Skip to main content
PMC home page
Annals of Surgery logoLink to Annals of Surgery
. 1981 Sep;194(3):279–289. doi: 10.1097/00000658-198109000-00005

Cervical esophageal dysphagia: indications for and results of cricopharyngeal myotomy.

F H Ellis Jr, R E Crozier
PMCID: PMC1345350  PMID: 6791598

Abstract

Twenty patients with cervical esophageal dysphagia were treated by cricopharyngeal myotomy. Of these 20 patients, ten had pharyngoesophageal diverticula, four had a hypertensive upper esophageal sphincter (UES), four had bulbar palsy, and two has miscellaneous forms of cricopharyngeal dysfunction. Preoperative esophageal manometric examination revealed mean UES pressures of 37.2 mmHg +/- 4.8 SEM in patients with diverticula-markedly lower (p = 0.01) than in normal patients (55.9 mmHg +/- 5.0 SEM). In patients with hypertensive UES the mean pressure was 166.2 mmHg +/- 13.4, significantly higher (p less than 0.001) than normal. Incoordination of the deglutitive response of the UES characterised by premature relaxation and contraction was present in all patients with diverticula and in one other patient. Another patient exhibited incomplete sphincteric relaxation (achalasia). A 4-5 cm myotomy of the cricopharyngeus muscle and adjacent esophageal muscle was performed in all patients. On the patients with diverticula two also had diverticulectomy. No patient with bulbar palsy was benefited. All other patients were relieved of dysphagia by the operation, with the exception of one patient with a diverticulum. A subsequent diverticulectomy was required in this patient. Postoperative manometric examination revealed an average decrease in UES pressure of 63% and an average decreased in length of the high pressure zone of 1.4 cm.

Full text

PDF
280

Images in this article

280Fig. 1.
on p.280
281Fig. 2.
on p.281
281Fig. 3.
on p.281
284Fig. 6.
on p.284
285Fig. 7.
on p.285
285Fig. 8.
on p.285

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. ASHERSON N. Achalasia of the cricopharyngeal sphincter; a record of case, with profile pharyngograms. J Laryngol Otol. 1950 Dec;64(12):747–758. doi: 10.1017/s0022215100012755. [DOI] [PubMed] [Google Scholar]
  2. Akl B. F., Blakeley W. R. Late assessment of results of cricopharyngeal myotomy for cervical dysphagia. Am J Surg. 1974 Dec;128(6):818–822. doi: 10.1016/0002-9610(74)90078-6. [DOI] [PubMed] [Google Scholar]
  3. Berte L. E., Winans C. S. Lower-esophageal sphincter function does not determine resting upper-esophageal sphincter pressure. Am J Dig Dis. 1977 Oct;22(10):877–880. doi: 10.1007/BF01076163. [DOI] [PubMed] [Google Scholar]
  4. Borrie J., Wilson R. L. Oesophageal diverticula: principles of management and appraisal of classification. Thorax. 1980 Oct;35(10):759–767. doi: 10.1136/thx.35.10.759. [DOI] [PMC free article] [PubMed] [Google Scholar]
  5. Calcaterra T., Kadell B. M., Ward P. H. Dysphagia secondary to cricopharyngeal muscle dysfunction, Surgical Management. Arch Otolaryngol. 1975 Dec;101(12):726–729. doi: 10.1001/archotol.1975.00780410018004. [DOI] [PubMed] [Google Scholar]
  6. DOHLMAN G., MATTSSON O. The endoscopic operation for hypopharyngeal diverticula: a roentgencinematographic study. AMA Arch Otolaryngol. 1960 May;71:744–752. doi: 10.1001/archotol.1960.03770050004002. [DOI] [PubMed] [Google Scholar]
  7. Duranceau A., Forand M. D., Fauteux J. P. Surgery in oculopharyngeal muscular dystrophy. Am J Surg. 1980 Jan;139(1):33–39. doi: 10.1016/0002-9610(80)90226-3. [DOI] [PubMed] [Google Scholar]
  8. Duranceau A., Jamieson G., Hurwitz A. L., Jones R. S., Postlethwait R. W. Alteration in esophageal motility after laryngectomy. Am J Surg. 1976 Jan;131(1):30–35. doi: 10.1016/0002-9610(76)90416-5. [DOI] [PubMed] [Google Scholar]
  9. Ellis F. H., Jr, Leonardi H. K., Dabuzhsky L., Crozier R. E. Surgery for short esophagus with stricture: an experimental and clinical manometric study. Ann Surg. 1978 Sep;188(3):341–350. doi: 10.1097/00000658-197809000-00009. [DOI] [PMC free article] [PubMed] [Google Scholar]
  10. Ellis F. H., Jr, Schlegel J. F., Lynch V. P., Payne W. S. Cricopharyngeal myotomy for pharyngo-esophageal diverticulum. Ann Surg. 1969 Sep;170(3):340–349. doi: 10.1097/00000658-196909010-00004. [DOI] [PMC free article] [PubMed] [Google Scholar]
  11. Helsper J. T., Lance J. S., Baldridge E. T., Vap J. G. Cricopharyngeal achalasia. Am J Surg. 1974 Oct;128(4):521–526. doi: 10.1016/0002-9610(74)90266-9. [DOI] [PubMed] [Google Scholar]
  12. Henderson R. D., Marryatt G. Cricopharyngeal myotomy as a method of treating cricopharyngeal dysphagia secondary to gastroesophageal reflux. J Thorac Cardiovasc Surg. 1977 Nov;74(5):721–725. [PubMed] [Google Scholar]
  13. Hiebert C. A. Surgery for cricopharyngeal dysfunction under local anesthesia. Am J Surg. 1976 Apr;131(4):423–427. doi: 10.1016/0002-9610(76)90151-3. [DOI] [PubMed] [Google Scholar]
  14. Hoehn J. G., Payne W. S. Resection of pharyngoesophageal diverticulum using stapling device. Mayo Clin Proc. 1969 Oct;44(10):738–741. [PubMed] [Google Scholar]
  15. Hunt P. S., Connell A. M., Smiley T. B. The cricopharyngeal sphincter in gastric reflux. Gut. 1970 Apr;11(4):303–306. doi: 10.1136/gut.11.4.303. [DOI] [PMC free article] [PubMed] [Google Scholar]
  16. Hurwitz A. L., Duranceau A. Upper-esophageal sphincter dysfunction. Pathogenesis and treatment. Am J Dig Dis. 1978 Mar;23(3):275–281. doi: 10.1007/BF01072329. [DOI] [PubMed] [Google Scholar]
  17. Hurwitz A. L., Nelson J. A., Haddad J. K. Oropharyngeal dysphagia Manometric and cine esophagraphic findings. Am J Dig Dis. 1975 Apr;20(4):313–324. doi: 10.1007/BF01237788. [DOI] [PubMed] [Google Scholar]
  18. Hurwitz A. L., Nelson J. A., Haddad J. K. Oropharyngeal dysphagia Manometric and cine esophagraphic findings. Am J Dig Dis. 1975 Apr;20(4):313–324. doi: 10.1007/BF01237788. [DOI] [PubMed] [Google Scholar]
  19. KAPLAN S. Paralysis of deglutition, a post-poliomyelitis complication treated by section of the cricopharyngeus muscle. Ann Surg. 1951 Apr;133(4):572–573. doi: 10.1097/00000658-195104000-00021. [DOI] [PMC free article] [PubMed] [Google Scholar]
  20. Kilman W. J., Goyal R. K. Disorders of pharyngeal and upper esophageal sphincter motor function. Arch Intern Med. 1976 May;136(5):592–601. [PubMed] [Google Scholar]
  21. Lebo C. P., U K. S., Norris F. H., Jr Cricopharyngeal myotomy in amyotrophic lateral sclerosis. Laryngoscope. 1976 Jun;86(6):862–868. doi: 10.1288/00005537-197606000-00013. [DOI] [PubMed] [Google Scholar]
  22. Lichter I. Motor disorder in pharyngoesophageal pouch. J Thorac Cardiovasc Surg. 1978 Aug;76(2):272–275. [PubMed] [Google Scholar]
  23. Mills C. P. Dysphagia in pharyngeal paralysis treated by cricopharyngeal sphincterotomy. Lancet. 1973 Mar 3;1(7801):455–457. doi: 10.1016/s0140-6736(73)91881-3. [DOI] [PubMed] [Google Scholar]
  24. Mitchell R. L., Armanini G. B. Cricopharyngeal myotomy: treatment of dysphagia. Ann Surg. 1975 Mar;181(3):262–266. doi: 10.1097/00000658-197503000-00003. [DOI] [PMC free article] [PubMed] [Google Scholar]
  25. Orringer M. B. Extended cervical esophagomyotomy for cricopharyngeal dysfunction. J Thorac Cardiovasc Surg. 1980 Nov;80(5):669–678. [PubMed] [Google Scholar]
  26. Siewert J. R., Blum A. L. The oesophagus. Part I: Surgery at the upper oesophageal sphincter, tubular oesophagus and lower oesophageal sphincter. Clin Gastroenterol. 1979 May;8(2):271–291. [PubMed] [Google Scholar]
  27. Smiley T. B., Caves P. K., Porter D. C. Relationship between posterior pharyngeal pouch and hiatus hernia. Thorax. 1970 Nov;25(6):725–731. doi: 10.1136/thx.25.6.725. [DOI] [PMC free article] [PubMed] [Google Scholar]
  28. Smith R. A., Norris F. H., Jr Symptomatic care of patients with amyotrophic lateral sclerosis. JAMA. 1975 Nov 17;234(7):715–717. [PubMed] [Google Scholar]
  29. Stanciu C., Bennett J. R. Upper oesophageal sphincter yield pressure in normal subjects and in patients with gastro-oesophageal reflux. Thorax. 1974 Jul;29(4):459–462. doi: 10.1136/thx.29.4.459. [DOI] [PMC free article] [PubMed] [Google Scholar]
  30. Watson W. C., Sullivan S. N. Hypertonicity of the cricopharyngeal sphincter: A cause of globus sensation. Lancet. 1974 Dec 14;2(7894):1417–1419. doi: 10.1016/s0140-6736(74)90074-9. [DOI] [PubMed] [Google Scholar]
  31. Welsh G. F., Payne W. S. The present status of one-stage pharyngo-esophageal diverticulectomy. Surg Clin North Am. 1973 Aug;53(4):953–958. doi: 10.1016/s0039-6109(16)40101-5. [DOI] [PubMed] [Google Scholar]
  32. Winans C. S. The pharyngoesophageal closure mechanism: a manometric study. Gastroenterology. 1972 Nov;63(5):768–777. [PubMed] [Google Scholar]
  33. Worman L. W. Pharyngoesophageal diverticulum--excision or incision? Surgery. 1980 Feb;87(2):236–237. [PubMed] [Google Scholar]

Articles from Annals of Surgery are provided here courtesy of Lippincott, Williams, and Wilkins

RESOURCES