Cricopharyngeal Myotomy (CPM)
A procedure in which the cricopharyngeus muscle, which makes a “ring” around the upper esophagus, is divided or cut across in order to break its grip. A cricopharyngeal myotomy is done in cases where this cricopharyngeus muscle (i.e., the upper esophageal sphincter) fails to relax when one swallows (cricopharyngeal dysfunction), resulting in a functional obstruction.
Cricopharyngeal dysfunction can be seen alone, or, as illustrated below, in combination with a Zenker’s diverticulum. Symptoms of cricopharyngeal dysfunction include dysphagia, with solids more so than with liquids. If a Zenker’s diverticulum is present, the patient may also experience late “regurgitation” of undigested food retained for hours or longer in the sac.
Cricopharyngeal Myotomy
Cricopharyngeal myotomy (1 of 7)
Cricopharyngeal myotomy (1 of 7)
Cricopharyngeal myotomy (2 of 7)
Cricopharyngeal myotomy (2 of 7)
Cricopharyngeal myotomy (3 of 7)
Cricopharyngeal myotomy (3 of 7)
Cricopharyngeal myotomy (4 of 7)
Cricopharyngeal myotomy (4 of 7)
Cricopharyngeal myotomy (5 of 7)
Cricopharyngeal myotomy (5 of 7)
Cricopharyngeal myotomy (6 of 7)
Cricopharyngeal myotomy (6 of 7)
Cricopharyngeal myotomy (7 of 7)
Cricopharyngeal myotomy (7 of 7)
Cricopharyngeal Dysfunction, before and after Myotomy
Cricopharyngeal dysfunction: before myotomy (1 of 2)
Cricopharyngeal dysfunction: before myotomy (1 of 2)
Cricopharyngeal dysfunction: after myotomy, resolved (2 of 2)
Cricopharyngeal dysfunction: after myotomy, resolved (2 of 2)
Example 2
Cricopharyngeal dysfunction: before myotomy (1 of 2)
Cricopharyngeal dysfunction: before myotomy (1 of 2)
Cricopharyngeal dysfunction: after myotomy, resolved (1 of 2)
Cricopharyngeal dysfunction: after myotomy, resolved (1 of 2)
Example 3
Cricopharyngeal dysfunction: before myotomy (1 of 2)
Cricopharyngeal dysfunction: before myotomy (1 of 2)
Cricopharyngeal dysfunction: after myotomy (2 of 2)
Cricopharyngeal dysfunction: after myotomy (2 of 2)
Cricopharyngeus Myotomy for Recreational Eating and Management of Saliva
Panormaic view, post CPM (1 of 4)
Panormaic view, post CPM (1 of 4)
Trumpet maneuver (2 of 4)
Trumpet maneuver (2 of 4)
Closer view (3 of 4)
Closer view (3 of 4)
Well-managed saliva (4 of 4)
Well-managed saliva (4 of 4)
98 year-old before and after Myotomy
Immediately after swallowing (1 of 10)
Immediately after swallowing (1 of 10)
Zenker’s (2 of 10)
Zenker’s (2 of 10)
Dysphagia (3 of 10)
Dysphagia (3 of 10)
Residue from Zenker’s (4 of 10)
Residue from Zenker’s (4 of 10)
X-ray showing Zenker’s (5 of 10)
X-ray showing Zenker’s (5 of 10)
Moments later (6 of 10)
Moments later (6 of 10)
After myotomy (7 of 10)
After myotomy (7 of 10)
No residue (8 of 10)
No residue (8 of 10)
Zenker’s gone (9 of 10)
Zenker’s gone (9 of 10)
No barium in hypopharynx (10 of 10)
No barium in hypopharynx (10 of 10)
Great View of Fresh Cricopharyngeus Myotomy Surgical Wound
CPM dysfunction (1 of 4)
CPM dysfunction (1 of 4)
VFSS six years later (2 of 4)
VFSS six years later (2 of 4)
Five days post-op (3 of 4)
Five days post-op (3 of 4)
Cervical esopagus (4 of 4)
Cervical esopagus (4 of 4)
Bolus Stream before and after Cricopharyngeus Myotomy
Pre-myotomy (1 of 2)
Post-myotomy (2 of 2)
VESS (videoendoscopic swallow study) Findings after Radiotherapy
Narrowed pharyngeal wall (1 of 7)
Narrowed pharyngeal wall (1 of 7)
Swallowing applesauce (2 of 7)
Swallowing applesauce (2 of 7)
After sipping water (3 of 7)
After sipping water (3 of 7)
Gravity aiding in swallowing (4 of 7)
Gravity aiding in swallowing (4 of 7)
Lifting larynx (5 of 7)
Lifting larynx (5 of 7)
A closer look (6 of 7)
A closer look (6 of 7)
Gravity aiding again in swallowing (7 of 7)
Gravity aiding again in swallowing (7 of 7)
The Evolution of a Cricopharyngeus Myotomy Wound
Difficulty swallowing solid foods (1 of 8)
Difficulty swallowing solid foods (1 of 8)
Pooled saliva (2 of 8)
Pooled saliva (2 of 8)
Muscle bulge (3 of 8)
Muscle bulge (3 of 8)
Residue in swallow crescent (4 of 8)
Residue in swallow crescent (4 of 8)
Three weeks later (5 of 8)
Three weeks later (5 of 8)
Residual “wound” (6 of 8)
Residual “wound” (6 of 8)
Three months post-op (7 of 8)
Three months post-op (7 of 8)
At close range (8 of 8)
At close range (8 of 8)
Zenker’s Diverticulum a Week after Cricopharyngeus Myotomy
Zenker’s Sac (1 of 3)
Zenker’s Sac (1 of 3)
Zenker’s Sac (2 of 3)
Zenker’s Sac (2 of 3)
Zenker’s Sac (3 of 3)
Zenker’s Sac (3 of 3)

Swallowing Trouble 101
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).