Effect of cricopharyngeus muscle surgery on the pharynx

Allen, Jacqui; White, Cheryl; Leonard, Rebecca J.; Belafsky, Peter C.

doi:10.1002/lary.21002

Cited by 34 publications

(28 citation statements)

References 26 publications

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“…This suggests that outlet obstruction relief (via myotomy) provides an opportunity for the proximal pharynx to improve contraction and contribute to increased swallow efficiency. This is in keeping with previous work of Belafsky et al demonstrating a worsening pharyngeal constriction ratio (and, therefore, pharyngeal strength) as patients progressed from a nonobstructive bar to an obstructive bar and finally to a cricopharyngeal bar associated with a Zenker's diverticulum . It is still not clear as to what is the correct time to intervene in order to prevent pharyngeal decline, but our study now suggests that even with established abnormal parameters there can be improvement in pharyngeal function if relief of obstruction occurs.…”

Section: Discussionsupporting

confidence: 92%

“…It has been suggested that underlying neurologic disease should be a contraindication to cricopharyngeal surgery, but this is not supported by our findings. 16,17 In this cohort of 40 patients, those with neurologic conditions retained the worst self-reported swallowing symptoms postsurgery; however (with the exception of 1 patient), they still achieved significant benefits both clinically with self-reported tools and dietary improvement and objectively as assessed by our chosen swallowing parameters.…”

mentioning

confidence: 78%

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Assessment of videofluoroscopic swallow study findings before and after cricopharyngeal myotomy

2017

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Section: Discussionsupporting

confidence: 92%

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confidence: 78%

Assessment of videofluoroscopic swallow study findings before and after cricopharyngeal myotomy

2017

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“…Some patients may derive symptomatic improvement with dilatation of the cricopharyngeus [37]. However, the options faced by those who remain symptomatic are limited: either re-attempting an endoscopic approach or consideration of an external procedure.…”

Section: Endoscopic Stapling Of Zenker's Diverticulum In the United Kmentioning

confidence: 99%

Endoscopic stapling of Zenker’s diverticulum: establishing national baselines for auditing clinical outcomes in the United Kingdom

Leong

Wilkie

Webb

2012

Eur Arch Otorhinolaryngol

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Endoscopic stapling of Zenker's diverticulum (ZD) is now established practice in the UK and is routinely performed by the vast majority of otolaryngologists. Both The National Confidential Enquiry into Peri-Operative Deaths and the National Institute for Health and Clinical Excellence recommended that the procedure be undertaken at specialist centres and that each department should audit their respective outcomes. Despite the abundance of review articles, it remains unclear what variables a meaningful audit is required to collate and what gold standards every department in the UK undertaking surgery for ZD should aspire to achieve. The objective was to review the outcomes of endoscopic stapling of Zenker's diverticulum at this institution. In addition, a review of other UK departments was undertaken to formulate minimum clinical standards and recommendations of best practice. Review of patient case notes and a structured search of PubMed were used as materials. Fifteen retrospective case series were identified from the literature search which fulfilled the inclusion criteria. Fifty-one patients were identified from the present audit. When these were added to the review, a total of 585 patients were available for meta-analysis. 540 (92.3%) were successfully stapled. Forty-five (7.7%) procedures were abandoned intra-operatively. The most common reason was difficulty assessing the small pouch. The majority of patients (92%) had resumed oral intake by the second post-operative day. Most patients (87%) were discharged by the second post-operative day. Outcomes were good with over 90% reporting resolved or significantly improved symptoms. Minor complications included dental trauma, transient hoarseness and sore throat causing delayed resumption of oral intake. The overall perforation rate was 4.8%. One death was reported. In conclusion endoscopic stapling of pharyngeal pouch is a safe procedure that is associated with good outcomes and low complication rates. No death has been reported since 2000 in the UK. The data presented in this review represent current clinical standards reported over the past 15 years by UK departments and serve as a useful benchmark for any future audits undertaken.

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“…Severe dysphagia indicates a requirement for feeding tube placement. Moderate dysphagia can be relieved by such procedures as cervical oesophageal balloon dilatation, 8 cricopharyngeal myotomy 9 , 10 and laryngeal elevation 11 . However, severe oropharyngeal dysphagia is difficult to ameliorate, even using laryngotracheal closure 12 or laryngectomy; patients with severe trismus and bilateral hypoglossal nerve palsy are especially difficult to treat.…”

Section: Discussionmentioning

confidence: 99%

Cervical oesophagostomy in patients with severe dysphagia following radiotherapy for nasopharyngeal carcinoma

et al. 2014

J. Laryngol. Otol.

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Objective:This study aimed to investigate the validity and feasibility of cervical oesophagostomy as a treatment for patients with severe dysphagia after radiotherapy for nasopharyngeal carcinoma.Methods:The study retrospectively analysed the clinical data, symptoms, physical signs, treatment and outcomes of 12 patients treated with cervical oesophagostomy for severe dysphagia after radiotherapy for nasopharyngeal carcinoma, from 2006 to 2010.Results:In all 12 cases, the oesophageal stoma remained stable, without any complications such as pharyngeal fistula or inflammation. No oesophageal stricture or granuloma growth was observed. All patients reported significant improvement in their nutritional status and quality of life after the oesophagostomy surgery.Conclusion:Cervical oesophagostomy is a valid and feasible method of treating severe dysphagia following radiotherapy for nasopharyngeal carcinoma. Oesophagostomy shows specific advantages over nasogastric tubing, gastrostomy and jejunostomy. Patients' nutrition and quality of life can be improved significantly if cervical oesophagostomy is executed in a timely fashion, especially in cases with severe trismus and multiple radiation-induced cranial nerve palsies unresponsive to rehabilitation.

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Effect of cricopharyngeus muscle surgery on the pharynx

Abstract: Relief of CP obstruction by surgery or dilation improves pharyngeal constriction and PES opening. Dilation of the pharynx possibly related to prolonged outlet obstruction does not improve. CP myotomy appears more effective than dilation or botulinum toxin in relieving obstruction.

Cited by 34 publications

References 26 publications

Assessment of videofluoroscopic swallow study findings before and after cricopharyngeal myotomy

Assessment of videofluoroscopic swallow study findings before and after cricopharyngeal myotomy

Endoscopic stapling of Zenker’s diverticulum: establishing national baselines for auditing clinical outcomes in the United Kingdom

Cervical oesophagostomy in patients with severe dysphagia following radiotherapy for nasopharyngeal carcinoma

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