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Targeted use of endoscopic CO2 laser cricopharyngeal myotomy for improving swallowing function following head and neck cancer treatment

Published online by Cambridge University Press:  11 November 2014

N Dawe ,
J Patterson ,
D Hamilton  and
C Hartley
N Dawe*
Affiliation:
ENT Department, Sunderland Royal Hospital, UK
J Patterson
Affiliation:
Speech and Language Therapy Department, Sunderland Royal Hospital, UK
D Hamilton
Affiliation:
ENT Department, Sunderland Royal Hospital, UK
C Hartley
Affiliation:
ENT Department, Sunderland Royal Hospital, UK
*
Address for correspondence: Mr Nicholas Dawe, ENT Department, Sunderland Royal Hospital, Kayll Road, Sunderland, SR4 7TPUnited Kingdom E-mail: N.DAWE@NHS.NET
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Abstract

Background:

Cricopharyngeal dysfunction following head and neck cancer treatment may lead to a significant reduction in oral intake. Carbon dioxide laser is an established procedure for the treatment of non-malignant cricopharyngeal disorders. We report our experience of laser cricopharyngeal myotomy with objective swallowing outcome measures, before and after treatment.

Methods:

We identified 11 patients who had undergone carbon dioxide laser cricopharyngeal myotomy for dysphagia following radiotherapy, with or without chemotheraphy between January 2006 and July 2011. We analysed the swallowing outcomes following carbon dioxide laser cricopharyngeal myotomy by retrospective grading of pre- and post-procedure videofluoroscopic swallowing study of liquids, using the validated Modified Barium Swallow Impairment Profile.

Results:

The median Modified Barium Swallow Impairment Profile score was 13 pre-myotomy and 10 post-myotomy. This difference between scores was non-significant (p = 0.41). The median, cricopharyngeal-specific Modified Barium Swallow Impairment Profile variables (14 and 17) improved from 3 to 2, but were similarly non-significant (p = 0.16). We observed the improved Modified Barium Swallow Impairment Profile scores post-procedure in the majority of patients.

Conclusion:

Endoscopic carbon dioxide laser cricopharyngeal myotomy remains a viable option in treatment-related cricopharyngeal dysfunction; its targeted role requires further prospective study. Objective analysis of the technique can be reported using the validated Modified Barium Swallow Impairment Profile.

Keywords

Esophageal Sphincter, UpperPharyngeal MusclesHead and Neck NeoplasmsDeglutition DisordersRadiotherapyChemoradiotherapy
Type
Short Communication
Information
The Journal of Laryngology & Otology , Volume 128 , Issue 12 , December 2014 , pp. 1105 - 1110
Copyright
Copyright © JLO (1984) Limited 2014 

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Footnotes

Presented as a poster at the 14th British Academic Conference in Otolaryngology, 4–7 July 2012, Glasgow, United Kingdom

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