The risk and complications of aspiration following cricopharyngeal myotomy

This article reviews a series of patients undergoing cricopharyngeal myotomy and determines whether clinically dangerous aspiration is seen postoperatively. A total of 23 patients underwent myotomy. Indications included Zenker's diverticulum (14), anticipated or real dysphagia from skull base lesions (5), dysphagia from stroke (2), and dysphagia from glossectomy and radiation therapy (2). Surgical procedures, complications, and effectiveness were reviewed. Of patients with Zenker's diverticula, 13 of 14 had clinically useful improvement in dysphagia. Of patients with skull base lesions, all 5 had improvement (4 of these also had thyroplasites and cervical plexus-to-superior laryngeal nerve anastomoses). Of the patients with strokes, neither had significant improvement. Of the patients with glossectomy and radiation, 1 had useful improvement. Complications were seen in 5 patients: 2 had self-limiting pharyngeal leaks, and 3 had pneumonia 1-4 months postoperatively. One patient also had a postoperative ipsilateral recurrent laryngeal nerve injury. There were no postoperative deaths. In conclusion, cricopharyngeal myotomy has definite utility in the management of cervical dysphagia, even though the etiology of the dysphagia can be multifactorial. Risks directly attributable to the procedure are usually self-limiting; serious complications are usually associated with the underlying disease. The addition of adjunctive procedures, such as thyroplasty and superior laryngeal nerve reinnervation, may be of additional benefit to patients with high extracranial vagal injuries.