43030 Cricopharyngeal myotomy

Name of the Procedure:

Cricopharyngeal Myotomy

Summary

Cricopharyngeal myotomy is a surgical procedure that involves cutting the cricopharyngeal muscle in the throat to improve swallowing. This is often performed to alleviate conditions where the muscle fails to relax properly, causing difficulties in swallowing.

Purpose

The procedure addresses cricopharyngeal dysfunction and sometimes Zenker’s diverticulum. The goal is to ease swallowing by allowing the esophagus to open more fully during the swallowing process.

Indications

Symptoms:

• Difficulty swallowing (dysphagia)
• Regurgitation of undigested food
• Sensation of a lump in the throat
• Chronic aspiration or choking during eating

Patient Criteria:

• Diagnosis of cricopharyngeal achalasia
• Presence of Zenker's diverticulum
• Failed conservative treatments or dilations

Preparation

• Patients are typically instructed to fast for 8-12 hours before the procedure.
• Adjustments to medications, particularly blood thinners, may be required.
• Pre-procedure assessments may include a barium swallow study, esophagram, or esophageal manometry.

Procedure Description

1. Anesthesia: General anesthesia is administered to ensure the patient is unconscious and pain-free.
2. Access: A small incision is made in the neck.
3. Isolation: The cricopharyngeal muscle is isolated.
4. Myotomy: The muscle fibers of the cricopharyngeal muscle are carefully cut.
5. Closure: The incision is closed with sutures.
6. Post-Procedure: The patient is taken to recovery to awaken from anesthesia.

Duration

The procedure typically takes between 30 and 60 minutes.

Setting

Cricopharyngeal myotomy is usually performed in a hospital’s surgical suite or an outpatient surgical center.

Personnel

• Surgeon (often an otolaryngologist or a general surgeon)
• Anesthesiologist
• Surgical nurses and technicians

Risks and Complications

Common Risks:

• Infection
• Bleeding
• Swelling

Rare Complications:

• Injury to nearby structures (e.g., esophagus, nerves)
• Persistent swallowing difficulties
• Voice changes

Benefits

Expected Benefits:

• Improved ability to swallow
• Reduction in choking or aspiration episodes
• Enhanced quality of life

Realization Timeline:

Benefits can often be noticed within days to a few weeks after the procedure.

Recovery

• Patients may experience sore throat or mild discomfort post-procedure.
• Liquid or soft food diet is usually recommended initially.
• Follow-up appointments to monitor healing and swallowing improvement.
• Most patients can resume normal activities within one to two weeks.

Alternatives

Other Treatment Options:

• Swallowing therapy
• Endoscopic dilation
• Botulinum toxin injection

Pros and Cons:

• Swallowing therapy and dilation are less invasive but may not provide long-term relief.
• Botulinum toxin injection offers temporary relief and needs repeat treatments.

Patient Experience

During the Procedure:

• The patient will be under general anesthesia and won't feel anything during the surgery.

Post-Procedure:

• Mild throat pain or discomfort is common after waking up.
• Pain management includes medications prescribed by the surgeon.
• Supportive care and comfort measures such as ice packs and throat lozenges may be recommended.