CRICOPHARYNGEAL MYOTOMY FOR NEUROGENIC OROPHARYNGEAL DYSPHAGIA

Background: Forty patients (18 women, 22 men) with incapacitating orop haryngeal dysphagia of neurologic origin underwent cricopharyngeal myo tomy, The subjective and objective response to myotomy was analyzed re trospectively with a mean postoperative follow-up of 48 months (range 1 to 255 months). Results: Radiologic evidence of functional obstructi on caused by incoordination and incomplete relaxation of the upper eso phageal sphincter was significantly reduced, Manometric recordings of resting and closing pressures of the upper esophageal sphincter were a lso 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 e sophageal sphincter, observed in the preoperative period, persisted af ter the operation. Radionuclide emptying studies in which a single liq uid bolus was used showed persistent hypopharyngeal stasis with a 20% retention of radioactive material at 120 seconds, Subjectively, 33 pat ients initially had frequent aspiration episodes. Twenty became free o f symptoms after myotomy (p < 0.01) and in six others the symptoms wer e improved. Overall, seven patients claimed to be free of symptoms of dysphagia and no longer had pharyngo-oral or pharyngonasal regurgitati ons and aspirations after their operation, Twenty-three other patients had improvement in symptoms, Ten patients reported no change in sympt oms, All of them either were unable to swallow voluntarily or had dysa rthria when assessed before the operation. One retropharyngeal hematom a is the only postoperative complication recorded, The operative morta lity was 2.5% (1/40), Conclusion: Cricopharyngeal myotomy palliates ne urogenic oropharyngeal dysphagia in patients with intact oral-phase de glutition.