In essence, the forces of swallowing are delivered against a somewhat unyielding muscle, and this causes the wall of the swallowing passage just above the cricopharyngeus muscle (i.e., the upper esophageal sphincter) to balloon outward. Hence, unknown to many, the Zenker’s diverticulum is only the reflection of the main problem, which is cricopharyngeal dysfunction.
Treatment for ZD
Myotomy of the cricopharyngeus muscle tends to resolve symptoms, even though the Zenker’s diverticulum is left in place and not removed.
Photo Essays of Zenkers Diverticulum
Post-swallow Return of Saliva into the Hypopharynx
This man began to experience solid food lodgment a few years earlier, along with gurgling noises every time he swallows. Even on an initial examination, Zenker’s diverticulum can be strongly suspected based on the findings of the videoendoscopic swallow study (VESS). Upon review of a videofluoroscopic swallow study (VFSS), a Zenker’s diverticulum is indeed the explanation for the findings below, which went away completely (return of saliva, gurgling noises, and food lodgment) after myotomy.
Reflux Into Hypopharynx, Characteristic of Cricopharyngeal Dysfunction
Videoendoscopic View of Zenker’s Sac Opening and Cricopharyngeus Bar
Cricopharyngeus Non-Relaxation and Zenker’s Sac Seen During VESS
Zenker’s Diverticulum Returns Its Contents Upwards to the Throat After Each Swallow
Post-swallow Hypopharyngeal Reflux (Zenker’s Diverticulum): VESS vs. VFSS
A-CPD with or without Zenker’s Diverticulum
A small percentage of (mostly) older people develop a progressive but treatable swallowing disorder called antegrade cricopharyngeal dysfunction (A-CPD). They have difficulty initially with solid foods and pills.
As the months and years pass, the tendency for food to lodge in the throat gradually increases. Eventually, they must limit their diets to softer and “easier” things more and more like “baby food.” Special focus is placed on an effective endoscopic (through the mouth) laser procedure: cricopharyngeal myotomy.