Targeted use of endoscopic CO2 laser cricopharyngeal myotomy for improving swallowing function following head and neck cancer treatment.
BACKGROUND
Cricopharyngeal dysfunction following head and neck cancer treatment may lead to a significant reduction in oral intake. Carbon dioxide laser is an established procedure for the treatment of non-malignant cricopharyngeal disorders. We report our experience of laser cricopharyngeal myotomy with objective swallowing outcome measures, before and after treatment.


METHODS
We identified 11 patients who had undergone carbon dioxide laser cricopharyngeal myotomy for dysphagia following radiotherapy, with or without chemotheraphy between January 2006 and July 2011. We analysed the swallowing outcomes following carbon dioxide laser cricopharyngeal myotomy by retrospective grading of pre- and post-procedure videofluoroscopic swallowing study of liquids, using the validated Modified Barium Swallow Impairment Profile.


RESULTS
The median Modified Barium Swallow Impairment Profile score was 13 pre-myotomy and 10 post-myotomy. This difference between scores was non-significant (p = 0.41). The median, cricopharyngeal-specific Modified Barium Swallow Impairment Profile variables (14 and 17) improved from 3 to 2, but were similarly non-significant (p = 0.16). We observed the improved Modified Barium Swallow Impairment Profile scores post-procedure in the majority of patients.


CONCLUSIONS
Endoscopic carbon dioxide laser cricopharyngeal myotomy remains a viable option in treatment-related cricopharyngeal dysfunction; its targeted role requires further prospective study. Objective analysis of the technique can be reported using the validated Modified Barium Swallow Impairment Profile.
ENT Department,Sunderland Royal Hospital,UK.
N
N
Dawe
Speech and Language Therapy Department,Sunderland Royal Hospital,UK.
J
J
Patterson
ENT Department,Sunderland Royal Hospital,UK.
D
D
Hamilton
ENT Department,Sunderland Royal Hospital,UK.
C
C
Hartley
D000368:Aged; D000369:Aged, 80 and over; D003413:Cricoid Cartilage / Q000473:pathology / Q000601:surgery*; D003680:Deglutition Disorders / Q000209:etiology / Q000473:pathology / Q000503:physiopathology / Q000601:surgery*; D004724:Endoscopy / Q000379:methods; D005260:Female; D005355:Fibrosis; D006258:Head and Neck Neoplasms / Q000188:drug therapy* / Q000473:pathology / Q000532:radiotherapy*; D006801:Humans; D054020:Lasers, Gas / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D010609:Pharyngeal Muscles / Q000473:pathology / Q000601:surgery*; D011832:Radiation Injuries / Q000209:etiology / Q000503:physiopathology / Q000601:surgery*; D012189:Retrospective Studies