Cricopharyngeal myotomy for neurogenic oropharyngeal dysphagia

N. C. Poirier, L. Bonavina, R. Taillefer, A. Nosadini, A. Peracchia, A. Duranceau, M. B. Orringer, R. J. Landreneau, N. Altorki

Research output: Contribution to journalArticle

24 Citations (Scopus)

Abstract

Background: Forty patients (18 women, 22 men) with incapacitating oropharyngeal dysphagia of neurologic origin underwent cricopharyngeal myotomy. The subjective and objective response to myotomy was analyzed retrospectively with a mean postoperative follow-up of 48 months (range 1 to 255 months). Results: Radiologic evidence of functional obstruction caused by incoordination and incomplete relaxation of the upper esophageal sphincter was significantly reduced. Manometric recordings of resting and closing pressures of the upper esophageal sphincter were also significantly altered by the myotomy. Resting pressures decreased from 65 to 18 mm Hg and closing pressures dropped from 69 to 22 mm Hg. The relaxation time and poor coordination at the level of the upper esophageal sphincter, observed in the preoperative period, persisted after the operation. Radionuclide emptying studies in which a single liquid bolus was used showed persistent hypopharyngeal stasis with a 20% retention of radioactive material at 120 seconds. Subjectively, 33 patients initially had frequent aspiration episodes. Twenty became free of symptoms after myotomy (p <0.01) and in six others the symptoms were improved. Overall, seven patients claimed to be free of symptoms of dysphagia and no longer had pharyngo-oral or pharyngonasal regurgitations and aspirations after their operation. Twenty-three other patients had improvement in symptoms. Ten patients reported no change in symptoms. All of them either were unable to swallow voluntarily or had dysarthria when assessed before the operation. One retropharyngeal hematoma is the only postoperative complication recorded. The operative mortality was 2.5% (1/40). Conclusion: Cricopharyngeal myotomy palliates neurogenic oropharyngeal dysphagia in patients with intact oral-phase deglutition.

Original languageEnglish
Pages (from-to)233-241
Number of pages9
JournalJournal of Thoracic and Cardiovascular Surgery
Volume113
Issue number2
DOIs
Publication statusPublished - 1997

Fingerprint

Deglutition Disorders
Upper Esophageal Sphincter
Deglutition
Pressure
Preoperative Period
Dysarthria
Ataxia
Radioisotopes
Hematoma
Nervous System
Mortality

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Surgery

Cite this

Poirier, N. C., Bonavina, L., Taillefer, R., Nosadini, A., Peracchia, A., Duranceau, A., ... Altorki, N. (1997). Cricopharyngeal myotomy for neurogenic oropharyngeal dysphagia. Journal of Thoracic and Cardiovascular Surgery, 113(2), 233-241. https://doi.org/10.1016/S0022-5223(97)70318-0

Cricopharyngeal myotomy for neurogenic oropharyngeal dysphagia. / Poirier, N. C.; Bonavina, L.; Taillefer, R.; Nosadini, A.; Peracchia, A.; Duranceau, A.; Orringer, M. B.; Landreneau, R. J.; Altorki, N.

In: Journal of Thoracic and Cardiovascular Surgery, Vol. 113, No. 2, 1997, p. 233-241.

Research output: Contribution to journalArticle

Poirier, NC, Bonavina, L, Taillefer, R, Nosadini, A, Peracchia, A, Duranceau, A, Orringer, MB, Landreneau, RJ & Altorki, N 1997, 'Cricopharyngeal myotomy for neurogenic oropharyngeal dysphagia', Journal of Thoracic and Cardiovascular Surgery, vol. 113, no. 2, pp. 233-241. https://doi.org/10.1016/S0022-5223(97)70318-0
Poirier, N. C. ; Bonavina, L. ; Taillefer, R. ; Nosadini, A. ; Peracchia, A. ; Duranceau, A. ; Orringer, M. B. ; Landreneau, R. J. ; Altorki, N. / Cricopharyngeal myotomy for neurogenic oropharyngeal dysphagia. In: Journal of Thoracic and Cardiovascular Surgery. 1997 ; Vol. 113, No. 2. pp. 233-241.
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