PubMed · 1587221
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R J Adamek, M Wegener, D Ricken. 1992-05-22. [Long-term manometry in diffuse esophageal spasm].. https://pubmed.ncbi.nlm.nih.gov/1587221/
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Because pharyngoesophageal spasm can limit successful voice restoration after total laryngectomy, 24 patients underwent a modified pharyngeal closure in an effort to avoid this problem. All patients underwent total laryngectomy with appropriate neck dissections and pharyngeal closure with a half-muscle closure technique in which only one side of the remnant constrictor muscles was used to reinforce the primary closure. Twenty-three patients underwent voice restoration. Twenty-two (96%) had a functional voice, and 1 patient (4%) had pharyngoesophageal spasm that required a secondary myotomy. One fistula (4%) occurred and resolved with conservative measures. Quantitative voice analysis demonstrated no significant differences between half-closure patients and control patients for fundamental frequency (96 Hz versus 101 Hz) or intensity (57 dB versus 64 dB). Extensive qualitative analysis by trained and naive listeners revealed no differences. This preliminary report indicates the half-muscle closure modification of the pharyngeal closure at primary laryngectomy may provide a simple and effective means of avoiding pharyngoesophageal spasm and maintaining an effective voice without increased complications.
Diffuse esophageal spasm is a rare condition, which has generally been treated conservatively in Japan. A case of this disorder treated successfully by long myotomy is reported with a knowledge of prolonged pressure monitoring of the esophagus. A 56-year-old woman was admitted to our hospital with dysphagia. Barium swallow and esophagoscopy showed contraction of the esophagus, and manometry showed normal peristalsis, so the diagnosis of achalasia was ruled out. Prolonged pressure monitoring of the esophagus showed spastic contractions with the pressure over 130 mmHg that continued for 25 sec during meals, which led us to the diagnosis of diffuse esophageal spasm. Extramucosal long myotomy of the esophagus and a modified Belsey Mark IV operation were performed. The postoperative course was satisfactory and esophageal functional tests showed no spasms. The patient regained weight without dysphagia.