External approach to cricopharyngeus muscle (CP) myotomy

Although endoscopic cricopharyngeal myotomy (CPM) is used in some institutions, external CPM has continued to be the preferred approach since its inception in the early 1950s. Many acceptable approaches to CPM exist, and there is no evidence that one technique produces superior results or fewer complications. The purpose of this article, therefore, is to review the anatomy and physiology of the upper esophageal sphincter (UES) and to describe a technique that has been successful and has the added advantage that a CP muscle biopsy can be obtained (at the time of surgery). This biopsy, when submitted to histological (and histochemical) examination, can sometimes elucidate a neuromuscular cause for UES dysfunction. The indications, contraindications, and complications of the procedure are also discussed.