Circopharyngeal Sphincter

 
[Surgical rehabilitation of neuromuscular swallowing disorders with special regard to cricopharyngeal myotomy and glottopexy]

[Article in German]

Linke R, Bockmuhl U, Haake K.

HNO-Klinik und Poliklinik der Charite, Humboldt-Universitat Berlin, Germany. robert.linke@t-online.de

Surgical Rehabilitation of Neuromuscular Swallowing Disorders with Special Regard to Cricopharyngeal Myotomy and Glottopexy.

BACKGROUND: The surgical rehabilitation of patients with swallowing disorders caused by neuromuscular insufficiency with life-threatening aspiration presents a special challenge to the ENT-surgeon.

METHODS: In a period of 5 years we decided on a surgical treatment in altogether 12 patients with paralytical dysphagia. In 6 patients we combined a cricopharyngeal myotomy with a complete closure of the glottis, in 5 patients we performed a sole cricopharyngeal myotomy. In another patient we restricted ourselves to glottopexy only.

RESULTS: In all cases the dysphagia giving rise to the surgical intervention was regredient so far that the removal of the percutan endoscopic gastrostomy postsurgically was possible. 3 special cases are presented in detail.

DISCUSSION: The main part of the therapy is the subtle and complete cricopharyngeal myotomy. Particulary good results are available with a combination of the latter with a reversible glottopexy.

CONCLUSIONS: After the failure of conservative therapy the indication for a surgical treatment should be made on a large scale.

Publication Types:

• Case Reports

PMID: 11793267 [PubMed - indexed for MEDLINE]

[Surgical indications in cricopharyngeal dysfunction]

[Article in German]

Zugel N, Hopfner W, Wienbeck M, Witte J.

Klinik fur Allgemein- und Abdominalchirurgie, Zentralklinikums Augsburg.

In 1989, five patients were treated for a cricopharyngeal dysfunction by cervical myotomy. In the past, due to extremely limited indications for surgery, repeated efforts of conservative treatment had been attempted in patients with idiopathic cricopharyngeal dysfunction and tracheopulmonary aspiration and/or permanent inability of oral nourishment. These patients underwent surgery after an interdisciplinary clinical assessment. Four out of five patients showed immediate improvement of their serious symptoms. Cervical myotomy is not expected to be successful in patients with insufficient oropharyngeal propulsion, as we could see in one female patient with severe upper oesophageal sphincter spasm. According to the literature and to our results, approximately 70 to 90% of the patients with idiopathic dysfunction of the cricopharyngeal muscle, who underwent surgery, showed significant improvement or even recovery. Due to the multifactoral genesis of the cricopharyngeal dysfunction it is understandable, that the surgical result is heavily dependent on the preoperative interdisciplinary diagnosis. In summary, for idiopathic cricopharyngeal dysfunction with complications we recommend the early and technically simple operation.

PMID: 1748025 [PubMed - indexed for MEDLINE]

Treatment of cricopharyngeal dysfunction by endoscopic laser myotomy.

Brondbo K.

Department of Otorhinolaryngology, National Hospital (Rikshospitalet), Oslo, Norway.

Cricopharyngeal dysfunction may be caused by a central or peripheral nerve disease, a muscular disease, previous neck surgery or it may be idiopathic. The treatment may be a myotomy of the cricopharyngeal muscle carried out externally or endoscopically. Since 1995 we have treated 17 patients with endoscopic myotomy of the cricopharyngeal muscle with the CO2 laser. Anamnesis was the basis for the diagnosis and we obtained further information from videoradiographs of the upper gastrointestinal tract and from manometry. There were no immediate or late complications from the surgery. Three patients died from other diseases, the remaining 14 patients were sent a follow-up questionnaire and asked to grade their complaints pre- and postoperatively and to answer questions about their weight. All patients except one stated that their swallowing abilities had improved since the surgery and more than half of the patients had gained weight. A low rate of complications and postoperative morbidity, combined with good functional results, indicate that endoscopic laser myotomy should be recommended for treatment of cricopharyngeal dysfunction.

PMID: 10909025 [PubMed - indexed for MEDLINE]

Cricopharyngeal myotomy: a review of surgical results in patients with cricopharyngeal achalasia of neurogenic origin.

Berg HM, Jacobs JB, Persky MS, Cohen NL.

Cricopharyngeal myotomy is an effective procedure for the treatment of swallowing disorders due to dysfunction of the upper esophageal sphincter and pharyngeal musculature. Eight patients with documented pharyngeal and sphincteric dysfunction have undergone myotomies with significant improvement in swallowing associated with restoration of oral feeding without aspiration in 5, while 3 patients have not improved. The preoperative work-up and evaluation is discussed as well as criteria that may identify those patients most likely to benefit from this treatment.

PMID: 4058211 [PubMed - indexed for MEDLINE]

Transmucosal cricopharyngeal myotomy with the potassium-titanyl-phosphate laser in the treatment of cricopharyngeal dysmotility.

Halvorson DJ, Kuhn FA.

Dept of Surgery, Medical College of Georgia, Augusta 30912-4060.

Cricopharyngeal dysfunction is a relatively uncommon disorder that is widely misunderstood. Cricopharyngeal dysmotility is thought to represent abnormal function of the upper esophageal or cricopharyngeal sphincter. The cause of this dysfunction is related to uncoordinated pharyngeal swallowing, achalasia, or a combination of these factors. Unfortunately, standard diagnostic tests have not consistently demonstrated a failure of the cricopharyngeal sphincter to malfunction; therefore, cricopharyngeal myotomy has been suggested as a diagnostic and therapeutic tool in the treatment of dysmotility. Our report focuses on the current trends in the diagnosis and treatment of cricopharyngeal dysfunction. We also present a case report of a transmucosal cricopharyngeal myotomy performed with the potassium-titanyl-phosphate (KTP) laser. The KTP laser was found to be relatively safe and effective and did not demonstrate significant morbidity. Our conclusion was that a transmucosal cricopharyngeal myotomy with the KTP laser may represent a viable alternative for patients with cricopharyngeal dysmotility.

Publication Types:

• Case Reports

PMID: 8122832 [PubMed - indexed for MEDLINE]