The Prevalence of Cricopharyngeal Webs in Elderly Cadavers

Abstract

Objective Cricopharyngeal webs (CPW) are a frequent cause of solid food dysphagia. They are difficult to diagnose and are often missed on swallowing fluoroscopy. The prevalence of CPWs is uncertain. The purpose of this study was to determine the prevalence of CPWs in elderly cadavers. Methods Direct laryngoscopy and cervical esophagoscopy were performed in 19 embalmed cadavers by independent two‐clinician consensus. Cadaver demographics and the presence and laterality of a CPW were recorded. The prevalence of CPW was calculated, and the size of the cricopharyngeus muscle (CPM) was quantified. Results The mean age of the cohort was 83 ( ± 12) years. Fifty‐three percent were female, and the mean body mass index was 19.7 ( ± 3). The causes of death were cardiovascular disease (10 of 19), cancer (5 of 19), and respiratory failure (4 of 19). A CPW was present in 68% (13 of 19) of cadavers. Forty‐seven percent (9 of 19) had a unilateral web, and 21% (4 of 19) had a bilateral web. There was no laterality predominance (P > 0.05). Forty‐two percent (8 of 19) had no CPM prominence; 32% (6 of 19) had a small/moderate CPM prominence; and 26% (5 of 19) had a significant CPM prominence. Conclusion The prevalence of cricopharyngeal webs in elderly cadavers is high (68%). The clinician should maintain a high index of suspicion for CPWs in patients with no other identifiable etiology of solid food dysphagia. Level of Evidence 3b Laryngoscope, 129:63–66, 2019

Three‐dimensional analysis of the human pharyngoesophageal sphincter

“…19,20 Increased radiographic resolution is thought to identify a larger number of webs and physical obstructions, although we expect anatomic studies represent the gold standard given better tissue-level resolution and evaluation. 18,20 We did not have enough available cadavers to provide a population-level analysis by PES casting; however, we expect we would find similarly higher numbers than the reported radiologic studies.…”

“…These webs are well‐known entities, although the clinical significance of them is difficult to evaluate given an underappreciation in the general population and up to 15% among patients reporting dysphagia based on radiographic studies 19–20 . Increased radiographic resolution is thought to identify a larger number of webs and physical obstructions, although we expect anatomic studies represent the gold standard given better tissue‐level resolution and evaluation 18,20 . We did not have enough available cadavers to provide a population‐level analysis by PES casting; however, we expect we would find similarly higher numbers than the reported radiologic studies.…”

“…3) or a hypopharyngeal web. Recent work by Mehdizadeh et al (2019) identified that a high proportion of cadavers had PES webs (68%), indicating this is a common occurrence that likely increases with age as a result of the microtrauma caused by the tens of millions of swallows over a lifetime 18 . These webs are well‐known entities, although the clinical significance of them is difficult to evaluate given an underappreciation in the general population and up to 15% among patients reporting dysphagia based on radiographic studies 19–20 .…”

“…Recent work by Mehdizadeh et al (2019) identified that a high proportion of cadavers had PES webs (68%), indicating this is a common occurrence that likely increases with age as a result of the microtrauma caused by the tens of millions of swallows over a lifetime. 18 These webs are well-known entities, although the clinical significance of them is difficult to evaluate given an underappreciation in the general population and up to 15% among patients reporting dysphagia based on radiographic studies. 19,20 Increased radiographic resolution is thought to identify a larger number of webs and physical obstructions, although we expect anatomic studies represent the gold standard given better tissue-level resolution and evaluation.…”

Fluoroscopic Swallowing Abnormalities in Dysphagic Patients Following Anterior Cervical Spine Surgery

“…A cricopharyngeal web was defined as a protrusion on the posterior hypopharyngeal wall with a corresponding projection on the back of the cricoid seen on the lateral fluoroscopic view. 20 Cricopharyngeal bars were defined as distinct posterior indentation, apart from osteophytes or hardware, at the pharyngoesophageal segment between cervical vertebrae 3 and 6, observed in the lateral view. 21 Traction diverticula were also noted and were defined as pharyngoesophageal diverticula located in the cervical region instrumented during ACSS, by definition these traction diverticula only occur in patients whose cervical esophagus have been instrumented, in contrast to the more common pulsion Zenker’s diverticula.…”