Cricopharyngeus Muscle Myotomy
A cricopharyngeus muscle myotomy is a procedure in which the cricopharyngeus muscle is cut to improve swallowing.
Indications/Contraindications
Cricopharyngeal dysfunction (hyperfunction) contributing to dysphagia, globus pharyngeus, or diverticulum. Cricopharyngeal dysfunction may be caused by scarring, cancer, or neurogenic processes.
Cricopharyngeal myotomy may be performed in conjunction with a total laryngectomy.
Extensive esophageal reflux is a contraindication since it may allow undesired reflux of gastric contents into the laryngopharynx, putting the patient at risk for aspiration pneumonia.
In the Clinical Setting
Key Point
Careful endoscopic assessment of the esophageal inlet should always be performed to rule out neoplasm or other non-muscular causes of dysfunction, such as scarring.
Pitfall
Presence of a prominent bar on fluoroscopy is not itself an indication for myotomy; esophageal function should always be assessed to ensure that severe reflux or esophageal dysmotility has not caused compensatory cricopharyngeal prominence. The cricopharyngeus muscle must be obstructive and there must be adequate pharyngeal strength and laryngeal elevation present for the myotomy to be of any benefit. This is assessed with a combination of videofluoroscopy and pharyngeal and upper esophageal sphincter manometry.
From a Technical Perspective
Key Point
To be most effective, the cricopharyngeal myotomy should be full thickness along the entire length of the muscle, at least 2–4 cm in length.
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