Epiglottic position after cricothyroidotomy: a comparison with tracheotomy

Dysphagia is a known problem in patients with tracheotomy, but its association with cricothyroidotomy is not well studied. The purpose of this study was to evaluate dysphagia in patients with cricothyroidotomy and to determine if there is a reliable indicator of swallowing dysfunction in these patients. A review of charts for patients with modified barium swallow studies conducted at the New York University Medical Center Swallowing Disorders Center yielded three groups of patients: patients with cricothyroidotomy, patients with tracheotomy, and normal patients. There were 8 patients in each group. In all patients in the cricothyroidotomy group, there was a greater impairment of epiglottic displacement, laryngeal elevation, and upper esophageal opening than in the tracheotomy group. This problem with epiglottic displacement produced susceptibility to laryngeal penetration and, in turn, increased the risk of aspiration in those patients with cricothyroidotomy. After cricothyroidotomy tube removal, a return to normal epiglottic movement was observed within 2 months. One mechanism of swallowing dysfunction is impaired posterior displacement of the epiglottis over the glottic aperture. This impaired epiglottic motion appears to be related to restricted laryngeal elevation secondary to tethering of the larynx anteriorly at the site of the cricothyroidotomy. Additionally, we noted a decrease in the opening of the upper esophageal sphincter.