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The cricopharyngeus muscle is situated at the pharyngoesophageal junction, forming part of the upper esophageal sphincter. It is a striated muscle and the main component of the closure muscles of the esophageal introitus. Cricopharyngeal dysfunction can cause difficulties with swallowing, and this can be treated with a cricopharyngeal myotomy, a procedure that involves cutting the muscle to allow it to relax more easily.
| Characteristics | Values |
|---|---|
| Location | Upper esophageal sphincter (UES) |
| Composition | Striated muscle |
| Function | Contracts to open and close the esophagus, allowing food and liquid to pass through |
| Innervation | Branches of the vagus nerves and recurrent laryngeal nerve |
| Dysfunction | Cricopharyngeal dysfunction, also known as cricopharyngeal achalasia or cricopharyngeal spasm |
| Diagnosis | Visual examination, esophageal manometry, modified barium swallow study (MBS), flexible endoscopic evaluation of swallowing, video-fluoroscopic swallow study |
| Treatment | Cricopharyngeal myotomy, botulinum toxin injection, balloon dilation, acid reflux medications, counseling, muscle relaxants, supplements, relaxation techniques |
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What You'll Learn
Cricopharyngeal spasms
The cricopharyngeal muscle is located at the top of the oesophagus (food pipe) and at the bottom of the pharynx. It is also known as the upper oesophageal sphincter (UES). The UES is responsible for preventing anything, like air, from reaching the oesophagus in between drinks and meals.
The spasms can be caused by low serotonin levels, which can be associated with anxiety and depression. They can also be caused by or worsened by acid reflux, inflammatory diseases, neurological conditions, or GERD. They may also appear after an accident or disease, and there may be hereditary factors. In some cases, they can be a symptom of generalized anxiety disorder.
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Cricopharyngeal dysfunction
The cricopharyngeus muscle (CPM) is one component of the upper oesophageal sphincter (UES). It is a striated muscle that is responsible for the high-pressure zone within the EI (oesophageal introitus or upper oesophageal sphincter muscles). The UES is situated at the top of the oesophagus.
The causes of cricopharyngeal dysfunction may include normal ageing or changes in nerve signalling pathways. This condition could also be caused by damage to the swallowing mechanism resulting from heartburn, stroke, or muscle scarring due to trauma or radiation therapy.
Treatments for cricopharyngeal dysfunction include cricopharyngeus muscle myotomy, a procedure in which a doctor cuts the UES to prevent it from over-tightening. This can be performed through an incision on the neck or via a newer, minimally invasive endoscopic procedure, in which a laser is introduced through the mouth. Botox injections can also be used to treat the condition by temporarily paralysing the UES.
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Diagnosis and treatment
The cricopharyngeus muscle (CPM) is a key component of the upper oesophageal sphincter (UES). Cricopharyngeal spasms occur when the CPM tightens more than it should. These spasms are harmless but can cause uncomfortable symptoms, such as the feeling of choking. The CPM's failure to relax or expand appropriately during deglutition is called cricopharyngeus muscle dysfunction (CPD) or cricopharyngeal achalasia. CPD can cause dysphagia, or difficulty swallowing, in solid food or solid and liquid form.
There are several diagnostic tools available to distinguish CPD from other causes of UES dysfunction. These include flexible endoscopic evaluation of swallowing, video-fluoroscopic swallow study, and high-resolution manometry. A barium swallow test can also be used, in which a patient drinks a barium liquid that coats their digestive tract so that X-rays can examine the oesophagus.
Cricopharyngeal spasm treatments include acid reflux medications, such as H2 blockers or proton pump inhibitors, and muscle relaxants. Botox injections can also be used to temporarily weaken the affected muscles. In rare cases, surgery may be required, in which incisions are made in the CPM to prevent it from contracting too much.
Cricopharyngeal myotomy is a surgical treatment for hypertonicity of the CPM, indicated for patients with moderate to severe dysphagia and sequelae such as weight loss and pneumonia. The endoscopic approach is preferred as it is less invasive and has fewer associated risks. Cricopharyngeal myotomy can also be used to treat Zenker's diverticula, which can cause dysphagia and regurgitation of undigested food.
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The upper oesophageal sphincter
The UES has two major functions: to prevent air from entering the oesophagus during breathing, and to prevent reflux of oesophageal contents into the pharynx to guard against airway aspiration. The UES is best recognised functionally as a high-pressure zone, with the cricopharyngeus muscle being a major contributor. The UES pressure zone is 3–4 cm long, while the cricopharyngeus muscle itself is only 1 cm in width. The UES pressure is not entirely the result of myogenic activity, but also passive elasticity of the tissues.
The UES function is controlled by a variety of reflexes that involve afferent inputs to the motor neurons innervating the sphincter. These reflexes elicit either contraction or opening of the UES. The opening of the UES involves the relaxation of the cricopharyngeus and thyropharyngeus muscles, and the forward movement of the larynx by the contraction of hyoid muscles. When food or liquid is coming towards the UES, it relaxes or opens so that food can enter the oesophagus. When there is no food or liquid, it stays closed. An inability of the sphincter to open leads to difficulty in swallowing, a condition known as cricopharyngeal bar.
Cricopharyngeal spasms occur when the cricopharyngeal muscle tightens more than it should, causing an uncomfortable sensation in the throat. These spasms are harmless and usually go away on their own, but they can cause symptoms such as a choking sensation or a feeling of having something stuck in the throat. Treatment options include medications, botulinum toxin injections, muscle relaxants, and physical therapy.
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The role of the CPM in swallowing
The cricopharyngeal muscle (CPM), also known as the cricopharyngeus or upper oesophageal sphincter (UES), is a crucial component of the human swallowing mechanism. Located at the top of the oesophagus, or food pipe, the CPM is responsible for opening and closing the passage to the oesophagus, allowing food and liquid to pass through.
During the act of swallowing, the CPM relaxes, allowing the passage of food and liquid. This relaxation is a complex process involving the coordination of various nerves and muscles. The CPM is innervated by branches of the vagus nerve and the recurrent laryngeal nerve, which play a role in signalling the CPM to relax. This relaxation is essential for successful swallowing, as a failure of this mechanism can lead to dysphagia, or difficulty swallowing.
Cricopharyngeal spasm or cricopharyngeal achalasia is a condition where the CPM contracts too much or too tightly, resulting in an uncomfortable sensation in the throat. While harmless, these spasms can cause symptoms such as a choking feeling or a lump in the throat. Treatment options for cricopharyngeal spasms include medications, such as acid reflux drugs, muscle relaxants, and botulinum toxin injections, as well as physical therapy, counselling, and mindfulness techniques.
CPM dysfunction, or cricopharyngeal muscle dysfunction (CPD), can also occur when the CPM fails to relax or expand properly. This can be caused by various factors, including muscle enlargement, scarring from radiation therapy, stroke, or reflux. CPM dysfunction can lead to significant swallowing difficulties and may require interventions such as non-surgical dilation, botulinum toxin injections, or cricopharyngeal myotomy (a surgical procedure to cut the CPM).
The evaluation and diagnosis of CPM-related issues are important steps in determining the appropriate treatment. Techniques such as ultrasonography (US), videofluoroscopic evaluation, manometry, and endoscopic examination are used to assess CPM function during swallowing. These evaluations help in understanding the structural changes and pressure variations within the CPM during the act of swallowing.
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Frequently asked questions
The cricopharyngeal muscle is located at the top of the oesophagus.
The cricopharyngeal muscle is a muscular constrictor that relaxes and opens when food approaches, allowing food and liquid to pass through.
Cricopharyngeal dysfunction occurs when the cricopharyngeal muscle does not relax sufficiently during swallowing, preventing food and liquid from passing through. This can be treated with Botox injections, muscle dilation, or cricopharyngeal myotomy.
