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Section of the Cricopharyngeus Muscle for Dysphagia

Section of the Cricopharyngeus Muscle for Dysphagia Abstract EFFICIENT and effortless swallowing at the upper end of the esophagus requires, among other events, coordinated and powerful contraction of the pharyngeal constrictors coupled with relaxation of the cricopharyngeus muscle, or upper esophageal sphincter, at the precise moment of arrival of the bolus from above. This highly coordinated sequence of events in normal persons has been demonstrated by a number of investigators using pressure recording,1,2 routine radiographic,3,4 and cineradiographic techniques.5-8 The peristaltic wave begun by the pharyngeal constrictors is propagated into the esophagus proper but first must traverse the zone of increased pressure at the level of the cricopharyngeal sphincter. Code and his associates have shown in normal swallowing that there is a precisely timed and pronounced relaxation of the sphincter beginning immediately prior to pharyngeal contraction, "ensuring that the doorway to the esophagus is open as the swallowed material is forced toward it" (Fig 1). The References 1. Reference 6, 8-10, 12, 13, 19, 22, 30-32, 34, 36, 39. 2. Code, C.F., et al: An Atlas of Esophageal Motility in Health and Disease , Springfield, Ill: Charles C Thomas, Publisher, 1958. 3. Kramer, P., et al: The Dynamics of Swalloing: I. Normal Pharyngeal Swallowing Mechanisms J Clin Invest 36:581-588, 1957.Crossref 4. Asherson, N.: Achalasia of the Cricopharyngeal Sphincter , J Laryng 64:747-758, 1950.Crossref 5. Templeton, F.E., and Kredel, R.A.: The Cricopharyngeal Sphincter—A Roentgenologic Study , Laryngoscope 53:1-12, 1943.Crossref 6. Crichlow, T.V.L.: The Cricopharyngeus in Radiography and Cineradiography , Brit J Radiol 29:546-556, 1956.Crossref 7. Ardran, G.M., and Kemp, F.H.: The Radiography of the Lower Lateral Food Channels , J Laryng 75:358-370, 1961.Crossref 8. Ramsey, G.H., et al: Cinefluorographic Analysis of the Mechanism of Swallowing , Radiology 64:498-518, 1955.Crossref 9. Cross, F.S.; Johnson, G.F.; and Gerein, A.N.: Esophageal Diverticula: Associated Neuromuscular Changes in the Esophagus , Arch Surg 83:525-533 ( (Oct) ) 1961.Crossref 10. Sutherland, H.D.: Cricopharyngeal Achalasia , J Thorac Cardiov Surg 43:114-126, 1962. 11. Negus, V.E.: Etiology of Pharyngeal Diverticula , Bull Hopkins Hosp 101:209-223, 1957. 12. Peterman, A.F.; Lillington, G.A.; and Jamplis, R.W.: Progressive Muscular Dystrophy With Ptosis and Dysphagia , Arch Neurol 10:38-41, 1964.Crossref 13. Belsey, R.: Functional Disease of the Oesophagus , Postgrad Med J 39:290-298, 1963.Crossref 14. Wilkins, S.A., Jr.: Indications for Section of the Cricopharyngeus Muscle , Amer J Surg 108:533-538, 1964.Crossref 15. Kramer, P., et al: The Dynamics of Swallowing: II. Neuromuscular Dysphagia of Pharynx , J Clin Invest 36:589-595, 1957.Crossref 16. Leach, W.: Generalized Muscular Diseases Presenting as Pharyngeal Dysphagia , J Laryng 76:237-240, 1962.Crossref 17. Lund, W.S.; A Study of the Cricopharyneal Sphincter in Man and in the Dog , Ann Roy Coll Surg 37:225-246, 1965. 18. Kaplan, S.: Paralysis of Deglutition, a Postpoliomyelitis Complication Treated by Section of the Cricopharyngeus Muscle , Ann Surg 133:572-573, 1951.Crossref 19. Kaplan, S.: Paralysis of the Swallowing Mechanism Following Bulbar Poliomyelitis , Arch Otolaryng 65:495-498, 1957.Crossref 20. Davis, N.V.; Mitchel, B.F.; and Adams, M.: Cricopharyngeal Achalasia: Variant of Hypopharyngeal Diverticulum Syndrome , Texas Med J 62:47-49, 1966. 21. Rogers, L.: The Treatment of Spasmodic Dysphagia by Sympathetic Denervation , Brit J Surg 22:829-832, 1935.Crossref 22. Kelly, A.B.: Spasm at the Entrance to the Esophagus , J Laryng Rhinol Otol 34:285-289, 1919.Crossref 23. Negus, V.E.: Pharyngeal Diverticula , Brit J Surg 38:129-146 1950.Crossref 24. Batson, O.V.: The Cricopharyngeus Muscle , Ann Otol 64:47-54, 1955. 25. Terracol, J., and Sweet, R.H.: Diseases of the Esophagus , Philadelphia: W. B. Saunders Co., 1958. 26. Mitchell, G.A.G.: The Autonomic Nerve Supply of the Throat, Nose, and Ear , J Laryng 68:495-516, 1954.Crossref 27. Kirchner, J.A.: The Motor Activity of the Cricopharyngeus Muscle , Laryngoscope 68:1119-1159, 1958.Crossref 28. Conley, J.J.: Swallowing Dysfunctions Associated with Radical Surgery of the Head and Neck , Arch Surg 80:602-612 ( (April) ) 1960.Crossref 29. Fischer, R.A., et al: Esophageal Motility in Neuromuscular Disorders , Ann Intern Med 63:229-248, 1965.Crossref 30. Higgs, B.; Kerr, F.W.L.; and Ellis, F.H., Jr.: The Experimental Production of Esophageal Achalasia by Electrolytic Lesions in the Medulla , J Thorac Cardiov Surg 50:613-625, 1965. 31. Dohlman, G., and Mattsson, O.: The Endoscopic Operation for Hypopharyngeal Diverticula , Arch Otolaryng 71:744-752, 1960.Crossref 32. Holinger, P.H.: Endoscopic Management of Zenker's Diverticulum , Bull Gastroint Endosc 11:10-11, 1964. 33. Jackson, C., and Shallow, T.A.: Diverticula of the Esophagus Pulsion, Traction, Malignant, and Congenital , Ann Surg 83:1-19, 1926. 34. Asherson, N.: The Vagaries of Dysphagia , Proc Roy Soc Med 55:117-124, 1962. 35. Wilson, C.P.: Pharyngeal Diverticula, Their Cause and Treatment , J Laryngol 76:151-180, 1962.Crossref 36. Bingham, D.L.C.: Cricopharyngeal Achalasia , Canad Med Assoc J 89:1071-1073, 1963. 37. Kinley, C.E.: The Management of Hypopharyngeal Diverticulum , Canad J Surg 9:27-32, 1966. 38. Victor, M.; Hayes, R.; and Adams, R.D.: Oculopharyngeal Muscular Dystrophy , New Eng J Med 267:1267-1272, 1962.Crossref 39. Lewis, I.: Late Onset Muscle Dystrophy: Oculopharyngoesophageal Variety , Canad Med Assoc J 95:146-150, 1966. 40. Warren, K.W.: Some Technical Considerations in the Management of Pharyngo-esophageal Diverticulum , Surg Clin N Amer 40:633-643, 1960. 41. Clagett, O.T.: Pharyngo-esophageal Diverticula , Surg Clin N Amer 43:1165-1169, 1963. 42. Boyd, D.P.: Esophageal Diverticulum , Surg Clin N Amer 44:589-595, 1964. http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Archives of Surgery American Medical Association

Section of the Cricopharyngeus Muscle for Dysphagia

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Publisher
American Medical Association
Copyright
Copyright © 1968 American Medical Association. All Rights Reserved.
ISSN
0004-0010
eISSN
1538-3644
DOI
10.1001/archsurg.1968.01330230053008
Publisher site
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Abstract

Abstract EFFICIENT and effortless swallowing at the upper end of the esophagus requires, among other events, coordinated and powerful contraction of the pharyngeal constrictors coupled with relaxation of the cricopharyngeus muscle, or upper esophageal sphincter, at the precise moment of arrival of the bolus from above. This highly coordinated sequence of events in normal persons has been demonstrated by a number of investigators using pressure recording,1,2 routine radiographic,3,4 and cineradiographic techniques.5-8 The peristaltic wave begun by the pharyngeal constrictors is propagated into the esophagus proper but first must traverse the zone of increased pressure at the level of the cricopharyngeal sphincter. Code and his associates have shown in normal swallowing that there is a precisely timed and pronounced relaxation of the sphincter beginning immediately prior to pharyngeal contraction, "ensuring that the doorway to the esophagus is open as the swallowed material is forced toward it" (Fig 1). The References 1. Reference 6, 8-10, 12, 13, 19, 22, 30-32, 34, 36, 39. 2. Code, C.F., et al: An Atlas of Esophageal Motility in Health and Disease , Springfield, Ill: Charles C Thomas, Publisher, 1958. 3. Kramer, P., et al: The Dynamics of Swalloing: I. Normal Pharyngeal Swallowing Mechanisms J Clin Invest 36:581-588, 1957.Crossref 4. Asherson, N.: Achalasia of the Cricopharyngeal Sphincter , J Laryng 64:747-758, 1950.Crossref 5. Templeton, F.E., and Kredel, R.A.: The Cricopharyngeal Sphincter—A Roentgenologic Study , Laryngoscope 53:1-12, 1943.Crossref 6. Crichlow, T.V.L.: The Cricopharyngeus in Radiography and Cineradiography , Brit J Radiol 29:546-556, 1956.Crossref 7. Ardran, G.M., and Kemp, F.H.: The Radiography of the Lower Lateral Food Channels , J Laryng 75:358-370, 1961.Crossref 8. Ramsey, G.H., et al: Cinefluorographic Analysis of the Mechanism of Swallowing , Radiology 64:498-518, 1955.Crossref 9. Cross, F.S.; Johnson, G.F.; and Gerein, A.N.: Esophageal Diverticula: Associated Neuromuscular Changes in the Esophagus , Arch Surg 83:525-533 ( (Oct) ) 1961.Crossref 10. Sutherland, H.D.: Cricopharyngeal Achalasia , J Thorac Cardiov Surg 43:114-126, 1962. 11. Negus, V.E.: Etiology of Pharyngeal Diverticula , Bull Hopkins Hosp 101:209-223, 1957. 12. Peterman, A.F.; Lillington, G.A.; and Jamplis, R.W.: Progressive Muscular Dystrophy With Ptosis and Dysphagia , Arch Neurol 10:38-41, 1964.Crossref 13. Belsey, R.: Functional Disease of the Oesophagus , Postgrad Med J 39:290-298, 1963.Crossref 14. Wilkins, S.A., Jr.: Indications for Section of the Cricopharyngeus Muscle , Amer J Surg 108:533-538, 1964.Crossref 15. Kramer, P., et al: The Dynamics of Swallowing: II. Neuromuscular Dysphagia of Pharynx , J Clin Invest 36:589-595, 1957.Crossref 16. Leach, W.: Generalized Muscular Diseases Presenting as Pharyngeal Dysphagia , J Laryng 76:237-240, 1962.Crossref 17. Lund, W.S.; A Study of the Cricopharyneal Sphincter in Man and in the Dog , Ann Roy Coll Surg 37:225-246, 1965. 18. Kaplan, S.: Paralysis of Deglutition, a Postpoliomyelitis Complication Treated by Section of the Cricopharyngeus Muscle , Ann Surg 133:572-573, 1951.Crossref 19. Kaplan, S.: Paralysis of the Swallowing Mechanism Following Bulbar Poliomyelitis , Arch Otolaryng 65:495-498, 1957.Crossref 20. Davis, N.V.; Mitchel, B.F.; and Adams, M.: Cricopharyngeal Achalasia: Variant of Hypopharyngeal Diverticulum Syndrome , Texas Med J 62:47-49, 1966. 21. Rogers, L.: The Treatment of Spasmodic Dysphagia by Sympathetic Denervation , Brit J Surg 22:829-832, 1935.Crossref 22. Kelly, A.B.: Spasm at the Entrance to the Esophagus , J Laryng Rhinol Otol 34:285-289, 1919.Crossref 23. Negus, V.E.: Pharyngeal Diverticula , Brit J Surg 38:129-146 1950.Crossref 24. Batson, O.V.: The Cricopharyngeus Muscle , Ann Otol 64:47-54, 1955. 25. Terracol, J., and Sweet, R.H.: Diseases of the Esophagus , Philadelphia: W. B. Saunders Co., 1958. 26. Mitchell, G.A.G.: The Autonomic Nerve Supply of the Throat, Nose, and Ear , J Laryng 68:495-516, 1954.Crossref 27. Kirchner, J.A.: The Motor Activity of the Cricopharyngeus Muscle , Laryngoscope 68:1119-1159, 1958.Crossref 28. Conley, J.J.: Swallowing Dysfunctions Associated with Radical Surgery of the Head and Neck , Arch Surg 80:602-612 ( (April) ) 1960.Crossref 29. Fischer, R.A., et al: Esophageal Motility in Neuromuscular Disorders , Ann Intern Med 63:229-248, 1965.Crossref 30. Higgs, B.; Kerr, F.W.L.; and Ellis, F.H., Jr.: The Experimental Production of Esophageal Achalasia by Electrolytic Lesions in the Medulla , J Thorac Cardiov Surg 50:613-625, 1965. 31. Dohlman, G., and Mattsson, O.: The Endoscopic Operation for Hypopharyngeal Diverticula , Arch Otolaryng 71:744-752, 1960.Crossref 32. Holinger, P.H.: Endoscopic Management of Zenker's Diverticulum , Bull Gastroint Endosc 11:10-11, 1964. 33. Jackson, C., and Shallow, T.A.: Diverticula of the Esophagus Pulsion, Traction, Malignant, and Congenital , Ann Surg 83:1-19, 1926. 34. Asherson, N.: The Vagaries of Dysphagia , Proc Roy Soc Med 55:117-124, 1962. 35. Wilson, C.P.: Pharyngeal Diverticula, Their Cause and Treatment , J Laryngol 76:151-180, 1962.Crossref 36. Bingham, D.L.C.: Cricopharyngeal Achalasia , Canad Med Assoc J 89:1071-1073, 1963. 37. Kinley, C.E.: The Management of Hypopharyngeal Diverticulum , Canad J Surg 9:27-32, 1966. 38. Victor, M.; Hayes, R.; and Adams, R.D.: Oculopharyngeal Muscular Dystrophy , New Eng J Med 267:1267-1272, 1962.Crossref 39. Lewis, I.: Late Onset Muscle Dystrophy: Oculopharyngoesophageal Variety , Canad Med Assoc J 95:146-150, 1966. 40. Warren, K.W.: Some Technical Considerations in the Management of Pharyngo-esophageal Diverticulum , Surg Clin N Amer 40:633-643, 1960. 41. Clagett, O.T.: Pharyngo-esophageal Diverticula , Surg Clin N Amer 43:1165-1169, 1963. 42. Boyd, D.P.: Esophageal Diverticulum , Surg Clin N Amer 44:589-595, 1964.

Journal

Archives of SurgeryAmerican Medical Association

Published: May 1, 1968

References