Jw. Lim et al., EPIGLOTTIC POSITION AFTER CRICOTHYROIDOTOMY - A COMPARISON WITH TRACHEOTOMY, The Annals of otology, rhinology & laryngology, 106(7), 1997, pp. 560-562
Dysphagia is a known problem in patients with tracheotomy, but its ass
ociation with cricothyroidotomy is not well studied. The purpose of th
is study was to evaluate dysphagia in patients with cricothyroidotomy
and to determine if there is a reliable indicator of swallowing dysfun
ction in these patients. A review of charts for patients with modified
barium swallow studies conducted at the New York University Medical C
enter Swallowing Disorders Center yielded three groups of patients: pa
tients with cricothyroidotomy, patients with tracheotomy, and normal p
atients. There were 8 patients in each group. In all patients in the c
ricothyroidotomy group, there was a greater impairment of epiglottic d
isplacement, laryngeal elevation, and upper esophageal opening than in
the tracheotomy group. This problem with epiglottic displacement prod
uced susceptibility to laryngeal penetration and, in turn, increased t
he risk of aspiration in those patients with cricothyroidotomy. After
cricothyroidotomy tube removal, a return to normal epiglottic movement
was observed within 2 months. One mechanism of swallowing dysfunction
is impaired posterior displacement of the epiglottis over the glottic
aperture. This impaired epiglottic motion appears to be related to re
stricted laryngeal elevation secondary to tethering of the larynx ante
riorly at the site of the cricothyroidotomy. Additionally, we noted a
decrease in the opening of the upper esophageal sphincter.