Manofluorographic and functional outcomes after endoscopic laser cricopharyngeal myotomy for cricopharyngeal bar.
OBJECTIVE
To investigate the manofluorographic and functional outcomes after endoscopic laser cricopharyngeal myotomy (ELCPM) for cricopharyngeal (CP) bar.


METHODS
Case series with chart review.


METHODS
Academic medical center.


METHODS
Review of patients undergoing ELCPM between 2001 and 2007 was undertaken to determine the demographic, clinical, and manofluorographic findings before and six months after surgery. Two groups were established according to pharyngeal driving pressures: normal pressure group (> 55 mm Hg) and low pressure group (< 55 mm Hg).


RESULTS
Fourteen patients underwent ELCPM for CP bar without a concomitant head and neck or Zenker's procedure. There were no major surgical complications. All 14 patients improved at least one stage on the Functional Outcome Swallowing Scale (FOSS) after surgery. There was a statistically significant decrease in the FOSS stages after surgery. Videofluoroscopy demonstrated a significant postoperative increase in the mean cross-sectional CP opening (CP-area) from 32.75 to 123.52 mm(2). Manofluorographic pressure recordings showed a significant postoperative decrease in the intrabolus pressure gradient across the cricopharyngeal region (IB-Gra) from 25.44 to 13.22 mm Hg. Despite significant overall results, the change in the IB-Gra showed no difference between the patient groups.


CONCLUSIONS
Subjective (FOSS) and objective manofluorographic (CP-area, IB-Gra) improvement in CP bar patients occurred after ELCPM. We suggest IB-Gra as a reliable objective indicator for patients who might benefit from ELCPM and as an appropriate parameter for follow-up after surgery. However, continued research on a larger patient population is required to enhance our understanding of CP bar and predictors of outcome after treatment of CP bar dysphagia.
Ozgursoy
Ozan B
OB
Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic Florida, Jacksonville, FL 32224, USA. Ozgursoy.Ozan@mayo.edu
Salassa
John R
JR
D000368:Aged; D000369:Aged, 80 and over; D003413:Cricoid Cartilage; D016099:Endoscopy, Gastrointestinal; D004947:Esophagus / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D005260:Female; D006801:Humans; D053685:Laser Therapy; D008297:Male; D008365:Manometry; D008875:Middle Aged; D010609:Pharyngeal Muscles / Q000601:surgery*; D010614:Pharynx / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D011859:Radiography; D012189:Retrospective Studies