The Experts below are selected from a list of 288 Experts worldwide ranked by ideXlab platform
André Duranceau - One of the best experts on this subject based on the ideXlab platform.
-
open and endoscopic Cricopharyngeal Myotomy
2013Co-Authors: André DuranceauAbstract:Cricopharyngeal Myotomy is a recognized treatment for disorders of the pharyngoesophageal junction. The etiology of these disorders is either neurologic, muscular, idiopathic, iatrogenic or may result from distal esophageal dysfunction or obstruction. Independently of the cause for the abnormal function, the operation aims at improving bolus transport from pharynx to cervical esophagus. Indications investigation and the open approach technique are described with the rationale for the operation. The clinical and functional results are discussed for each category of dysfunction. The recent literature emphasizes the advent of minimally invasive surgery to remove the obstructive effects of the upper esophageal sphincter. The vast majority of these operations are now reported for the pharyngoesophageal diverticulum. However, endoscopic Cricopharyngeal Myotomy has now been performed for Cricopharyngeal dysfunction. This chapter aims at reviewing the results of both the open or endoscopic Cricopharyngeal Myotomy to treat oropharyngeal dysphagia.
-
Cricopharyngeal Myotomy for neurogenic oropharyngeal dysphagia
The Journal of Thoracic and Cardiovascular Surgery, 1997Co-Authors: Nancy Poirier, A. Nosadini, Raymond Taillefer, Alberto Peracchia, Luigi Bonavina, André DuranceauAbstract:Background: Forty patients (18 women, 22 men) with incapacitating oropharyngeal dysphagia of neurologic origin underwent Cricopharyngeal Myotomy. The subjective and objective response to Myotomy was analyzed retrospectively with a mean postoperative follow-up of 48 months (range 1 to 255 months). Results: Radiologic evidence of functional obstruction caused by incoordination and incomplete relaxation of the upper esophageal sphincter was significantly reduced. Manometric recordings of resting and closing pressures of the upper esophageal sphincter were also significantly altered by the Myotomy. Resting pressures decreased from 65 to 18 mm Hg and closing pressures dropped from 69 to 22 mm Hg. The relaxation time and poor coordination at the level of the upper esophageal sphincter, observed in the preoperative period, persisted after the operation. Radionuclide emptying studies in which a single liquid bolus was used showed persistent hypopharyngeal stasis with a 20% retention of radioactive material at 120 seconds. Subjectively, 33 patients initially had frequent aspiration episodes. Twenty became free of symptoms after Myotomy (p < 0.01) and in six others the symptoms were improved. Overall, seven patients claimed to be free of symptoms of dysphagia and no longer had pharyngo-oral or pharyngonasal regurgitations and aspirations after their operation. Twenty-three other patients had improvement in symptoms. Ten patients reported no change in symptoms. All of them either were unable to swallow voluntarily or had dysarthria when assessed before the operation. One retropharyngeal hematoma is the only postoperative complication recorded. The operative mortality was 2.5% (1/40). Conclusion: Cricopharyngeal Myotomy palliates neurogenic oropharyngeal dysphagia in patients with intact oral-phase deglutition.
-
sleeve recording of upper esophageal sphincter resting pressures during Cricopharyngeal Myotomy
Annals of Surgery, 1997Co-Authors: Manuel Pera, Akira Yamada, Clement A. Hiebert, André DuranceauAbstract:Objective The manometric effects of a 6-cm Cricopharyngeal Myotomy are recorded while the operation is being performed from cervical esophagus to the cricopharyngeus and then to the hypopharynx. Background Data Cricopharyngeal Myotomy is used in the treatment of oropharyngeal dysphagia of different causes. The operation decreases the resting pressure in the upper esophageal sphincter (UES). The components responsible for this decrease have not been clarified. Methods Fourteen patients with oropharyngeal dysphagia underwent a sleeve recording of the UES resting pressures under general anesthesia before and after sequential Myotomy of the pharyngoesophageal junction. Patients were assessed in the awake state before and after the whole Myotomy. Results Upper esophageal pressures remain unchanged after division of 2 cm of the cervical esophageal muscle. Section of 2 cm of the Cricopharyngeal area results in a significant decrease of the sphincter resting pressure (p < 0.01). The division of 2 cm of hypopharyngeal muscle results in a further significant reduction of the resting pressure (p < 0.005). Conclusions Extension of the Cricopharyngeal Myotomy over hypopharyngeal musculature produces a more significant decrease of UES resting pressure.
-
Cricopharyngeal Myotomy for neurogenic oropharyngeal dysphagia
'Elsevier BV', 1997Co-Authors: N. C. Poirier, A. Nosadini, Raymond Taillefer, Alberto Peracchia, Luigi Bonavina, André DuranceauAbstract:Forty patients (18 women, 22 men) with incapacitating oropharyngeal dysphagia of neurologic origin underwent Cricopharyngeal Myotomy. The subjective and objective response to Myotomy was analyzed retrospectively with a mean postoperative follow-up of 48 months (range 1 to 255 months)
-
Sleeve recording of upper esophageal sphincter resting pressures during Cricopharyngeal Myotomy.
Annals of surgery, 1997Co-Authors: Manuel Pera, Akira Yamada, Clement A. Hiebert, André DuranceauAbstract:The manometric effects of a 6-cm Cricopharyngeal Myotomy are recorded while the operation is being performed from cervical esophagus to the cricopharyngeus and then to the hypopharynx. Cricopharyngeal Myotomy is used in the treatment of oropharyngeal dysphagia of different causes. The operation decreases the resting pressure in the upper esophageal sphincter (UES). The components responsible for this decrease have not been clarified. Fourteen patients with oropharyngeal dysphagia underwent a sleeve recording of the UES resting pressures under general anesthesia before and after sequential Myotomy of the pharyngoesophageal junction. Patients were assessed in the awake state before and after the whole Myotomy. Upper esophageal pressures remain unchanged after division of 2 cm of the cervical esophageal muscle. Section of 2 cm of the Cricopharyngeal area results in a significant decrease of the sphincter resting pressure (p < 0.01). The division of 2 cm of hypopharyngeal muscle results in a further significant reduction of the resting pressure (p < 0.005). Extension of the Cricopharyngeal Myotomy over hypopharyngeal musculature produces a more significant decrease of UES resting pressure.
Manuel Pera - One of the best experts on this subject based on the ideXlab platform.
-
sleeve recording of upper esophageal sphincter resting pressures during Cricopharyngeal Myotomy
Annals of Surgery, 1997Co-Authors: Manuel Pera, Akira Yamada, Clement A. Hiebert, André DuranceauAbstract:Objective The manometric effects of a 6-cm Cricopharyngeal Myotomy are recorded while the operation is being performed from cervical esophagus to the cricopharyngeus and then to the hypopharynx. Background Data Cricopharyngeal Myotomy is used in the treatment of oropharyngeal dysphagia of different causes. The operation decreases the resting pressure in the upper esophageal sphincter (UES). The components responsible for this decrease have not been clarified. Methods Fourteen patients with oropharyngeal dysphagia underwent a sleeve recording of the UES resting pressures under general anesthesia before and after sequential Myotomy of the pharyngoesophageal junction. Patients were assessed in the awake state before and after the whole Myotomy. Results Upper esophageal pressures remain unchanged after division of 2 cm of the cervical esophageal muscle. Section of 2 cm of the Cricopharyngeal area results in a significant decrease of the sphincter resting pressure (p < 0.01). The division of 2 cm of hypopharyngeal muscle results in a further significant reduction of the resting pressure (p < 0.005). Conclusions Extension of the Cricopharyngeal Myotomy over hypopharyngeal musculature produces a more significant decrease of UES resting pressure.
-
Sleeve recording of upper esophageal sphincter resting pressures during Cricopharyngeal Myotomy.
Annals of surgery, 1997Co-Authors: Manuel Pera, Akira Yamada, Clement A. Hiebert, André DuranceauAbstract:The manometric effects of a 6-cm Cricopharyngeal Myotomy are recorded while the operation is being performed from cervical esophagus to the cricopharyngeus and then to the hypopharynx. Cricopharyngeal Myotomy is used in the treatment of oropharyngeal dysphagia of different causes. The operation decreases the resting pressure in the upper esophageal sphincter (UES). The components responsible for this decrease have not been clarified. Fourteen patients with oropharyngeal dysphagia underwent a sleeve recording of the UES resting pressures under general anesthesia before and after sequential Myotomy of the pharyngoesophageal junction. Patients were assessed in the awake state before and after the whole Myotomy. Upper esophageal pressures remain unchanged after division of 2 cm of the cervical esophageal muscle. Section of 2 cm of the Cricopharyngeal area results in a significant decrease of the sphincter resting pressure (p < 0.01). The division of 2 cm of hypopharyngeal muscle results in a further significant reduction of the resting pressure (p < 0.005). Extension of the Cricopharyngeal Myotomy over hypopharyngeal musculature produces a more significant decrease of UES resting pressure.
Clement A. Hiebert - One of the best experts on this subject based on the ideXlab platform.
-
sleeve recording of upper esophageal sphincter resting pressures during Cricopharyngeal Myotomy
Annals of Surgery, 1997Co-Authors: Manuel Pera, Akira Yamada, Clement A. Hiebert, André DuranceauAbstract:Objective The manometric effects of a 6-cm Cricopharyngeal Myotomy are recorded while the operation is being performed from cervical esophagus to the cricopharyngeus and then to the hypopharynx. Background Data Cricopharyngeal Myotomy is used in the treatment of oropharyngeal dysphagia of different causes. The operation decreases the resting pressure in the upper esophageal sphincter (UES). The components responsible for this decrease have not been clarified. Methods Fourteen patients with oropharyngeal dysphagia underwent a sleeve recording of the UES resting pressures under general anesthesia before and after sequential Myotomy of the pharyngoesophageal junction. Patients were assessed in the awake state before and after the whole Myotomy. Results Upper esophageal pressures remain unchanged after division of 2 cm of the cervical esophageal muscle. Section of 2 cm of the Cricopharyngeal area results in a significant decrease of the sphincter resting pressure (p < 0.01). The division of 2 cm of hypopharyngeal muscle results in a further significant reduction of the resting pressure (p < 0.005). Conclusions Extension of the Cricopharyngeal Myotomy over hypopharyngeal musculature produces a more significant decrease of UES resting pressure.
-
Sleeve recording of upper esophageal sphincter resting pressures during Cricopharyngeal Myotomy.
Annals of surgery, 1997Co-Authors: Manuel Pera, Akira Yamada, Clement A. Hiebert, André DuranceauAbstract:The manometric effects of a 6-cm Cricopharyngeal Myotomy are recorded while the operation is being performed from cervical esophagus to the cricopharyngeus and then to the hypopharynx. Cricopharyngeal Myotomy is used in the treatment of oropharyngeal dysphagia of different causes. The operation decreases the resting pressure in the upper esophageal sphincter (UES). The components responsible for this decrease have not been clarified. Fourteen patients with oropharyngeal dysphagia underwent a sleeve recording of the UES resting pressures under general anesthesia before and after sequential Myotomy of the pharyngoesophageal junction. Patients were assessed in the awake state before and after the whole Myotomy. Upper esophageal pressures remain unchanged after division of 2 cm of the cervical esophageal muscle. Section of 2 cm of the Cricopharyngeal area results in a significant decrease of the sphincter resting pressure (p < 0.01). The division of 2 cm of hypopharyngeal muscle results in a further significant reduction of the resting pressure (p < 0.005). Extension of the Cricopharyngeal Myotomy over hypopharyngeal musculature produces a more significant decrease of UES resting pressure.
Akira Yamada - One of the best experts on this subject based on the ideXlab platform.
-
sleeve recording of upper esophageal sphincter resting pressures during Cricopharyngeal Myotomy
Annals of Surgery, 1997Co-Authors: Manuel Pera, Akira Yamada, Clement A. Hiebert, André DuranceauAbstract:Objective The manometric effects of a 6-cm Cricopharyngeal Myotomy are recorded while the operation is being performed from cervical esophagus to the cricopharyngeus and then to the hypopharynx. Background Data Cricopharyngeal Myotomy is used in the treatment of oropharyngeal dysphagia of different causes. The operation decreases the resting pressure in the upper esophageal sphincter (UES). The components responsible for this decrease have not been clarified. Methods Fourteen patients with oropharyngeal dysphagia underwent a sleeve recording of the UES resting pressures under general anesthesia before and after sequential Myotomy of the pharyngoesophageal junction. Patients were assessed in the awake state before and after the whole Myotomy. Results Upper esophageal pressures remain unchanged after division of 2 cm of the cervical esophageal muscle. Section of 2 cm of the Cricopharyngeal area results in a significant decrease of the sphincter resting pressure (p < 0.01). The division of 2 cm of hypopharyngeal muscle results in a further significant reduction of the resting pressure (p < 0.005). Conclusions Extension of the Cricopharyngeal Myotomy over hypopharyngeal musculature produces a more significant decrease of UES resting pressure.
-
Sleeve recording of upper esophageal sphincter resting pressures during Cricopharyngeal Myotomy.
Annals of surgery, 1997Co-Authors: Manuel Pera, Akira Yamada, Clement A. Hiebert, André DuranceauAbstract:The manometric effects of a 6-cm Cricopharyngeal Myotomy are recorded while the operation is being performed from cervical esophagus to the cricopharyngeus and then to the hypopharynx. Cricopharyngeal Myotomy is used in the treatment of oropharyngeal dysphagia of different causes. The operation decreases the resting pressure in the upper esophageal sphincter (UES). The components responsible for this decrease have not been clarified. Fourteen patients with oropharyngeal dysphagia underwent a sleeve recording of the UES resting pressures under general anesthesia before and after sequential Myotomy of the pharyngoesophageal junction. Patients were assessed in the awake state before and after the whole Myotomy. Upper esophageal pressures remain unchanged after division of 2 cm of the cervical esophageal muscle. Section of 2 cm of the Cricopharyngeal area results in a significant decrease of the sphincter resting pressure (p < 0.01). The division of 2 cm of hypopharyngeal muscle results in a further significant reduction of the resting pressure (p < 0.005). Extension of the Cricopharyngeal Myotomy over hypopharyngeal musculature produces a more significant decrease of UES resting pressure.
Peak Woo - One of the best experts on this subject based on the ideXlab platform.
-
Transoral resection of short segment Zenker's diverticulum and Cricopharyngeal Myotomy: An alternative minimally invasive approach
The Laryngoscope, 2010Co-Authors: Melissa Mortensen, Madeleine R. Schaberg, Eric M. Genden, Peak WooAbstract:Transoral treatment of Cricopharyngeal bar and small Zenker's diverticulum remains a challenge. We propose a new transoral approach for transoral Cricopharyngeal Myotomy (TOCPM) for patients with Cricopharyngeal spasm and pharyngeal bar, and for transoral resection of diverticula (TORD) with Cricopharyngeal Myotomy in the patient with small (<3 cm) Zenker's diverticulum. A retrospective review was conducted of 45 patients with Cricopharyngeal spasm (21) and Zenker's diverticulum (24), where 14 patients were considered suitable for TORD and TOCPM. TOCPM used the Weerda laryngoscope (Karl Storz, Tuttlingen, Germany) to expose the Cricopharyngeal bar using a microscope; the mucosa is cut and then the muscle is transected using monopolar cautery. A 0 degrees endoscope is inserted through the incision to ensure complete Myotomy. Incision closure is by interrupted 4-0 Vicryl sutures (Ethicon Inc., Somerville, NJ) and fibrin glue. For the TORD procedure, the diverticular sac is everted and then resected using scissors. Through the sac opening, the TOCPM is completed. The sac opening is then closed as described in TOCPM. The patients are kept without food for 24 hours, followed by feeding and discharge. Modified barium swallow (MBS) evaluated functional results. Fourteen patients underwent TOCPM (eight), and TOCPM+TORD (six). There was one case of TOCPM that was aborted due to excessive bleeding, which prevented full Myotomy. The rest did well. All were discharged the next day. Two poor results from the TOCPM and TOCPM+TORD group were due to poor esophageal motility. The remainder of patients had resolution of dysphagia and normalized MBS. No patient developed stricture or complications. Short segment Zenker's diverticulum and Cricopharyngeal bar can now be addressed completely with a transoral approach. Because there is complete closure of the mucosal incision, prolonged hospitalization can be avoided.
-
transoral resection of short segment zenker s diverticulum and Cricopharyngeal Myotomy an alternative minimally invasive approach
Laryngoscope, 2009Co-Authors: Melissa Mortensen, Madeleine R. Schaberg, Eric M. Genden, Peak WooAbstract:Objectives/Hypothesis: Transoral treatment of Cricopharyngeal bar and small Zenker's diverticulum remains a challenge. We propose a new transoral approach for transoral Cricopharyngeal Myotomy (TOCPM) for patients with Cricopharyngeal spasm and pharyngeal bar, and for transoral resection of diverticula (TORD) with Cricopharyngeal Myotomy in the patient with small (<3 cm) Zenker's diverticulum. Methods: A retrospective review was conducted of 45 patients with Cricopharyngeal spasm (21) and Zenker's diverticulum (24), where 14 patients were considered suitable for TORD and TOCPM. TOCPM used the Weerda laryngoscope (Karl Storz, Tuttlingen, Germany) to expose the Cricopharyngeal bar using a microscope; the mucosa is cut and then the muscle is transected using monopolar cautery. A 0° endoscope is inserted through the incision to ensure complete Myotomy. Incision closure is by interrupted 4-0 Vicryl sutures (Ethicon Inc., Somerville, NJ) and fibrin glue. For the TORD procedure, the diverticular sac is everted and then resected using scissors. Through the sac opening, the TOCPM is completed. The sac opening is then closed as described in TOCPM. The patients are kept without food for 24 hours, followed by feeding and discharge. Modified barium swallow (MBS) evaluated functional results. Results: Fourteen patients underwent TOCPM (eight), and TOCPM+TORD (six). There was one case of TOCPM that was aborted due to excessive bleeding, which prevented full Myotomy. The rest did well. All were discharged the next day. Two poor results from the TOCPM and TOCPM+TORD group were due to poor esophageal motility. The remainder of patients had resolution of dysphagia and normalized MBS. No patient developed stricture or complications. Conclusions: Short segment Zenker's diverticulum and Cricopharyngeal bar can now be addressed completely with a transoral approach. Because there is complete closure of the mucosal incision, prolonged hospitalization can be avoided.