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Updated: Dec 29, 2025
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Published on: August 11, 2023
Modified external approach to the pediatric cricopharyngeal myotomy: A case series
Asitha D L Jayawardena1, Lauren E Miller1, Lara Hirner2
1Massachusetts Eye and Ear Infirmary, Department of Otolaryngology Head and Neck Surgery, Boston, MA, USA.
Insights
A modified pediatric cricopharyngeal myotomy improved swallowing function in 86% of young patients with upper esophageal sphincter issues. This modified external approach shows promise as a safe and effective treatment for pediatric cricopharyngeal achalasia.
Area of Science:
- Pediatric surgery
- Gastroenterology
- Swallowing disorders
Background:
- Inappropriate upper esophageal sphincter (UES) relaxation causes dysphagia in children.
- Current treatment options may have limitations.
Purpose of the Study:
- To evaluate the efficacy and safety of a modified external cricopharyngeal myotomy in pediatric patients.
- To assess outcomes using video fluoroscopic swallow study (VFSS) and manometry.
Main Methods:
- A case series of 7 pediatric patients undergoing the modified procedure between 2017-2019.
- Primary outcomes included post-operative diet and aspiration/penetration on VFSS.
- UES pressures were measured using pediatric manometry.
Main Results:
- 86% of patients showed improved swallowing function post-surgery.
- No complications were observed during or after the procedure.
- A significant decrease in UES residual and mean pressures was noted.
Conclusions:
- The modified external approach is a safe and efficient procedure for pediatric cricopharyngeal myotomy.
- Further long-term studies are required to confirm efficacy in treating pediatric cricopharyngeal achalasia.
Objective:
To assess the success of a modified approach to external pediatric cricopharyngeal myotomy in children with inappropriate upper esophageal sphincter relaxation as determined by video fluoroscopic swallow study (VFSS) and pediatric manometry findings.
Methods:
This is a case series in which hospital records of all patients who underwent a modified external approach to pediatric cricopharyngeal myotomy 2017 to 2019 were reviewed at a single institution. The primary outcome measure was post-operative diet and presence of aspiration/penetration on post-operative VFSS.
Results:
A total of 7 patients underwent modified external approach to pediatric cricopharyngeal myotomy. The average age of the child at the time of surgery was 5.6 (±3.7) years. The average duration (SD) of surgery was 90 (±30) minutes and no complications were observed. 6 of 7 patients (86%) demonstrated an improvement in swallow function after the procedure. The single child who did not was suffering from a posterior fossa tumor which was resected and radiated, which likely made their dysphagia multi-factorial. Although no pediatric normative data exists for upper esophageal sphincter pressure, we observed an average decrease in UES residual pressure of 8.5 (±15.1) mmHg and an average decrease in mean UES pressure of 21.2 (±35.1) mmHg.
Conclusions:
The modified external approach to the pediatric cricopharyngeal myotomy appears to be a safe and efficient procedure with no apparent complications to date. However, further longitudinal data is needed to formally evaluate the efficacy of this procedure when treating pediatric cricopharyngeal achalasia.
