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In the September 1999 issue of the ARCHIVES, Jacobs et al¹ conclude that cricopharyngeal myotomy performed during head and neck cancer resection fails to improve postoperative dysphagia. As a result of this finding, the authors suggest that there is no indication for prospective myotomy in patients undergoing major head and neck cancer surgery. They also dispute the value of myotomy in other circumstances. However, we question the impact of these conclusions, which were based on the findings of videofluoroscopic examinations alone.

Recent studies have demonstrated the value of videoendoscopic examination and pharyngeal/esophageal manometry in evaluating swallowing function and, specifically, in determining cricopharyngeal strength and coordination.^2-3 The use of videofluoroscopy alone for postoperative evaluation prevents any determination of the cause of clinical failure in this population. Causes of clinical failure include incomplete myotomy, fibrotic scarring at the site of myotomy, pharyngeal paresis, and esophageal dysmotility. We believe that none of these . . . [Full Text of this Article]