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

  • N Dawe (a1), J Patterson (a2), D Hamilton (a1) and C Hartley (a1)



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.


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.


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.


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.


Corresponding author

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



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1Gillespie, MB, Brodsky, MB, Day, TA, Lee, FS, Martin-Harris, B. Swallowing-related quality of life after head and neck cancer treatment. Laryngoscope 2004;114:1362–7
2Nguyen, NP, Sallah, S, Karlsson, U, Antoine, JE. Combined chemotherapy and radiation therapy for head and neck malignancies: quality of life issues. Cancer 2002;94:1131–41
3Pauloski, BR, Rademaker, AW, Logemann, JA, Newman, L, MacCracken, E, Gaziano, J et al. Relationship between swallow motility disorders on videofluorography and oral intake in patients treated for head and neck cancer with radiotherapy with or without chemotherapy. Head Neck 2006;28:1069–76
4Wang, JJ, Goldsmith, TA, Holman, AS, Cianchetti, M, Chan, AW. Pharyngoesophageal stricture after treatment for head and neck cancer. Head Neck 2012;34:967–73
5Pitman, M, Weissbrod, P. Endoscopic CO2 laser cricopharyngeal myotomy. Laryngoscope 2009;119:4553
6Silver, N. Endoscopic cricopharyngeal myotomy for stenosis after XRT. Otolaryngol Head Neck Surg 2010;143(suppl):183–4
7Martin-Harris, B, Brodsky, MB, Michel, Y, Castell, DO, Schleicher, M, Sandidge, J et al. MBS measurement tool for swallow impairment—MBSImp: establishing a standard. Dysphagia 2008;23:392405
8Bonett, DG, Price, RM. Statistical inference for a linear function of medians: confidence intervals, hypothesis testing, and sample size requirements. Psychol Methods 2002;7:370–83
9List, MA, Ritter-Sterr, C, Lansky, SB. A performance status scale for head and neck cancer patients. Cancer 1990;66:564–9
10Sandidge, J. The Modified Barium Swallow Impairment Profile (MBSImP): a new standard physiologic approach to swallowing assessment and targeted treatment. Perspectives on Swallowing and Swallowing Disorders (Dysphagia) 2009;18:117–22
11Rosenthal, DI, Lewin, JS, Eisbruch, A. Prevention and treatment of dysphagia and aspiration after chemoradiation for head and neck cancer. J Clin Oncol 2006;24:2636–43
12Horowitz, JB, Sasaki, CT. Effect of cricopharyngeus myotomy on postlaryngectomy pharyngeal contraction pressures. Laryngoscope 1993;103:138–40
13Jacobs, JR, Logemann, J, Pajak, TF, Pauloski, BR, Collins, S, Casiano, RR et al. Failure of cricopharyngeal myotomy to improve dysphagia following head and neck cancer surgery. Arch Otolaryngol Head Neck Surg 1999;125:942–6
14Dauer, E, Salassa, J, Iuga, L, Kasperbauer, J. Endoscopic laser vs open approach for cricopharyngeal myotomy. Otolaryngol Head Neck Surg 2006;134:830–5
15Brøndbo, K. Treatment of cricopharyngeal dysfunction by endoscopic laser myotomy. Acta Otolaryngol Suppl 2000;543:222–4
16Lawson, G, Remacle, M. Endoscopic cricopharyngeal myotomy: indications and technique. Curr Opin Otolaryngol Head Neck Surg 2006;14:437–41
17Herberhold, C, Walther, EK. Endoscopic laser myotomy in cricopharyngeal achalasia. Adv Otorhinolaryngol 1995;49:144–7
18Lim, RY. Endoscopic CO2 laser cricopharyngeal myotomy. J Clin Laser Med Surg 1995;13:241–7
19Takes, RP, van den Hoogen, FJ, Marres, HA. Endoscopic myotomy of the cricopharyngeal muscle with CO2 laser surgery. Head Neck 2005;27:703–9
20Bammer, T, Salassa, JR, Klingler, PJ. Comparison of methods for determining cricopharyngeal intrabolus pressure in normal patients as possible indicator for cricopharyngeal myotomy. Otolaryngol Head Neck Surg 2002;127:299308
21Halvorson, DJ, Kuhn, FA. Transmucosal cricopharyngeal myotomy with the potassium-titanyl-phosphate laser in the treatment of cricopharyngeal dysmotility. Ann Otol Rhinol Laryngol 1994;103:173–7
22Chang, CW, Liou, SS, Netterville, JL. Anatomic study of laser-assisted endoscopic cricopharyngeus myotomy. Ann Otol Rhinol Laryngol 2005;114:897901
23Chitose, S, Sato, K, Hamakawa, S, Umeno, H, Nakashima, T. A new paradigm of endoscopic cricopharyngeal myotomy with CO2 laser. Laryngoscope 2011;121:567–70
24Logemann, JA, Pauloski, BR, Rademaker, AW, Lazarus, CL, Gaziano, J, Stachowiak, L et al. Swallowing disorders in the first year after radiation and chemoradiation. Head Neck 2008;30:148–58



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