Pharyngoesophageal dysfunctions. The role of cricopharyngeal myotomy
L. Bonavina, N. A. Khan and T. R. DeMeester
Eighteen patients were evaluated for primary symptoms of cervical dysphagia
and/or laryngeal aspiration and subsequently had a cricopharyngeal myotomy.
Twelve patients had a neurologic lesion as the cause of the symptoms. Four
patients had a Zenker's diverticulum as demonstrated by barium contrast
roentgenograms. Two patients complained of persistent suprasternal
dysphagia following one or more antireflux repairs for gastroesophageal
reflux disease. Esophageal manometry identified a pharyngoesophageal motor
disorder in all but four patients, two of the four with Zenker's
diverticulum and the two who had an antireflux procedure. The results show
that cricopharyngeal myotomy should be reserved for patients with an
identifiable motor disorder confined to the pharyngeal phase of swallowing,
ie, failure of the pharyngeal pump or cricopharyngeal incoordination and/or
incomplete relaxation. Exceptions to this rule are as follows: Zenker's
diverticulum, in which an abnormality may not always be detected but of
which the results of surgery demonstrate the effectiveness of this
procedure; and pharyngoesophageal complaints associated with reflux, most
of which resolve with the restoration of distal esophageal sphincter
competence. In those few patients in whom these conditions persist, a
cricopharyngeal myotomy may be beneficial. Caution should be used in
applying the procedure to individuals who have had multiple antireflux
repairs.
