Videofluoroscopic findings in dysphagic patients with cricopharyngeal dysfunction: before and after open cricopharyngeal myotomy.
OBJECTIVE
Functional outcomes after open cricopharyngeal myotomy (CPM) for Zenker's diverticulum (ZD) and cricopharyngeal dysfunction without diverticulum (CPD) have not been uniformly measured by videofluorographic swallow study (VFSS). Here we characterize preoperative VFSS findings in these groups and evaluate the effect of CPM on swallowing via postoperative VFSS.


METHODS
We performed a retrospective review of paired preoperative and postoperative VFSS results from 50 patients (36 with ZD and 14 with CPD) over 6 years. Semiquantitative scales were used to assess 1) degree of stasis in the pharyngeal recesses; 2) degree of narrowing at the pharyngoesophageal sphincter (PES); 3) aspiration; and 4) diverticular size. Findings were compared between the groups and across subjects.


RESULTS
Pharyngeal stasis was more severe in subjects with CPD than in subjects with ZD, both before and after CPM (p = .02 and p = .0002, respectively). The CPM improved PES narrowing in both groups (p = .03; p = .06) and reduced diverticular size in the ZD group (p < .001), but it did not significantly reduce the stasis severity or the proportion of patients with aspiration.


CONCLUSIONS
According to VFSS, CPM opens up the PES and decreases diverticular size. More severe stasis in CPD suggests that diffuse pharyngeal weakness may play a role in this disease, and may partially explain the variable post-CPM outcomes that have been observed in CPD.
Muñoz
Amanda A
AA
Department of Otology and Laryngology, Harvard Medical School, Brigham and Women's Hospital, Boston, Massachusetts, USA.
Shapiro
Jo
J
Cuddy
Lorraine Downey
LD
Misono
Stephanie
S
Bhattacharyya
Neil
N
D000368:Aged; D003680:Deglutition Disorders / Q000000981:diagnostic imaging* / Q000503:physiopathology / Q000601:surgery*; D049631:Esophageal Sphincter, Upper / Q000000981:diagnostic imaging* / Q000503:physiopathology / Q000601:surgery*; D005260:Female; D005471:Fluoroscopy; D006801:Humans; D008297:Male; D053120:Respiratory Aspiration / Q000503:physiopathology / Q000601:surgery; D012189:Retrospective Studies; D012720:Severity of Illness Index; D016896:Treatment Outcome; D014741:Video Recording; D016672:Zenker Diverticulum / Q000000981:diagnostic imaging* / Q000503:physiopathology / Q000601:surgery*