cricopharyngeal

Cricopharyngeal refers to the cricopharyngeus muscle, the part of the inferior pharyngeal constrictor that forms the upper esophageal sphincter (UES). It lies at the junction between the laryngopharynx and the esophagus, at the level of the cricoid cartilage.

The cricopharyngeus maintains a tonic barrier at rest to prevent air from entering the esophagus and to limit reflux. During swallowing, it relaxes in coordination with hyolaryngeal elevation to open the UES and allow the bolus to pass from the pharynx into the esophagus.

Cricopharyngeal dysfunction (CPD) occurs when relaxation is delayed or the muscle remains overly tight. Patients may report dysphagia for liquids and/or solids, coughing or choking with meals, regurgitation, or a sensation of a lump in the throat (globus). CPD can be isolated or occur with other disorders such as Zenker’s diverticulum, stroke-related dysphagia, or radiation-induced changes.

Evaluation usually includes a videofluoroscopic swallow study (modified barium swallow) to assess UES opening, and esophageal manometry to measure resting pressure and relaxation of the cricopharyngeus. Endoscopy may be used to exclude structural lesions.

Treatment depends on cause and patient factors. Swallowing therapy with targeted maneuvers can improve function. If persistent, interventions include botulinum toxin injection into the cricopharyngeus to reduce tone, endoscopic or open cricopharyngeal myotomy, or dilation of the UES. In cases associated with Zenker’s diverticulum, the CP muscle is commonly addressed during diverticulectomy or diverticulotomy.