Failure of cricopharyngeal myotomy to improve dysphagia following head and neck cancer surgery

Objective: To determine whether cricopharyngeal myotomy can improve dysphagia associated with head and neck cancer surgery. Design: Prospective, randomized, multicenter trial. Setting: Twelve clinical sites across the United States. Patients: Between 1989 and 1994, 125 patients undergoing combined modality therapy for head and neck cancer, including resection of the tongue base or supraglottic larynx, were prospectively entered into the trial. Intervention: Cricopharyngeal myotomy on a randomized basis. Main Outcome Measures: Videofluoroscopic examination to determine oropharyngeal swallowing efficiency, which is defined as the ratio of percentage of the bolus swallowed to total swallowing time using 3 different bolus consistencies. Results: No significant difference in oropharyngeal swallowing efficiency between myotomy vs no myotomy was seen at 6 months of follow-up regardless of bolus consistency. Conclusions: In this prospective test of cricopharyngeal myotomy, the procedure fails to significantly improve dysphagia associated with head and neck cancer surgery. The efficacy of this surgical procedure in other disease entities should also be rigorously explored.