Title:
Ins and outs of myotomy of the upper oesophageal sphincter in swallowing disorders
Authors:
G . Lawson and M. Remacle
Institutions:
Department of Otorhinolaryngology, Head & Neck Surgery, University Hospital of Louvain at Mont-Godinne, UCL, Belgium
Keywords:
Upper oesophageal dysfunction; endoscopic laser-assisted cricopharyngeal myotomy; cricopharyngeal dys- motility; dysphagia; C2laser
Pages:
83 - 89
Abstract:
Ins and outs of myotomy of the upper oesophageal sphincter in swallowing disorders. Objectives: Upper oesophageal dysfunction generally leads to severe dysphagia and aspiration. Several treatment modalities are available: dilatation, external myotomy of the cricopharyngeal muscle, local infiltration with botulinum toxin, and endoscopic transmucosal myotomy using a CO 2aser. The aim of this study is to assess the outcome of trans-oral cricopharyngeal myotomy in three groups of patients suffering from upper oesophageal sphincter dysfunction. Method: We retrospectively evaluated a group of 31 patients with upper oesophageal dysfunction (10 neurological dis- eases, 8 after chemoradiation, 12 failure of cricopharyngeal relaxation), all of whom were treated with endoscopic laser- assisted myotomy.A minimum follow-up of one year was required before inclusion in this study. Preoperative and post- operative assessments included videofluoroscopic and flexible endoscopic evaluations of the swallow as well as patients’ subjective ratings for dysphagia and aspiration. These investigations and self-assessments were rated from 0 (poor or abnormal) to 4 (good or normal). Results: The trans-oral approach was feasible without complications in all patients. Symptoms improved in most patients. There was no recurrence in the group of cricopharyngeal muscle relaxation failure; 5 out of 8 patients in the irradiation group suffered recurrence, as did 4 out of 10 neurological patients. Conclusions: Endoscopic laser-assisted cricopharyngeal myotomy seems to be a safe and effective technique for treating upper oesophageal dysfunction. However, complex pathology involving more than cricopharyngeal muscle leads to a high recurrence rate.
Issue:
Suppl. 10, 2008


Download:
Ins and outs of myotomy of the upper oesophageal sphincter in swallowing disorders