Cricopharyngeal incoordination in infancy

Abstract

Cricopharyngeal incoordination in newborns and infants is a polyetiological condition. From 1973 to 1986, 13 patients with defective swallowing mechanisms were seen at our hospital. The patients were divided into two groups. The first group, consisting of 8 patients with transient cricopharyngeal incoordination due to immaturity and birth trauma, did not require surgical intervention. The second group, composed of 5 patients with permanent incoordination, required surgical treatment. Cricopharyngeal achalasia and familial autonomic dysfunction (Riley-Day syndrome) were the most frequent causes in this group. We thought it wise to simplify feedings by using a gastrostomy, which we also used for retrograde dilatation. Permanent cricopharyngeal incoordination may be treated by dilatation or myotomy. Familial dysautonomia required additional surgical procedures, depending on the associated upper gastrointestinal disorder. Indications for myotomy of the cricopharyngeal muscle in infancy have not been clarified to date. Dilatation may improve the passage of food through the upper esophagus, but if this procedure fails, myotomy is indicated.