Management of the Cricopharyngeus

The cricopharyngeus muscle along with cervical esophageal musculature and the inferior pharyngeal constrictors make up the upper esophageal sphincter (UES). This complex controls anterograde and retrograde flow between the pharynx and esophagus to prevent aspiration of esophageal contents, prevent aerophagia, aid deglutition, and permit belching and vomiting. As the cricopharyngeal muscle resides in the transition zone between the inferior constrictors and cervical esophageal musculature and actively contributes to all UES functions, dysfunction can significantly impair deglutition. Cricopharyngeal dysfunction may result from aberrant neural input, fibrosis, or hypertonicity. Clinical manifestations range from a globus sensation to dysphagia and/or aspiration. Diagnostic tools include a clinical swallow evaluation, functional endoscopic evaluation of swallow, videofluoroscopy, manometry, and/or electromyography. Current evidence suggests that videofluoroscopy and manometry are most useful in directing treatment for the patient’s symptoms. Treatment of cricopharyngeal dysfunction ranges from swallow therapy in select cases to botulinum toxin injection, passive or active dilation, or open or endoscopic surgical myotomy. While few randomized controlled trials exist comparing treatment modalities, patient factors such as risks associated with general anesthesia and surgeon and patient goals can help direct a treatment plan.