Efficacy of adjunctive cricopharyngeus myotomy in supraglottic laryngectomy

This study investigates prospectively the effect of concurrent cricopharyng eus myotomy (CPM) on swallowing following horizontal supraglottic laryngect omy (SL) using fiberoptic, radiographic, and manometric evaluations and sug gests possible mechanisms regarding the role of CPM following SL. Six patie nts undergoing horizontal SL between 1995 and 1997 were enrolled in a prosp ective evaluation with a followup of 0.5-2.25 years. Three patients underwe nt concurrent CPM and three did not. Fiberoptic, radiographic, and manometr ic assessments were performed postoperatively. Although mean resting pressu res at the upper esophageal sphincter were reduced significantly by myotomy (12 mm Hg) compared with nonmyotomized patients (57 mm Hg), p < 0.01, no r ehabilitative advantage was observed in the former group. In fact, of the m yotomized patients, two required feeding gastrostomy tubes with resumption of an oral diet in one year and in two months, respectively, while the nonm yotomized patients were all capable of resuming a full oral diet within fou r weeks. It appears that CPM provides no rehabilitative advantage in patien ts undergoing SL.