What Is Cricopharyngeal Myotomy Surgery?

Cricopharyngeal myotomy surgery is a procedure in which a surgical cut is made to divide the cricopharyngeal muscle

The junction between the throat (pharynx) and the upper part of the food pipe (esophagus) is guarded by a muscular ring (upper esophageal sphincter or UES). The cricopharyngeal muscle mainly contributes to the formation of the UES. The muscle regulates the passage of food from the mouth to food pipe. Thus, while swallowing, this muscle relaxes to allow the food to enter the food pipe. Other times, the muscle stays contracted so that food cannot enter the airways in situations when an accidental food particle is straying into your pharynx. In some conditions, the cricopharyngeal muscle becomes abnormal or dysfunctional leading to a tightened UES. This condition is called upper esophageal dysfunction or cricopharyngeal achalasia. In such a situation, the passage of food from the mouth to the food pipe is hampered. This condition makes it difficult to swallow food; it is more difficult to swallow solid foods than liquid foods because liquids can pass relatively easily through the tight UES. The condition may progress to the extent that the person gets dependent upon a liquid diet and begins losing considerable weight. The main symptoms include:

• A feeling that something is sticking on the throat
• Pain during swallowing
• Heartburn
• Choking sensation
• Pressure in the neck during swallowing
• Hoarseness
• Recurrent chest infections
• Coughing

Cricopharyngeal myotomy surgery is a procedure in which a surgical cut is made to divide the cricopharyngeal muscle for weakening it. It relieves the difficulty in swallowing (dysphagia). The surgery can be done through the open-neck approach or by using the endoscope (a long, flexible tube with a camera and light source at one end). During the cricopharyngeal myotomy surgery

• The patient is made to lie on their back on the operation table.
• An intravenous (IV) line is established to administer fluids and medications.
• The doctor administers local or general anesthesia to the patient.
• The surgeon cleans the surgical site with an antiseptic solution.
• An incision (surgical cut) is made along with one of the neck creases for good aesthetic results.
• The surgeon identifies the cricopharyngeal muscle and repairs it to relieve tension in the UES. In the endoscopic approach, a laser is introduced through the mouth of the patient to relieve the muscle tension.
• The surgeon places a drain at the surgical site to allow the drainage of blood and other secretions from the surgical site (at the end of the procedure).
• Stitches are applied and dressing is done.

After the surgery:

• The patient is shifted to the recovery area where their vitals are monitored.
• The patient is generally kept under observation for a night after the surgery.
• A standard oral diet is generally started the night of the surgery.
• The drain is removed on the next day, and the patient can go home.

Both open neck and endoscopic approaches generally give good results. The patient reports improvement in their symptoms after the surgery. Although uncommon, some complications may develop after a cricopharyngeal myotomy. These include:

• Nausea or vomiting
• Sore throat
• Injury to the food pipe
• Nerve injury leading to a hoarse voice
• Bleeding
• Pain
• Persistent swallowing difficulty
• Hoarseness of voice
• Infections
• Scarring