Surgery for Swallowing Disorders

If nonsurgical treatments of swallowing disorders do not help, your doctor may prescribe surgery.

The types of surgical procedures we perform at the UPMC Swallowing Disorders Center help to:

• Improve the closure of valves within the swallowing mechanism, such as the soft palate and vocal cords.
• Open valves that are too tight — such as the upper esophageal sphincter — a “muscle-valve” between the throat (pharynx) and food pipe (esophagus).
• Correct mechanical blockage, such as narrowing of the throat or tumors.
• Separate the esophagus from the airway.
• Sustain weight or balance nutrition (gastrostomy tube placement).

Types of Surgical Procedures for Swallowing Disorders

Medialization of the vocal cord

Medialization refers to the process of moving a paralyzed vocal cord closer to the middle, so that the other vocal cord can close the gap between them and protect the windpipe (trachea).

Surgeons at UPMC's Swallowing Disorders Center can use either of the following methods to achieve this purpose:

• Vocal fold (cord) injection — this is the least invasive technique, but is not as precise as open surgical procedures (incision). Surgeons can inject the vocal cord through the mouth or skin of the neck with permanent or temporary materials. This adds bulk to the tissues of the vocal fold or moves it closer to the middle.
• Laryngeal framework surgery — this type of surgery uses an implant to add bulk or move the vocal cord closer to the middle. Some people require a stitch at the joint of the vocal cord to correct the position of the joint. Although this surgery involves an external incision to create a window in the larynx (voice box), the effect is very reliable and the improvement is instant.

Pharyngoesophageal dilation

Narrowing of the throat and upper esophagus — called stenosis — most often results from radiation therapy to the head and neck. Stenosis may also occur following surgery for tumors of the upper aerodigestive tract (voice box or food passage of the throat).

This narrowing may cause problems swallowing solids and/or liquids.

Pharyngoesophageal dilatation involves passing an inflatable balloon or bougie (long, think, flexible rubber cylinder) through the mouth into the throat to stretch the narrowed area.

Cricopharyngeal myotomy

The cricopharyngeus muscle is located at the level of the lower neck.

This muscle works like a valve to prevent:

• Swallowing air when we breathe.
• Food from coming back up into the throat after it swallowing.

The muscle is usually tight but relaxes to let food go down. In some conditions — such as a spasm or achalasia — the muscle fails to relax, stopping the passage of food from the throat into the esophagus.

In these cases, cricopharyngeal myotomy involves cutting the muscle to allow the free passage of food.

Zenker's diverticulum surgery

Zenker's diverticulum is an outpouching in the throat due to the upper esophageal sphincter failing to relax during swallowing.

Food may collect in this outpouching causing regurgitation after meals or aspiration (food spilling over from the pouch into the windpipe).

Surgeons may treat Zenker's diverticulum by making a cut in the neck and either:

• Removing the pouch from the throat.
• Securing the pouch so that it drains into the esophagus more effectively.

During this "open approach," surgeons often perform a cricopharyngeal myotomy (see above).

Another option surgeons may use to modify Zenker's diverticula is endoscopic (through the mouth, without incisions in the neck) surgery.

The endoscopic method involves looking through the mouth with a telescope and dividing the common wall to separate the pouch from the esophagus.

Palatopexy

A palatopexy is for people with a paralyzed soft palate (the tissue that hangs at the back of the throat), causing food to back flow into the nose.

This procedure repairs the soft palate to the back wall of the throat, using permanent stitches.

Laryngotracheal separation

In the extreme event that a patient continues to aspirate (food spills into the windpipe), leading to repeated pneumonias, surgeons can completely separate the floodway (esophagus) from the airway (trachea or windpipe).

A laryngotracheal separation is a last resort reserved for people who have suffered life-threatening strokes or have advanced stages of nervous system diseases, such as:

• MS (multiple sclerosis)
• ALS (amyotrophic lateral sclerosis or Lou Gehrig's disease)
• Parkinson’s

Although the doctors of the Swallowing Disorders Center do not perform gastrostomies (feeding tube insertion), they can refer you to another UPMC doctor. 

Learn More About Swallowing Disorders Surgery

 From Medscape:

• Cricopharyngeal Myotomy Treatment & Management: Surgical Therapy
• Zenker's Diverticulum: Endoscopic Diverticulotomy