Surgical rehabilitation of neuromuscular swallowing disorders with special regard to cricopharyngeal myotomy and glottopexy

Background: The surgical rehabilitation of patients with swallowing disorders caused by neuromuscular insufficiency with life-threatening aspiration presents a special challenge to the ENT-surgeon. Methods: In a period of 5 years we decided on a surgical treatment in altogether 12 patients with paralytical dysphagia. In 6 patients we combined a cricopharyngeal myotomy with a complete closure of the glottis, in 5 patients we performed a sole cricopharyngeal myotomy. In another patient we restricted ourselves to glottopexy only. Results: In all cases the dysphagia giving rise to the surgical intervention was regredient so far that the removal of the percutan endoscopic gastrostomy postsurgically was possible. 3 special cases are presented in detail. Discussion: The main part of the therapy is the subtle and complete cricopharyngeal myotomy. Particulary good results are available with a combination of the latter with a reversible glottopexy. Conclusions: After the failure of conservative therapy the indication for a surgical treatment should be made on a large scale.