Modified external approach to the pediatric cricopharyngeal myotomy: A case series.

OBJECTIVE: To assess the success of a modified approach to external pediatric cricopharyngeal myotomy in children with inappropriate upper esophageal sphincter relaxation as determined by video fluoroscopic swallow study (VFSS) and pediatric manometry findings. METHODS: This is a case series in which hospital records of all patients who underwent a modified external approach to pediatric cricopharyngeal myotomy 2017 to 2019 were reviewed at a single institution. The primary outcome measure was post-operative diet and presence of aspiration/penetration on post-operative VFSS. RESULTS: A total of 7 patients underwent modified external approach to pediatric cricopharyngeal myotomy. The average age of the child at the time of surgery was 5.6 (±3.7) years. The average duration (SD) of surgery was 90 (±30) minutes and no complications were observed. 6 of 7 patients (86%) demonstrated an improvement in swallow function after the procedure. The single child who did not was suffering from a posterior fossa tumor which was resected and radiated, which likely made their dysphagia multi-factorial. Although no pediatric normative data exists for upper esophageal sphincter pressure, we observed an average decrease in UES residual pressure of 8.5 (±15.1) mmHg and an average decrease in mean UES pressure of 21.2 (±35.1) mmHg. CONCLUSIONS: The modified external approach to the pediatric cricopharyngeal myotomy appears to be a safe and efficient procedure with no apparent complications to date. However, further longitudinal data is needed to formally evaluate the efficacy of this procedure when treating pediatric cricopharyngeal achalasia.

Modified approach for pediatric external cricopharyngeal myotomy.

Pediatric cricopharyngeal achalasia is an uncommon but important cause of oropharyngeal dysphagia. Failure of upper esophageal sphincter relaxation is the currently understood pathophysiology. Therapies include balloon dilation, botulinum toxin injection, and endoscopic or open cricopharyngeal myotomy (CPM). Open CPM is usually performed at the posterior midline of the cricopharyngeus and can be a risky procedure given concern for esophageal perforation and damage to the recurrent laryngeal nerve. Here, we present a novel modified technique for open CPM using a superficial anterolateral transection approach in the case of a young male with refractory cricopharyngeal achalasia.