Hypopharyngeal diverticulum and the cricopharyngeus muscle: a posterior surgical approach

Hypopharyngeal diverticulum and dysphagia due to cricopharyngeus muscle dysfunction are a continuing challenge to the head and neck surgeon. The ability to completely transect the cricopharyngeus muscle is generally agreed to be the key to successful relief of symptoms, and--to an even greater extent--to prevention of recurrence. In the past, the most significant complications arising from such surgery have been recurrent laryngeal nerve injury and recurrent diverticulum or cricopharyngeus spasm. Both of these problems have been prevented by a modified surgical approach which takes advantage of the relatively bloodless retropharyngeal space. The logic of this posterior approach to the cricopharyngeus, from an anatomic standpoint, coupled with the good visualization and relatively bloodless field when approaching the muscle, suggests that it might be a suitable substitute for the more common lateral approach if continued long-term experience in larger number of cases does not lead to significant complications.