Posterior Cricoid Region Fluoroscopic Findings: The Posterior Cricoid Plication

Abstract

The region posterior to the cricoid cartilage is challenging to assess fluoroscopically. The purpose of this investigation is to critically evaluate the posterior cricoid (PC) region on fluoroscopy and describe patterns of common findings. This was a case control study. All fluoroscopic swallowing studies performed between June 16, 2009, and February 9, 2010, were reviewed for features seen in the PC region. These findings were categorized into distinct patterns and compared to fluoroscopic studies performed in a cohort of normal volunteers. Two hundred patient studies and 149 healthy volunteer studies were reviewed. The mean age of the referred patient cohort and the volunteer cohort was 57 years (±19) and 61 years (±16), respectively (p > 0.05). The patient cohort was 53% male and the control cohort was 56% female (p > 0.05). Four groups were identified. Pharyngoesophageal webs were seen in 7% (10/149) of controls and 14% (28/200) of patients (p = 0.03). A PC arch impression was seen in 16% of patients (32/200) and controls (24/149) (p = 1). A PC plication was demonstrated in 23% (34/149) of controls and 30% (60/200) of patients (p = 0.13). No distinctive PC region findings were seen in 54% (81/149) of controls and 42% (84/200) of referred patients (p = 0.02). Four patients (2%) had both a web and a PC plication. Four categories of PC region findings were identified (unremarkable PC region, web, PC arch impression, and PC plication). Both patients referred for swallowing studies and healthy volunteers demonstrated esophageal webs, PC arch impressions, and PC plications. Only webs were more common in patients than in control subjects (p = 0.03). The PC impression and PC plication are likely to represent normal variants that may be identified on fluoroscopic swallow studies.

Maximum upper esophageal sphincter (UES) admittance: a non‐specific marker of UES dysfunction

“…Posterior pharyngeal impressions (typically termed CPBs) occur at similar rates in elderly patients with dysphagia and healthy volunteers. 32 No radiology data are available for our control subjects, as this was not clinically indicated. However, it is conceivable that some of the asymptomatic elderly individuals may have had an undiagnosed CP bar, which may become clinically significant as swallowing functional reserve diminishes further with age.…”

“…Posterior pharyngeal impressions (tepically rmed cricopharyngeal bars) occur at similar rates in elderly patients with dysphagia and healthy volunteers [32]. No radiology data are available for our control subjects, as this was not clinically indicated.…”

The “Postcricoid Cushion”

“…Evidence for this effect is found in the radiologic literature, where there are consistent descriptions of a ridge of tissue, distinct from the arch of the cricoid cartilage, which forms an impression or plication in the postcricoid region on esophagram. [25][26][27][28][29] This is considered a normal anatomic finding corresponding to the postcricoid venous plexus seen on adult anatomical dissections and presumably to the postcricoid cushion as well. The normal plication is considered to be dynamically passive, being drawn into the esophageal inlet during the negative pressure phase of the hypopharyngeal swallow.…”

“…Allen et al 28 reviewed fluoroscopic swallowing evaluations in adults with and without dysphagia. They identified a posterior cricoid "plication," distinct from a web or cricoid arch impression, in a third of all patients, attributing it to prolapsing mucosal folds over the muscles of the postcricoid region.…”

The Upper Esophageal Sphincter is Not Round: A Pilot Study Evaluating a Novel, Physiology-Based Approach to Upper Esophageal Sphincter Dilation

“…Cricopharyngeus muscle dysfunction is responsible for 11% of visits to an outpatient swallowing center, and upper esoph-ageal webs are present in 14% of persons who present with dysphagia and in 7% of the general population. 2,3 One of the most common treatments of oropharyngeal dysphagia caused by UES stenosis, cricopharyngeus muscle dysfunction, or a cervical esophageal web is esophageal dilation.…”