Pototschnig C, Thumfart WF, Eckel HE: Treatment of dysfunction of the cricopharyngeal muscle with botulinum toxin: introduction of a new, noninvasive method. Ann Otol Rhinol Laryngol 103:31–35, 1994Google Scholar

Copyright information

© Springer-Verlag New York Inc 1995

Authors and Affiliations

  • David W. Buchholz
    • 1
    • 2
    • 3
  1. 1.Department of NeurologyThe Johns Hopkins University School of MedicineBaltimoreUSA
  2. 2.The Johns Hopkins Outpatient CenterBaltimoreUSA
  3. 3.The Johns Hopkins Swallowing CenterBaltimoreUSA

Personalised recommendations