• Speech Sciences
• /
• v.11 no.1
• /
• pp.73-83
• /
• 2004

Electromyographic studies of the cricopharyngeus muscle using hooked wire electrodes were performed in thyroidectomized patients. The shape of the cricoid cartilage and soft tissue thickness in the postcricoid area were evaluated during pitch elevation and pitch lowering using conventional neck lateral films. The cricopharyngeus muscle simultaneously activated in the initial task of speech and continuously activated. Its activity lessened in the interrogative stress contrast of sentence terminals and increased in the pitch lowered contrast of sentence terminal. On the radiologic findings the cricoid cartilage was tilted backward during high pitched phonation and tilted forward during low pitched phonation. The soft tissue thickness of postcricoid area was thicker at the low pitch than at high pitch. At low pitch the cricoid cartilage paralleled along the vertebral column. This result suggests that the bulging of cricopharyngeus muscle in contraction induce a thickened the postcricoid area thickened, and exert pressure anteriorly exerted on the cricoid cartilage. This contraction of the cricopharyngeus muscle may result in shortening the vocal fold and lowering pitch.

• Journal of the Korean Society of Laryngology, Phoniatrics and Logopedics
• /
• v.30 no.2
• /
• pp.77-81
• /
• 2019

Dysphagia may result from dysfunction of any of the components involved in the complex neuromuscular interaction of swallowing. Hyperfunction of any of the muscles involved in swallowing is a frequent cause of dysphagia. The cricopharyngeus muscle (CPM) is a key component of the upper esophageal sphincter. Cricopharyngeus muscle dysfunction (CPD) refers to the muscle's failure to appropriately and completely relax or expand during deglutition. A variety of disease processes may cause CPD and accurate diagnosis is paramount for appropriate treatment. In appropriately selected patients, intervention at the CPM may yield significant improvement in dysphagia. Interventions include nonsurgical, pharyngoesophageal segment dilatation, botulinum toxin (BoNT) injection, and criccopharyngeal myotomy. Injections of BoNT in patients with CPD have been reported to result in marked relief of dysphagia. Different techniques for instilling BoNT into the CPM have been described. Awake, in-office CPM BoNT injection with electromyography and/or fluoroscopic or ultrasound guidance is performed transcervically or via flexible endoscopy. Operative CPM BoNT injection involves rigid laryngoscopy and esophagoscopy with direct visualization of the CPM. BoNT should be prepared in low-volume, high-concentration dilutions to minimize the potential for undesired diffusion of the toxin. The effects of BoNT occur within weeks of injection and typically last up to 5 or 6 months.

• Korean Journal of Bronchoesophagology
• /
• v.19 no.1
• /
• pp.19-24
• /
• 2013

Objective The objective was to evaluate changes in swallow safety and dietary status after the transcutaneous injection of botulinum toxin into the upper esophageal sphincter in a series of outpatients with dysphagia. Methods Patients who were at risk for aspiration and who had an unsuccessful trial of swallowing therapy were admitted to the study. All patients showed significant pooling of fluids in the pyriform sinus. All patients were treated in the office; none had previous esophageal dilatation. The upper border of the cricoid cartilage was identified using standard electromyogram procedures and botulinum toxin was injected. Outcomes were assessed using the penetration-aspiration scale, NIH swallowiwng safety score, patients' short-term and long-term subjective impressions of their ability to swallow, and change in dietary status. Results Ten patients underwent an instrumental evaluation of swallowing function. Of the 10 patients, 9 showed an overall improvement in their ability to take an oral diet safely. The penetration-aspiration scale, NIH swallowiwng safety score, patients' short-term and long-term subjective impressions of their ability to swallow, and change in dietary status were significantly improved after office-based botox injection. Conclusion Office-based EMG guided botox injection to the cricopharyngeus muscle is a simple, safe, and effective tool for dysphagia patients. Injection of Botox in the office should be considered when the dysphagia pattern is aspiration after swallow.

• Journal of the Korean Society of Laryngology, Phoniatrics and Logopedics
• /
• v.30 no.2
• /
• pp.136-138
• /
• 2019

Recently, negative pressure wound therapy (NPWT) has been reported to be effective for the treatment of cervical infections including retropharyngeal abscess. The 71-year-old woman with retropharyngeal abscess presented in this case showed improvement of infection through long-term NPWT. She continued to complain of swallowing difficulties after recovery. In this case, we performed the transcutaneous injection of botulinum toxin at the cricopharyngeus muscle for the patient who developed dysphagia after treatment for retropharyngeal abscess and observed improvement in swallowing.

• Anatomy and Cell Biology
• /
• v.51 no.4
• /
• pp.299-301
• /
• 2018

Killian-Jamieson diverticulum is a permanent protrusion of anterolateral proximal esophagus through anatomically weak muscular gap, known as Killian-Jamieson area, into adjacent area. During a routine educational dissection, we found a well-defined lateral diverticulum just inferior to the transverse fibers of the cricopharyngeus muscle in a Korean male cadaver. It had a dimension of $1.8{\times}1.4{\times}1.0cm$ with two types of epithelial cells, stratified squamous and simple cuboidal to low-columnar epithelium, and attenuated and haphazardly arranged muscle fibers. No epithelial dysplasia or malignant transformation was identified except ulcerative changes. Although Killian-Jamieson diverticulum is a very rare disease, clinicopathological aspects should be considered.

• Korean Journal of Bronchoesophagology
• /
• v.14 no.2
• /
• pp.57-63
• /
• 2008

Hypopharyngeal perforation secondary to tracheal intubation is rare, but may result in severe airway complications that include retropharyngeal abscess, pneumothorax, pneumonia, mediastinitis and death. The most common site of hypopharyngeal perforation is the pyriform sinus and the region of the cricopharyngeus muscle. We report a 62-year old man with intubation-induced hypopharyngeal injury presenting as deep neck infection. The patient presented with dyspnea and pain on the neck. Neck CT scan identified fluid and air collection on the neck from the hyoid bone to the thoracic inlet level. Despite of delayed diagnosis, we successfully operated him by using strap muscle myofascial transposition flap. The patient was followed up for 3 months without any complications.

• Journal of Chest Surgery
• /
• v.31 no.4
• /
• pp.432-435
• /
• 1998

Idiopathic cricopharyngeal achalasia is a rare condition that produces oropharyngeal dysphagia. It is caused by spasm of the cricopharyngeus and inability to relax with swallowing. A prominent muscle bar at the upper esophageal sphincter is a typical finding of the esophagogram. Cricopharyngeal myotomy is the treatment of choice. We report a case of cricopharyngeal myotomy for 61-year-old female patient.

• Korean Journal of Bronchoesophagology
• /
• v.13 no.2
• /
• pp.9-16
• /
• 2007

Cricopharyngeal dysphagia(CPD), a common condition in the dysphagic patient, refers to the dysfunction of the upper esophageal sphincter complex(UESC), which is composed of the cricopharyngeus, inferior pharyngeal constrictor and the upper segment of the cervical esophagus. Primary CPD is the disease entity solely confined to dysfunctional UESC, while secondary CPD encompasses various conditions that accompany UESC dysfunction. For proper diagnosis and treatment of such entity, a thorough understanding of the complex anatomy and physiology of the upper esophageal sphincter. Adequate relaxation of the cricopharyngeal muscle in conjunction with anterosuperior excursion of the larynx by suprahyoid muscles and propulsion of food bolus are prerequisite for normal swallow, mechanisms of which if altered result in cricopharyngeal dysfunction. Of the various methods used for the diagnosis of cricopharyngeal dysphagia, videofluoroscopy remains the method of choice. Mechanical dilatation of the cricopharayngeus, cricopharyngeal myotomy and botulinum toxin injection and head-lift exercise have been used in clinical practice to relieve dysphagia in such patients. Such procedures have therapeutic effect in primary CPD, but so often fail to relieve swallowing dysfunction in patient with secondary CPD. We herein explain ancillary procedures that support these primary treatment options, which lead to successful treatment of dysphagia.

• Journal of the Korean Society of Laryngology, Phoniatrics and Logopedics
• /
• v.22 no.1
• /
• pp.52-55
• /
• 2011

Hyperfunction of the upper esophageal sphincter (UES) can cause severe dysphagia. This condition referred as cricopharyngeal dysphagia may occur after head and neck surgery due to altered muscle spasm and stenosis of the pharyngo-esophageal segment. Among various treatment options available, Botulinum toxin A (Botox) injection offers a nonsurgical treatment which is useful especially for debilitated patients, and there has been a recent increase in the clinical use of Botox by otolaryngologists for managing such conditions. A 55-year-old male with base of tongue (BOT) cancer suffered from severe dysphagia after total glossectomy and neck dissection treatment. Videofluoroscopic swallow study (VFSS) and flexible endoscopic evaluation of swallowing (FEES) showed inability to pass food through the UES due to cricopharyngeal spasm. After injection of 10 U of Bot ox into each cricopharyngeus muscles (total 20 U) via EMG-guided percutaneous injection, swallowing function had improved and oral nutrition was possible, with food passing through the UES visualized on VFSS and FEES.

• Journal of Chest Surgery
• /
• v.29 no.6
• /
• pp.675-680
• /
• 1996

A case of giant fibrovascular polyp of the esophagus with a review of the literature is presented. A 52 year old man with into rmittent dysphagia was found to have an intraluminal esophageal lesion of remarkable size by the radiological studies, but overlooked at esophagoscopy. A giant esophageal polyp w s successfully re- moved surgically by transthoracic approach, although preoperative evaluation of the location and characteristics of the lesion was problematic. These pedunculated intraluminal polyps are rare and characterized by slow growing. benign nature that almost always originate at the level of. the cricopharyngeus muscle, and often attain giant proportions. Symptoms are related to esophageal ob- struction and sudden death by asphyxia can occur. Surgical removal is the choice of treatment.