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Videofluoroscopic swallow studies in unilateral cricopharyngeal dysfunction
Stacey L Halum1, Albert L Merati, Judith I Kulpa
1Department of Otolaryngology and Communicative Sciences, Medical College of Wisconsin, Milwaukee 53226, USA.
The Laryngoscope
|June 5, 2003
Summary
Unilateral cricopharyngeal dysfunction can cause dysphagia. Videofluoroscopic swallow studies, particularly posterior-anterior views, can identify this condition, often linked to vagal nerve injury, with myotomy providing effective treatment.
Area of Science:
- Otolaryngology
- Neurology
- Gastroenterology
Background:
- Unilateral cricopharyngeal dysfunction, though uncommon, can lead to significant dysphagia.
- This condition is not well-documented in existing literature.
- Dysphagia can be associated with vagal nerve injury.
Purpose of the Study:
- To identify characteristic videofluoroscopic swallow study (VFSS) findings in patients with unilateral cricopharyngeal dysfunction.
- To investigate the association between unilateral cricopharyngeal dysfunction and vagal nerve injury.
- To evaluate the outcomes of ipsilateral cricopharyngeal myotomy for dysphagia.
Main Methods:
- Retrospective clinical investigation.
- Review of patient charts, electromyography (EMG), videostroboscopy, and VFSS.
- Analysis of findings on posterior-anterior (PA) view VFSS for unilateral cricopharyngeal dysfunction.
- Assessment of outcomes following ipsilateral cricopharyngeal myotomy.
Main Results:
- Eighteen patients exhibited unilateral cricopharyngeal dysfunction on PA view VFSS, characterized by a unilateral shelf-like barrier and ipsilateral pyriform sinus pooling.
- Fourteen of these patients had histories suggestive of vagal nerve injury (trauma, neoplastic, iatrogenic, CNS disease).
- Vocal fold motion impairment was observed in 14 patients; EMG confirmed unilateral vagal or superior laryngeal nerve injuries in affected individuals.
- Fifteen patients underwent ipsilateral cricopharyngeal myotomy, with 14 experiencing functional resolution of dysphagia.
Conclusions:
- Dysphagia associated with unilateral vagal injury warrants careful VFSS assessment, including the PA view.
- The PA view of VFSS is crucial for detecting unilateral cricopharyngeal dysfunction.
- Ipsilateral cricopharyngeal myotomy is an effective treatment for dysphagia caused by unilateral cricopharyngeal dysfunction.