First, it is becoming increasingly popular as a treatment for several otolaryngologic disorders, including spasmodic dysphonias, hemifacial spasms, facial wrinkles, and cricopharyngeal
The results of a video-fluoroscopic swallow study were normal (no evidence of a cricopharyngeal
bar), and pH probe testing was negative for pharyngeal and esophageal reflux.
1) His initial surgery had been performed 2 decades earlier; at that time, he underwent a cricopharyngeal
myotomy and suspension of the diverticulum superiorly to the cervical fascia (diverticulopexy).
A fiberoptic endoscopic evaluation of swallowing with sensory testing revealed pooling in the posterior glottis and pyriform sinuses with postswallow aspiration and evidence of outlet obstruction at the level of the cricopharyngeal
A fluoroscopic swallow evaluation detected hypertrophy of the cricopharyngeal
muscle (figure, A).
The patient was offered a laryngeal suspension, cricopharyngeal
myotomy, and neurorrhaphy of the great auricular and superior laryngeal nerves, but she declined for personal reasons.
portion of the upper esophagus was visualized by slowly removing the esophagoscope during insufflation.
4) The critical aspect of all endoscopic techniques is the accomplishment of a complete cricopharyngeal
3) Once the endolaryngeal and cricopharyngeal
mucosa are divided, mucosal flaps are created on either side of the incision with microscissors, and a double-layer closure is made with the sutures placed in a distal to proximal fashion.
Dysphagia related to cervical pathology can have multiple etiologies, including cricopharyngeal
muscle dysfunction, stricture, primary neoplasms, and extrinsic compression (e.
It arises from the K-J space, a muscular dehiscence inferior to the cricopharyngeal
muscle and lateral to the longitudinal muscle of the esophagus.
10) Other conditions that should be considered in the differential diagnosis are Zenker diverticulum, laryngocele, esophageal diverticulum, an artificial pouch, cricopharyngeal
spasm, foreign body, neurologic disease, myopathies, and globus hystericus.