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J Thorac Cardiovasc Surg 1997;113:233-241
© 1997 Mosby, Inc.

GENERAL THORACIC SURGERY

CRICOPHARYNGEAL MYOTOMY FOR NEUROGENIC OROPHARYNGEAL DYSPHAGIA

Supported by the Department of Surgery Research and Development fund, Hôtel-Dieu de Montréal.

Received for publication May 6, 1996 Revisions requested June 5, 1996; revisions received Sept. 13, 1996 accepted for publication Sept. 18, 1996. Address for reprints: Dr. André Duranceau, Department of Surgery, Hôtel-Dieu de Montréal, 3840, St-Urbain Montréal, Québec, Canada H2W 1T8.

Abstract

Background: Forty patients (18 women, 22 men) with incapacitating oropharyngeal dysphagia of neurologic origin underwent cricopharyngeal myotomy. The subjective and objective response to myotomy was analyzed retrospectively with a mean postoperative follow-up of 48 months (range 1 to 255 months).Results: Radiologic evidence of functional obstruction caused by incoordination and incomplete relaxation of the upper esophageal sphincter was significantly reduced. Manometric recordings of resting and closing pressures of the upper esophageal sphincter were also significantly altered by the myotomy. Resting pressures decreased from 65 to 18 mm Hg and closing pressures dropped from 69 to 22 mm Hg. The relaxation time and poor coordination at the level of the upper esophageal sphincter, observed in the preoperative period, persisted after the operation. Radionuclide emptying studies in which a single liquid bolus was used showed persistent hypopharyngeal stasis with a 20% retention of radioactive material at 120 seconds. Subjectively, 33 patients initially had frequent aspiration episodes. Twenty became free of symptoms after myotomy (p < 0.01) and in six others the symptoms were improved. Overall, seven patients claimed to be free of symptoms of dysphagia and no longer had pharyngo-oral or pharyngonasal regurgitations and aspirations after their operation. Twenty-three other patients had improvement in symptoms. Ten patients reported no change in symptoms. All of them either were unable to swallow voluntarily or had dysarthria when assessed before the operation. One retropharyngeal hematoma is the only postoperative complication recorded. The operative mortality was 2.5% (1/40).Conclusion: Cricopharyngeal myotomy palliates neurogenic oropharyngeal dysphagia in patients with intact oral-phase deglutition.

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