Effect of cricopharyngeus myotomy on postlaryngectomy pharyngeal contraction pressures

Abstract

After total laryngectomy, the cricopharyngeus muscle, when intact, appears to inhibit the free flow of saliva and secretions past the pharyngeal repair into the upper esophagus. The authors hypothesize that cricopharyngeus myotomy reduces sphincteric pressure, thereby diminishing forces against the pharyngeal suture line. Peak pharyngeal pressures were recorded in patients who underwent total laryngectomy with and without cricopharyngeus myotomy. In patients without concurrent myotomy, peak pharyngeal pressures were all greater than 60 mm Hg. With concurrent myotomy, peak pharyngeal pressures averaged less than 40 mm Hg. Concurrent myotomy carries with it the potential for minimizing postoperative fistulization, eliminating dysphagia of cricopharyngeus spasm, and improving the acquisition of alaryngeal speech.

Videostroboscopy of the pharyngoesophageal segment in total laryngectomees

“…Likewise, no appreciable difference in speech quality was noted when comparing vibratory free margin PES length (long vs. short) at rest and during phonation in the poor and effective speaking groups. These findings suggest that from a functional standpoint, the best PES vibrator may be one that is thinner with less mucosal redundancy, thus refuting a generally accepted concept that the more pharyngeal mucosa remaining for closure after a laryngectomy, the better the postoperative function for voicing 23–27 …”

“…Indeed, our study demonstrated a high correlation between those patients with good volitional neuromuscular control of the PES and better overall TEP voice proficiency. Based on these findings, it may be logical not to perform procedures designed to prevent spasm at the time of the laryngectomy or secondary TEP, as a number of these patients will probably never develop such symptoms 25,26 . Instead, these techniques may be better utilized after evaluating patients for evidence of difficulty with voice onset, phonatory breaks during speech, strained‐strangled or high‐pressured voice, inability to produce any phonation at all, combined with videostroboscopic documentation of PES spasm (e.g., decreased mucosal wave fluidity, vibratory asynchrony, and spasmodic‐tight vibratory activity).…”

Health‐Related Quality of Life in Patients With Laryngeal Cancer: A Post‐Treatment Comparison of Different Modes of Communication

“…The swallowing problems could partly be explained by the absence of a constrictor myotomy or an insufficient myotomy in the total laryngectomy procedure in these patients. As suggested by Horowitz et al, 21 cricopharyngeus myotomy reduces sphincteric pressure and eliminates dysphagia caused by cricopharyngeus spasm as well as improves the acquisition of alaryngeal speech.…”

The applicability of high resolution manometry in total laryngectomy

“…Regarding myotomy, some authors have observed that there is a decrease in the peak of pharyngeal pressure and a decrease in spasms and hypertonicity in total laryngectomy patients (16,17,18,19) . In our study, none of the patients underwent these procedures.…”