Cricopharyngeal myotomy

Cricopharyngeal Myotomy is a surgical procedure aimed at treating dysphagia (difficulty swallowing) by cutting the cricopharyngeus muscle, which is part of the upper esophageal sphincter. This procedure is typically considered when there is a dysfunction or abnormal relaxation of the cricopharyngeus muscle, leading to swallowing difficulties.

Indications

Cricopharyngeal myotomy is primarily indicated for patients suffering from Zenker's diverticulum, a condition characterized by the formation of a pouch in the pharyngeal mucosa, which can collect food and cause dysphagia, bad breath, and risk of aspiration. It is also indicated in cases of cricopharyngeal spasm, achalasia of the upper esophageal sphincter, and other conditions leading to symptomatic dysphagia due to cricopharyngeal dysfunction.

Procedure

The procedure can be performed using either an open surgical approach or endoscopically. The choice of technique depends on the patient's specific condition, the presence of other esophageal or pharyngeal abnormalities, and the surgeon's expertise.

Open Cricopharyngeal Myotomy

In the open approach, an incision is made in the neck, and the cricopharyngeus muscle is exposed. The muscle is then cut, relieving the constriction at the upper esophageal sphincter. This approach may be combined with the removal of a Zenker's diverticulum if present.

Endoscopic Cricopharyngeal Myotomy

The endoscopic approach involves using a flexible or rigid endoscope inserted through the mouth. Specialized instruments are used to cut the cricopharyngeus muscle internally, without the need for external incisions. This method is less invasive and may have a shorter recovery time.

Risks and Complications

As with any surgical procedure, cricopharyngeal myotomy carries risks, including infection, bleeding, and damage to surrounding structures such as the esophagus and recurrent laryngeal nerve. There is also a risk of perforation, which can lead to mediastinitis, a serious infection of the mediastinum.

Recovery

Postoperative care involves a temporary modified diet to allow healing of the esophagus. Patients may also require speech and swallowing therapy to adapt to the changes in the swallowing mechanism and ensure safe and effective swallowing.

Outcomes

Cricopharyngeal myotomy has been shown to significantly improve swallowing function in patients with dysphagia due to cricopharyngeal dysfunction. Most patients experience a reduction in symptoms and an improved quality of life.

See Also

• Dysphagia
• Zenker's Diverticulum
• Esophageal Achalasia
• Esophageal Sphincter