Dysphagia pp 425-443 | Cite as

Surgical Aspects of Pharyngeal Dysfunction, Dysphagia, and Aspiration

Part of the Medical Radiology book series (MEDRAD)


Surgical treatment of oropharyngeal dysphagia and aspiration resulting from different disorders is a difficult issue. Sometimes the aim of the surgery is complete correction of the disorder (e.g., extraluminal obstruction), but more often no more than a reduction of the symptoms can be achieved (e.g., laryngeal suspension). The most frequent disorders eligible for surgical treatment are described and some others are described as examples of possible surgical approaches. The surgical techniques described are aimed at preservation or restoration of the function of the larynx and pharynx.


Percutaneous Endoscopic Gastrostomy Diffuse Idiopathic Skeletal Hyperostosis Oropharyngeal Dysphagia Laryngeal Elevation Cricopharyngeal Muscle 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


  1. Akhtar S, O’Flynn PE, Kelly A, Valentine PM (2000) The management of dysphagia in skeletal hyperostosis. J Laryngol Otol 114:154–157PubMedCrossRefGoogle Scholar
  2. Aviv JE, Mohr JP, Blitzer A et al (1997) Restoration of laryngopharyngeal sensation by neural anastomosis. Arch Otolaryngol Head Neck Surg 123:154–160PubMedCrossRefGoogle Scholar
  3. Bensaid AH, Dietmann JL, Kastler B et al (1992) Neurofibromatosis with dural ectasia and bilateral symmetrical pedicular clefts: report of two cases. Neuroradiology 34:107–109PubMedCrossRefGoogle Scholar
  4. Brandenberg G, Leibrock LG (1986) Dysphagia and dysphonia secondary to anterior cervical osteophytes. Neurosurgery 18:90–93PubMedCrossRefGoogle Scholar
  5. Brigand C, Ferraro P, Martin J, Duranceau A (2007) Risk factors in patients undergoing cricopharyngeal myotomy. Br J Surg 94:978–983PubMedCrossRefGoogle Scholar
  6. Calcatarra T (1971) Laryngeal suspension after supraglottic laryngectomy. Arch Otol 94:306–309CrossRefGoogle Scholar
  7. Carrau RL, Cintron FR, Astor F (1990) Transcervical approaches to the prevertebral space. Arch Otolaryngol Head Neck Surg 116:1071–1073CrossRefGoogle Scholar
  8. Christiaens P, De Roock W, Van Olmen A, Moons V, D’Haens G (2007) Treatment of ZD through a flexible endoscope with a transparent oblique-end hood attached to the tip and a monopolar forceps. Endoscopy 39(2):137–140PubMedCrossRefGoogle Scholar
  9. Coiffier L, Périé S, Laforêt P, Eymard B, St Guily JL (2006) Long-term results of cricopharyngeal myotomy in oculopharyngeal muscular dystrophy. Otolaryngol Head Neck Surg 135:218–222PubMedCrossRefGoogle Scholar
  10. Collard JM, Otte JB, Kestens PJ (1993) Endoscopic stapling technique of esophagodiverticulostomy for ZD. Ann Thorac Surg 56:573–576PubMedCrossRefGoogle Scholar
  11. Cook IJ (1993) Cricopharyngeal function and dysfunction. Dysphagia 8:244–251PubMedCrossRefGoogle Scholar
  12. Cook IJ, Kahrilas PJ (1999) AGA technical review on management of oropharyngeal dysphagia. Gatroenterology 116:455–478CrossRefGoogle Scholar
  13. Cook RD, Huang PC, Richtsmeier WJ, Scher RL (2000) Endoscopic staple-assisted esophagodiverticulostomy: an excellent treatment of choice for ZD. Laryngoscope 110:2020–2025PubMedCrossRefGoogle Scholar
  14. de Boer MF, Pruyn JF, van den Borne B, Knegt PP, Ryckman RM et al (1995) Rehabilitation outcomes of long-term survivors treated for head and neck cancer. Head Neck 17(6):503–515PubMedCrossRefGoogle Scholar
  15. Desprez JD, Kiehn CL (1959) Method of reconstruction following resection of the anterior oral cavity and mandible for malignancy. Plast Reconstr Surg 24:238–249CrossRefGoogle Scholar
  16. Dohlman G, Mattson O (1960) The endoscopic operation for hypopharyngeal diverticula. Arch Otolaryngol 71:744–752CrossRefGoogle Scholar
  17. Edgerton MT, Duncan MM (1959) Reconstruction with loss of the hyomandibular complex in excision of large cancers. Arch Surg 78:425–436CrossRefGoogle Scholar
  18. Erkulurawatra S, El Gammal T, Hawkins JB et al (1979) Intrathoracic meningoceles and neurfibromatosis. Arch Neurol 36:557–559CrossRefGoogle Scholar
  19. Flint PW, Purcell LL, Cummings CW (1997) Pathophysiology and indications for medialization thyroplasty in patients with dysphagia and aspiration. Otolaryngol Head Neck Surg 116:349–354PubMedCrossRefGoogle Scholar
  20. Freund B, Timon C (1992) Cervical meningocele presenting as a neck mass in a patient with neurofibromatosis 1. J Laryngol Otol 106:463–464PubMedCrossRefGoogle Scholar
  21. Fujimoto Y, Hasegawa Y, Yamada H et al (2007) Swallowing function following extensive resection of oral or oropharyngeal cancer with laryngeal suspension and cricopharyngeal myotomy. Laryngoscope 117:1343–1348PubMedCrossRefGoogle Scholar
  22. Giger R, Dulguerov P, Payer M (2006) Anterior cervical osteophytes causing dysphagia and dyspnea: an uncommon entity revisited. Dysphagia 21(4):259–263PubMedCrossRefGoogle Scholar
  23. Girgis JH, Guirguis NN, Mourice M (1982) Laryngeal and pharyngeal disorders in vertebral ankylosing hyperostosis. J Laryngol Otol 96:659–664PubMedCrossRefGoogle Scholar
  24. Goode RL (1976) Laryngeal suspension in head and neck surgery. Laryngoscope 86:349–355PubMedCrossRefGoogle Scholar
  25. Guily JL, Perie S, Willig TN, Chaussade S, Eymard B, Angelard B (1994) Swallowing disorders in muscular diseases: functional assessment and indications of cricopharyngeal myotomy. Ear Nose Throat J 73:34–40Google Scholar
  26. Habal MB, Murray JE (1972) Surgical treatment of life-endangering chronic aspiration pneumonia: use of an epiglottic flap to the arytenoids. Plast Reconstr Surg 59:305–311CrossRefGoogle Scholar
  27. Hatlebakk JG, Castell JA, Spiegel J, Paoletti V, Katz PO, Castell DO (1998) Dilatation therapy for dysphagia in patients with UES dysfunction–manometric and symptomatic response. Dis Esophagus 11:254–259PubMedGoogle Scholar
  28. Hawthorne M, Gray R, Cottam C (1987) Conservative laryngectomy (an effective treatment for severe aspiration in motor neurone disease). J Laryngol Otol 101:283–285PubMedCrossRefGoogle Scholar
  29. Kahrilas PJ, Dodds WJ, Dent J et al (1988) Upper esophageal sphincter function during deglutition. Gastroenterology 95:52–62PubMedGoogle Scholar
  30. Kaplan S (1951) Paralysis of deglutition, a post-poliomyelitis complication treated by section of the cricopharyngeus muscle. Ann Surg 133:572–573PubMedGoogle Scholar
  31. Kelly JH (2000) Management of UES disorders: indications and complications of myotomy. Am J Med 108:43S–46SPubMedCrossRefGoogle Scholar
  32. Kitahara S, Ikeda M, Ohmae Y et al (1993) Laryngeal closure at the level of the false vocal cord for the treatment of severe aspiration. J Laryngol Otol 107:826–828PubMedCrossRefGoogle Scholar
  33. Kos MP, David EF, Aalders IJ, Smit CF, Mahieu HF (2008) Long-term results of laryngeal suspension and UES myotomy as treatment of life-threatening aspiration. Ann Otol Rhinol Laryngol 117:574–580PubMedGoogle Scholar
  34. Kos MP, David EF, Mahieu HF (2009) Endoscopic CO2-laser Zenker’s diverticulotomy revisited. Ann Otol Rhinol Laryngol 118(7):512–518PubMedGoogle Scholar
  35. Kos MP, David EF, Klinkenberg-Knol EC, Mahieu HF (2010) Long-term results of external UES myotomy for oropharyngeal dysphagia. Dysphagia 25(3):169–176PubMedCrossRefGoogle Scholar
  36. Krause P, Castro WH (1994) Cervical hyperostosis: a rare cause of dysphagia. Case description and bibliographical survey. Eur Spine J 3:56–58PubMedCrossRefGoogle Scholar
  37. Laurell G, Kraepelien T, Mavroidis P, Lind BK, Fernberg JO et al (2003) Stricture of the proximal esophagus in head and neck carcinoma patients after radiotherapy. Cancer 97:1693–1700PubMedCrossRefGoogle Scholar
  38. Laurian N, Shvili Y, Zohar Y (1986) Epiglotto-aryepiglottopexy: a surgical procedure for severe aspiration. Laryngoscope 96:78–81PubMedCrossRefGoogle Scholar
  39. Leder SB, Acton LM, Lisitano HL, Murray JT (2005) Fiberoptic endoscopic evaluation of swallowing (FEES) with and without blue-dyed food. Dysphagia 20:157–162PubMedCrossRefGoogle Scholar
  40. Lindeman RC (1975) Diverting the paralysed larynx: a reversible procedure for intractable aspiration. Laryngoscope 85:157–180PubMedCrossRefGoogle Scholar
  41. Mahieu HF, de Bree R, Dagli SA, Snel AM (1996) The pharyngoesophageal segment: endoscopic treatment of ZD. Dis Esophagus 9:12–21Google Scholar
  42. Maple JT, Petersen BT, Baron TH, Kasperbauer JL, Wong Kee Song LM, Larson MV (2006) Endoscopic management of radiation-induced complete upper esophageal obstruction with an antegrade-retrograde rendezvous technique. Gastrointest Endosc 64(5):822–828PubMedCrossRefGoogle Scholar
  43. Matan AJ, Hsu J, Fredrickson A (2002) Management of respiratory compromise caused by cervical osteophytes: a case report and a review of the literature. Spine J 2:456–459PubMedCrossRefGoogle Scholar
  44. Mirza S, Dutt SN, Irving RM (2003) Iatrogenic perforation in endoscopie stapling divetiiculotomy for pbaryngeal pouches. J Laryngol Otol 117:93–98PubMedCrossRefGoogle Scholar
  45. Moerman MB (2006) Cricopharyngeal Botox injection: indications and technique. Curr Opin Otolaryngol Head Neck Surg 14:431–436PubMedCrossRefGoogle Scholar
  46. Mongomery WW (1975) Surgery to prevent aspiration. Arch Otolaryngol 101:679–682CrossRefGoogle Scholar
  47. Mosher HP (1917) Webs and pouches of the oesophagus: their diagnosis and treatment. Surg Gyn Obstet 25:175–187Google Scholar
  48. Oga M, Mashima T, Iwakuma T, Sugioka Y (1993) Dysphagia complications in ankylosing spinal hyperostosis and ossification of the posterior longitudinal ligament. Spine 18:391–394PubMedCrossRefGoogle Scholar
  49. Petro M, Wein RO, Minocha A (2005) Treatment of a radiation-induced esophageal web with retrograde esophagoscopy and puncture. Am J Otolaryngol 26(5):353–355PubMedCrossRefGoogle Scholar
  50. Piotet E, Escher A, Monnier P (2008) Esophageal and pharyngeal strictures: report on 1,862 endoscopic dilatations using the Savary-Gilliard technique. Eur Arch Otorhinolaryngol 265(3):357–364PubMedCrossRefGoogle Scholar
  51. Resnick D, Shaul SR, Robins JM (1975) Diffuse idiopathic skeletal hyperostosis (DISH): Forestier’s disease with extraspinal manifestations. Radiology 115:513–524PubMedGoogle Scholar
  52. Richter D (1995) Ventral hyperostosis of the cervical spine—a rare differential diagnosis of dysphagia. Chirurg 66:431–433PubMedGoogle Scholar
  53. Saetti R, Silvestrini M, Peracchia A, Narne S (2006) Endoscopic stapler-assisted Zenker’s diverticulotomy: which is the best operative facility? Head Neck 28(12):1084–1089PubMedCrossRefGoogle Scholar
  54. Sasaki CT, Milmoe G, Yanagisawa E (1980) Surgical closure of the larynx for intractable aspiration. Arch Otolaryngol 106:422–423PubMedCrossRefGoogle Scholar
  55. Seaman DL, de la Mora Levy J, Gostout CJ, Rajan E, Knipschield M (2008) A new device to simplify flexible endoscopic treatment of ZD. Gastrointest Endosc 67:112–115PubMedCrossRefGoogle Scholar
  56. Takes RP, van den Hoogen FJ, Marres HA (2005) Endoscopic myotomy of the cricopharyngeal muscle with CO2 laser surgery. Head Neck 27:703–709PubMedCrossRefGoogle Scholar
  57. Tang SJ, Jazrawi SF, Chen E, Tang L, Myers LL (2008) Flexible endoscopic clip-assisted Zenker’s diverticulotomy: the first case series (with videos). Laryngoscope 118(7):1199–1205PubMedCrossRefGoogle Scholar
  58. Tiwari R, Karim ABM, Greven AJ et al (1993) Total glossectomy with laryngeal preservation. Arch Otolaryngol Head and Neck Surg 119:945–949CrossRefGoogle Scholar
  59. Van Overbeek JJ (1997) The hypopharyngeal diverticulum. Endoscopic treatment and manometry (thesis). VanGorcum, AssenGoogle Scholar
  60. Van Overbeek JJ, Hoeksema PE, Edens E (1984) Micro-endoscopic surgery of the hypopharyngeal diverticulum using electrocoagulation or carbon dioxide laser. Ann Otol Rhinol Laryngol 93:34–36PubMedGoogle Scholar
  61. van Twisk JJ, Brummer RJ, Manni JJ (1998) Retrograde approach to pharyngo-esophageal obstruction. Gastrointest Endosc 48(3):296–299PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2011

Authors and Affiliations

  1. 1.ENT DepartmentMeander Medical CenterAmersfoortThe Netherlands
  2. 2.ENT DepartmentWaterland HospitalPurmerendThe Netherlands

Personalised recommendations