Cricopharyngeal myotomy in motor neurone disease.

Loizou, L A; Small, Michael F.; Dalton, G. A.

doi:10.1136/jnnp.43.1.42

Cited by 24 publications

(13 citation statements)

References 10 publications

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“…These data confirm that the main cause of dysphagia in MND patients is a defective oral phase of swallowing and that only a minority of patients show UOS dysfunction and could benefit from cricopharyngeal myotomy [21]. This may explain the contrasting results after cricopharyngeal myotomy in these patients, as reported in the literature [5,14,15,20,[23][24][25]37].…”

Section: Discussionsupporting

confidence: 84%

Radiological evidence of subclinical dysphagia in motor neuron disease

Briani

Marcon

Ermani

et al. 1998

Journal of Neurology

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Dysphagia in motor neuron disease (MND) may lead to dangerous complications such as cachexia and aspiration pneumonia. Functional evaluation of the oropharyngeal tract is crucial for identifying specific swallowing dysfunctions and planning appropriate rehabilitation. As part of a multidisciplinary study on the treatment of dysphagia in patients with neuromuscular diseases, 23 MND patients with different degrees of dysphagia underwent videofluoroscopy, videopharyngolaryngoscopy and pharyngo-oesophageal manometry. The results of the three instrumental investigations were analysed in order (1) to define the pattern of swallowing in MND patients complaining of dysphagia; (2) to evaluate whether subclinical abnormalities may be detected; and (3) to assess the role of videofluoroscopy, videopharyngolaryngoscopy and manometry in the evaluation of MND patients with deglutition problems. Correlations between the instrumental findings and clinical features (age of the patients, duration and severity of the disease, presence and degree of dysphagia) were also assessed. The results of our study showed that: (1) The oral phase of deglutition was compromised most often, followed by the pharyngeal phase. (2) In all patients without clinical evidence of dysphagia, subclinical videofluoroscopic alterations were present in a pattern similar to that found in the dysphagic group. (3) Videofluoroscopy was the most sensitive technique in identifying oropharyngeal alterations of swallowing. Impairment of the oral phase, abnormal pharyngo-oesophageal motility and incomplete relaxation of the upper oesophageal sphincter were the changes most sensitive in detecting dysphagia. Videofluoroscopy was also capable of detecting preclinical abnormalities in non-dysphagic patients who later developed dysphagia. Practical guidelines for the use of instrumental investigations in the assessment and management of dysphagia in MND patients are proposed.

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Section: Discussionsupporting

confidence: 84%

Radiological evidence of subclinical dysphagia in motor neuron disease

Briani

Marcon

Ermani

et al. 1998

Journal of Neurology

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“…Some patients with ALS may also benefit from this surgical procedure. 92 However, myotomy in neurogenic dysphagia is an area of intense con- troversy. In our experience, the procedure is not useful for most patients with severe oral or pharyngeal weakness.…”

Section: Impairment Of Deglutition In Neuromuscular Dis-mentioning

confidence: 99%

Neuromuscular diseases and disorders of the alimentary system

2002

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This review outlines the relationship and interaction between neuromuscular diseases and disorders of the alimentary system. Neuromuscular manifestations of gastrointestinal and hepatobiliary diseases are first considered. Such diseases may cause neuromuscular disorders by leading to nutritional deficiency or by more direct mechanisms. The pathogenesis, clinical features, and treatment of these various neuromuscular manifestations are discussed. The impact of disorders of nerve, neuromuscular transmission, and muscle on the alimentary system is then reviewed. The main sequelae are impaired deglutition and gastrointestinal dysmotility. The management of these complications is considered.

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“…Dysphagia and respiratory distress may sometimes be alleviated by cricopharyngeal myolomy particularly in cases of M N D (Mills, 1973;Loizou, Small & Dalton. 1980).…”

Section: Introductionmentioning

confidence: 99%

Histomorphometric and histopathological study of the human cricopharyngeus muscle: in health and in motor neuron disease

Kristmundsdottir

Mahon

Fróes

et al. 1990

Neuropathol Appl Neurobiol

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Abnormalities in muscle histology have been reported frequently for the cricopharyngeus muscle of patients with oculopharyngeal muscular dystrophy, motor neuron disease and other neurological disorders in which dysphagia is a common clinical sign. However, there are few detailed reports of the normal structure of this muscle nor quantitative baseline data with which to compare the diseased state. In this study, cricopharyngeus muscles from 21 healthy individuals and four patients with motor neuron disease underwent quantitative histological and histochemical examination. In addition to the extensive connective tissue content (40%), comprising abundant elastic fibres, cricopharyngeus muscles from normal individuals possessed small calibre striated muscle fibres (mean narrow diameter 30 microns) of widely varying size (coefficient of variation 41%). The majority of fibres were histochemically type I (82%) and highly oxidative. All muscles comprised numerous muscle fibres with aberrant histological and histochemical features (internalized nuclei, 'ragged red' crescents, splits, degenerating fibres, 'moth-eaten' fibres, or nemaline rods.) The histomorphometric and histopathological features were similar in males and females and some showed a correlation with age. There were increases in fibre size and roundedness and decreases in the numerical density and percentage of type I and split fibres in the specimens from older individuals. Cricopharyngeus muscles from patients with motor neuron disease were not significantly different from the controls for most parameters. It is therefore suggested that previous descriptions of specific cricopharyngeal pathology accompanying neuromuscular disease or dysphagia be interpreted with caution. The importance of obtaining normal structural, morphometric and histopathological data from muscles other than the usually biopsied limb muscles, is emphasized.

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Cricopharyngeal myotomy in motor neurone disease.

Cited by 24 publications

References 10 publications

Radiological evidence of subclinical dysphagia in motor neuron disease

Radiological evidence of subclinical dysphagia in motor neuron disease

Neuromuscular diseases and disorders of the alimentary system

Histomorphometric and histopathological study of the human cricopharyngeus muscle: in health and in motor neuron disease

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