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Videofluoroscopic swallow studies in unilateral cricopharyngeal dysfunction.
Laryngoscope. 2003 Jun; 113(6):981-4.L

Abstract

OBJECTIVES/HYPOTHESIS

Although the cricopharyngeus muscle is a ring-like structure, unilateral cricopharyngeal dysfunction can produce significant dysphagia. This entity has not been well described in the literature. The aims of the study were to identify the characteristic findings on videofluoroscopic swallow studies in patients with dysphagia secondary to unilateral cricopharyngeal dysfunction, to note the associated vagal nerve injury, and to evaluate patient outcomes following ipsilateral cricopharyngeal myotomy.

STUDY DESIGN

Retrospective clinical investigation.

METHODS

The clinic charts, electromyographic tests, videostroboscopic examinations, and videofluoroscopic swallow studies were reviewed from a series of patients who presented to our institution from 1993 to 2001 with dysphagia and findings on videofluoroscopic swallow studies suggestive of unilateral cricopharyngeal dysfunction on posterior-anterior view. In patients treated with ipsilateral cricopharyngeal myotomy, postoperative findings on swallow studies and patient outcomes were also reviewed.

RESULTS

Eighteen patients demonstrated findings characteristic of unilateral cricopharyngeal muscle dysfunction on videofluoroscopic swallow study. The common feature was a unilateral shelf-like barrier at the cricopharyngeus on the posterior-anterior view with pooling of liquid bolus in the ipsilateral pyriform sinus and episodic shunting to the contralateral side. Eight patients did not have evidence of cricopharyngeal dysfunction (ie, cricopharyngeal bar) on lateral films. Of the 18 patients, 14 had histories consistent with vagal injury secondary to trauma (n = 2), neoplastic involvement (n = 7), iatrogenic injury (n = 2), or central nervous system disease (n = 3). Results of videostroboscopic examinations demonstrated vocal fold motion impairment in 14 patients, and electromyographic test results confirmed unilateral vagal injuries in those who underwent electromyographic testing (n = 6). In the remaining 4 of 18 patients, videostroboscopic examinations demonstrated normal vocal fold abduction but impaired lengthening with a posterior glottic gap, and electromyographic test results (n = 4) indicated unilateral superior laryngeal nerve involvement. Of the 15 patients treated with ipsilateral cricopharyngeal myotomy, 1 patient required postoperative esophageal dilations for an esophageal stricture distal to the cricopharyngeus, whereas the remaining 14 patients had functional resolution of their dysphagia.

CONCLUSION

In patients presenting with dysphagia and evidence of unilateral vagal injury, careful assessment of posterior-anterior view on videofluoroscopic swallow study should be included to evaluate for unilateral cricopharyngeal dysfunction.

Authors+Show Affiliations

Department of Otolaryngology and Communicative Sciences, Medical College of Wisconsin, Milwaukee 53226, USA.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

12782808

Citation

Halum, Stacey L., et al. "Videofluoroscopic Swallow Studies in Unilateral Cricopharyngeal Dysfunction." The Laryngoscope, vol. 113, no. 6, 2003, pp. 981-4.
Halum SL, Merati AL, Kulpa JI, et al. Videofluoroscopic swallow studies in unilateral cricopharyngeal dysfunction. Laryngoscope. 2003;113(6):981-4.
Halum, S. L., Merati, A. L., Kulpa, J. I., Danielson, S. K., Jaradeh, S. S., & Toohill, R. J. (2003). Videofluoroscopic swallow studies in unilateral cricopharyngeal dysfunction. The Laryngoscope, 113(6), 981-4.
Halum SL, et al. Videofluoroscopic Swallow Studies in Unilateral Cricopharyngeal Dysfunction. Laryngoscope. 2003;113(6):981-4. PubMed PMID: 12782808.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Videofluoroscopic swallow studies in unilateral cricopharyngeal dysfunction. AU - Halum,Stacey L, AU - Merati,Albert L, AU - Kulpa,Judith I, AU - Danielson,Susan K, AU - Jaradeh,Safwan S, AU - Toohill,Robert J, PY - 2003/6/5/pubmed PY - 2003/7/24/medline PY - 2003/6/5/entrez SP - 981 EP - 4 JF - The Laryngoscope JO - Laryngoscope VL - 113 IS - 6 N2 - OBJECTIVES/HYPOTHESIS: Although the cricopharyngeus muscle is a ring-like structure, unilateral cricopharyngeal dysfunction can produce significant dysphagia. This entity has not been well described in the literature. The aims of the study were to identify the characteristic findings on videofluoroscopic swallow studies in patients with dysphagia secondary to unilateral cricopharyngeal dysfunction, to note the associated vagal nerve injury, and to evaluate patient outcomes following ipsilateral cricopharyngeal myotomy. STUDY DESIGN: Retrospective clinical investigation. METHODS: The clinic charts, electromyographic tests, videostroboscopic examinations, and videofluoroscopic swallow studies were reviewed from a series of patients who presented to our institution from 1993 to 2001 with dysphagia and findings on videofluoroscopic swallow studies suggestive of unilateral cricopharyngeal dysfunction on posterior-anterior view. In patients treated with ipsilateral cricopharyngeal myotomy, postoperative findings on swallow studies and patient outcomes were also reviewed. RESULTS: Eighteen patients demonstrated findings characteristic of unilateral cricopharyngeal muscle dysfunction on videofluoroscopic swallow study. The common feature was a unilateral shelf-like barrier at the cricopharyngeus on the posterior-anterior view with pooling of liquid bolus in the ipsilateral pyriform sinus and episodic shunting to the contralateral side. Eight patients did not have evidence of cricopharyngeal dysfunction (ie, cricopharyngeal bar) on lateral films. Of the 18 patients, 14 had histories consistent with vagal injury secondary to trauma (n = 2), neoplastic involvement (n = 7), iatrogenic injury (n = 2), or central nervous system disease (n = 3). Results of videostroboscopic examinations demonstrated vocal fold motion impairment in 14 patients, and electromyographic test results confirmed unilateral vagal injuries in those who underwent electromyographic testing (n = 6). In the remaining 4 of 18 patients, videostroboscopic examinations demonstrated normal vocal fold abduction but impaired lengthening with a posterior glottic gap, and electromyographic test results (n = 4) indicated unilateral superior laryngeal nerve involvement. Of the 15 patients treated with ipsilateral cricopharyngeal myotomy, 1 patient required postoperative esophageal dilations for an esophageal stricture distal to the cricopharyngeus, whereas the remaining 14 patients had functional resolution of their dysphagia. CONCLUSION: In patients presenting with dysphagia and evidence of unilateral vagal injury, careful assessment of posterior-anterior view on videofluoroscopic swallow study should be included to evaluate for unilateral cricopharyngeal dysfunction. SN - 0023-852X UR - https://www.unboundmedicine.com/medline/citation/12782808/Videofluoroscopic_swallow_studies_in_unilateral_cricopharyngeal_dysfunction_ L2 - https://doi.org/10.1097/00005537-200306000-00012 DB - PRIME DP - Unbound Medicine ER -