Modified Anterior Cricopharyngeal Myotomy Technique for Treatment of Adults with Cricopharyngeal Bar

Monday, October 13, 2025

1:00 PM - 1:06 PM EDT

Location: 242

Disclosure(s):

Derek A. Escalante, MD:

faculty for this accredited education activity has no relationship(s) with ineligible companies to disclose.

Keith D. Volner, DO:

faculty for this accredited education activity has no relationship(s) with ineligible companies to disclose.

Introduction: Cricopharyngeal bar is classically treated with a posterior cricopharyngeal (CP) myotomy as the only open option. We present a modified CP myotomy technique based on anatomic principles, previously described only in children, for treatment of adults with obstructing cricopharyngeal bars.

Methods: This retrospective case series examines outcomes of patients who underwent modified anterior CP myotomy in October 2024. A 41 year old man and 35 year old woman with dysphagia and prominent cricopharyngeal bars on videofluoroscopic swallow study (VFSS) underwent modified CP myotomy as described by Mohan et al in 2018: a midline horizontal incision was made inferior to the cricoid, the midline raphe was divided, and the cricopharyngeus was isolated at its anterolateral attachment to the cricoid bilaterally and transected vertically. Pre and postoperative EAT-10 questionnaires, Pill-5 scores, Functional Outcomes Swallowing Scale Scores (FOSS), VFSS and speech and language pathology (SLP) interpretations were compared.

Results: Both patients resumed a regular diet on post op day 0 and noted immediate improvement in dysphagia with no complications. Post-operative FOSS stages normalized to 0 in both patients. Pre and post-op EAT-10 and Pill-5 scores available for one patient improved from 22 to 2 and from 9 to 0, respectively. The cricopharyngeal bars resolved on post-operative VFSS. SLP determination of pharyngoesophageal segment opening on VFSS review normalized in both patients to 0 (complete distension; no obstruction to flow) post-operatively.

Conclusions: Modified anterior CP myotomy with division of the cricopharyngeus muscle fibers at the attachment to the cricoid is a feasible and safe treatment for dysphagia caused by cricopharyngeal dysfunction in adults. This technique allows for immediate oral intake post-operatively, can result in immediate resolution of dysphagia symptoms, and obviates many of the risks inherent to the posterior approach to cricopharyngeal myotomy. Larger studies will allow for more robust comparison of pre and post-operative variables.

Presenting Author(s)

Keith D. Volner, DO

Pediatric Otolaryngologist
Tripler Army Medical Center
Honolulu, HI, United States

Disclosure information not submitted.

Co-Author(s)

Derek A. Escalante, MD

Chief of ENT Department
Darnall Army Medical Center
Belton, TX, United States

Disclosure information not submitted.
Lauren M. Welby Berra, MD

Resident Physician
Baylor COM – Temple Campus/Scott and White Otolaryngology
Temple, TX, United States

Disclosure information not submitted.
FC

Forrest D. Craig, MD

Chief, Dept of Surgery
Darnall Army Medical Center
Fort Hood, TX, United States

Disclosure information not submitted.
RO

Renee Ocampo, CCC-SLP

Darnall Army Medical Center, United States

Disclosure information not submitted.
RF

Rebecca Fowler, CCC-SLP

Darnall Army Medical Center, United States

Disclosure information not submitted.

Senior Author(s)

Keith D. Volner, DO

Pediatric Otolaryngologist
Tripler Army Medical Center
Honolulu, HI, United States

Disclosure(s):
faculty for this accredited education activity has no relationship(s) with ineligible companies to disclose.