A Case of Dysphagia Caused by Cervical Trauma, Successfully Treated by Cricopharyngeal Myotomy and Superior Laryngeal Neurectomy

We encountered a patient with dysphagia caused by cervical trauma, and successfully treated his condition by cricopharyngeal myotomy and superior laryngeal neurectomy. The patient was a 65-year-old man who had sustained a bruise in his left temporal region and neck when his motorcycle scraped a car. One year after the traffic accident, he consulted an orthopedic surgeon chiefly complaining of persistent cervical pain and dysphagia. Based on the results of a cervical CT and CT-myelogram, the patient was diagnosed as having spondylolisthesis of C 4 and spinal canal stenosis in C 4/5 and C 6/7. Since severe pain and dysphagia were persistently noted when the patient moved his neck and ate solid foods, respectively, he was referred to our department in June 2001. Laryngeal mirror examinations revealed a shortening of the longitudinal diameter of the pharyngeal space at the level of the hypopharynx. Although the oblique larynx was observed, there was neither organic vocal cord disorder nor recurrent nerve paralysis were apparent. The cervical CT demonstrated axial irregularity of the cervical spine and the oblique larynx. Esophagography showed barium retention during the pharyngeal phase and poor muscle relaxation at the pharyngoesophageal junction. Since the cervical pain corresponded to the bilateral superior laryngeal nerves, a vagus nerve dysfunction might be induced by the trauma to the laryngeal nerve plexus. Therefore, bilateral superior laryngeal nerve branch resection and cricopharyngeal myotomy were performed on May 13, 2002. From the first postoperative day, the cervical pain disappeared, and there was a gradual improvement in deglutition. Esophagography performed two weeks postoperatively demonstrated sufficient muscle relaxation at the pharyngoesophageal junction. The patient could swallow solid foods 1 month after surgery. There were neither intraoperative nor postoperative complications. The medulla oblongata is the swallowing center during the pharyngeal phase, involving the 7th, 9th, and 10th cranial nerves as afferent nerves and the 9th, 10th, and 12th cranial nerves as efferent nerves. One theory hypothesizes that the cervical sympathetic nerves are involved in the contraction and relaxation of the cricopharyngeal muscle, while the other hypothesizes that the vagus nerve plays the major role during the above process. However, both vagus nerve dysfunction induced by cervical trauma to the laryngeal nerve plexus and structural changes in the pharyngeal space induced by the cervical dislocation might have caused the dysphagia in our patient.