I am looking for information regarding a procedure, cricopharyngeal
myotomy. Is this used when esophageal strictures are found but dilation
is unsuccessful?
Also, what neuro assessment is done to check for damage to the 12th
cranial nerve? Thanks in advance for any information.
Yours truly
Reply: --------------------
Cricopharyngeal myotomy is a surgical procedure performed for the treatment of swallowing difficulty caused by a dysfunctional or hypertrophic (enlarged) upper esophageal sphincter muscle. This sphincter muscle is located near the bottom of one's larynx (Adam's apple). The diagnosis usually requires at the very least an esophagram which is an x-ray where barium or other contrast material is swallowed and viewed by x-ray as it goes down the esophagus. Another test known as esophageal manometry is also commonly performed whereby the opening pressure of this muscle can be measured. The cause of dysfunction of this muscle is not always clearly understood. It may occur as the result of neurologic disorders including stroke or it may be the result of chronic acid reflux from the stomach. Occasionally, severe hypertrophy of the cricopharyngeal muscle results in a pouch formation above the muscle known as a diverticulum (Zenker's). Initially dietary modifications and medical therapy may be helpful in mild cases. More bothersome cases may require esophageal dilatation to stretch the muscle out. When this fails, and symptoms are severe, cricopharyngeal myotomy is recommended whereby the muscle is actually cut via an external neck incision. It is important to note that cricopharyngeal dysphagia can be severe enough to cause pneumonias in some cases.
As to your latter question regarding the 12th cranial nerve, this is known as the hypoglossal nerve and it innervates the tongue. It is usually not necessary to perform sophisticated testing to identify 12th nerve dysfunction. This is because the physician can simply examine the movement of the tongue on oral cavity examination.
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Steve Dankle, MD
Otolaryngology-Head and Neck Surgery
Milwaukee, Wis
NOTICE: OFCN is not engaged in the rendering of professional medical services. The information contained on this system or any other OFCN system should not supplant individual professional consultation. It is offered exclusively as a community education service. Advice on individual problems must be obtained directly from a professional.
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