Failure of the tonically contracted upper esophageal sphincter to relax and open when one swallows. Antegrade cricopharyngeal dysfunction (A-CPD) is also known as cricopharyngeal achalasia. The cause is usually unknown.
The upper esophageal sphincter is also known as the cricopharyngeus muscle and is located at the lower level of the voicebox or larynx. This muscle is always contracted except at the moment of swallowing, when it relaxes briefly to let food or liquid pass through.
Symptoms and treatment for A-CPD:
Typically, individuals with cricopharyngeal dysfunction first notice that pills or solid food begin to lodge at the level of the lower part of the larynx. The problem tends to progress inexorably, though often slowly, as the years pass, until the individual must limit himself or herself to liquid and soft foods. Cricopharyngeal dysfunction is fully resolved through a straightforward surgical procedure (cricopharyngeal myotomy), performed through the mouth with the laser or, only occasionally, through a neck incision. See also: Zenker’s diverticulum.
Antegrade Cricopharyngeal Dysfunction, Before and After Myotomy
Very High-pitched Voice Elicits the Same Pharynx Contraction as Swallowing
Antegrade Cricopharyngeal Dysfunction, with Incipient Zenker’s
Reflux Into Hypopharynx, Characteristic of Antegrade Cricopharyngeal Dysfunction
Cricopharyngeus Non-Relaxation and Zenker’s Sac Seen During VESS
Videos:
Dr. Bastian explains this progressive swallowing problem and presents options for treatment. Cricopharyngeal dysfunction is caused by failure of relaxation of the upper esophageal sphincter—cricopharyngeus muscle—during eating. Typically it is solid foods that tend to lodge in the mid-neck area where this muscle is located.
This video shows x-rays of barium passing through the throat, first with a narrowed area caused by a non-relaxing upper esophageal sphincter (cricopharyngeus muscle), and then after laser division of this muscle. Preoperatively, food and pills were getting stuck at the level of the mid-neck, and the person was eating mostly soft foods. After the myotomy (division of the muscle), the patient could again swallow meat, pizza, pills, etc. without difficulty.
This video gives an overview of how swallowing works, how it can sometimes go wrong (presbyphagia or cricopharyngeal dysfunction), and possible ways to treat those problems (swallowing therapy or cricopharyngeal myotomy).