Dysphagia surgery
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Dysphagia surgery On the Web |
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American Roentgen Ray Society Images of Dysphagia surgery |
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Feham Tariq, MD [2], Hamid Qazi, MD, BSc [3]
Overview
Surgery is not the first-line treatment option for patients with dysphagia. Surgery is usually reserved for patients with either dysphagia leading to life-threatening aspiration, airway protection, and [indication 3]
Surgical Treatment of Oropharyngeal Dysphagia
Surgical treatments are usually only recommended as a last resort and is dependent on the underlying cause of dysphagia.
- Zenker's Diverticulectomy
- Surgery is the most definitive therapy for the Zenker's diverticulum..
- Tracheotomy
- Used for chronic aspiration
- The four major types of percutaneous tracheotomy:[1][2][3][4]
- Ciaglia's dilation over guidewire
- Grigg's modification employing guidewire dilating forceps
- Fantoni's translaryngeal tracheotomy, in which the tracheostomy tube is pulled from inside the trachea to outside at once without the need for serial dilation
- PercuTwist method, which utilizes a screw-in dilator
- Tracheostomy
- Vocal fold augmentation/injection
- Thryoplasty medialization
- Arytenoid adduction
- Partial or total laryngectomy
- Laryngotracheal separation
- Supralaryngetomy
- Palatoplasty
- Cricopharyngeal Myotomy
- Percutaneous endoscopic gastrostomy
Surgical Treatment of Esophageal Dysphagia
- Surgical treatment of esophageal dysphagia is dependent on the underlying cause of dysphagia.
- Please click on each medical condition listed below to read about the management.
- Cricopharyngeal myotomy technique is as follows:[5][6]
- Oblique, transverse, or S-shaped cervical incision is made preferably on the left side on the neck
- Dissection the sternocleidomastoid muscle and carotid sheath are retracted
- Laryngopharynx is then mobilized by blunt dissection to expose the cricopharyngeus muscle
- Intraluminal esophageal Foley catheter or the cuff of a second endotracheal tube inserted into the esophagus can be inflated to visualize the horizontal fibers of the cricopharyngeus muscles
- Intact esophageal mucosa should be visualized after myotomy
- Prevent fistula or mediastinitis any esophageal mucosa damage should be repaired
- Peptic stricture
- Esophageal rings and webs
- Esophageal cancer
- Achalasia
- Spastic motility disorders
- Diffuse esophageal spasm
- Nutcracker esophagus
- Hypertensive lower esophageal sphincter
- Nonspecific spastic esophageal motility disorders
References
- ↑ Ciaglia P, Firsching R, Syniec C (1985). "Elective percutaneous dilatational tracheostomy. A new simple bedside procedure; preliminary report". Chest. 87 (6): 715–9. PMID 3996056.
- ↑ Fantoni A, Ripamonti D (1997). "A non-derivative, non-surgical tracheostomy: the translaryngeal method". Intensive Care Med. 23 (4): 386–92. PMID 9142576.
- ↑ Belanger, Adam; Akulian, Jason (2014). "Interventional Pulmonology in the Intensive Care Unit: Percutaneous Tracheostomy and Gastrostomy". Seminars in Respiratory and Critical Care Medicine. 35 (06): 744–750. doi:10.1055/s-0034-1395504. ISSN 1069-3424.
- ↑ Griggs WM, Worthley LI, Gilligan JE, Thomas PD, Myburg JA (1990). "A simple percutaneous tracheostomy technique". Surg Gynecol Obstet. 170 (6): 543–5. PMID 2343371.
- ↑ Yip, Helena T.; Leonard, Rebecca; Kendall, Katherine A. (2006). "Cricopharyngeal Myotomy Normalizes the Opening Size of the Upper Esophageal Sphincter in Cricopharyngeal Dysfunction". The Laryngoscope. 116 (1): 93–96. doi:10.1097/01.mlg.0000184526.89256.85. ISSN 0023-852X.
- ↑ Lucke, C.; Meffert, O.; Weiß, D. (2008). "Cricopharyngeale Achalasie beim Schlaganfallpatienten". DMW - Deutsche Medizinische Wochenschrift. 109 (20): 792–795. doi:10.1055/s-2008-1069275. ISSN 0012-0472.