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Query: UMLS:C0032290 (aspiration pneumonia)
 2,291 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Optimum surgical management of the hypopharyngeal diverticulum is controversial. The authors discuss 48 consecutive patients (average age 72.1 years) with documented hypopharyngeal diverticula who were treated by cricopharyngeus myotomy, leaving the diverticula in situ. All came to the hospital with dysphagia; other symptoms included postdeglutitive cough, regurgitation, aspiration, and weight loss. Seven patients had had previous surgery for a Zenker's diverticulum with recurrence. Aspiration pneumonia was treated in 9 patients; 28 patients had concurrent chronic obstructive pulmonary disease or cardiovascular disease. Thirty-nine patients had cricopharyngeus myotomy under local anesthesia, 5 had cricopharyngeus myotomy under general endotracheal anesthesia, and 4 patients underwent myotomy with a cervical esophagostomy. There was one mortality (2.1%) and no incidence of postoperative bleeding, sepsis, or cranial nerve injury. Follow-up was done with 30 patients via telephone an average of 64 months after operation. Twenty-one of 30 patients reported excellent relief of symptoms, 5 reported improvement with occasional symptoms, and 4 patients described persistent dysphagia. Cricopharyngeus myotomy under local anesthetic is a safe and effective approach to the patient with a hypopharyngeal diverticulum. The awake patient can swallow on command, which enables the surgeon to identify the upper esophageal sphincter (UES) and to perform an accurate, complete myotomy. The absence of a pharyngeal suture line eliminates the risk of leakage and mediastinal sepsis, and allows early, postoperative feeding and discharge.
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PMID:Treatment of Zenker's diverticula by cricopharyngeus myotomy under local anesthesia. 148 6

Cricopharyngeal myotomy was performed on 60 patients suffering from cervical oesophageal dysphagia. Of 37 that had a Zenker diverticulum the diverticulum was excised in 24. All patients were free of symptoms on post-operative follow-up at 2-10 years. In 10 patients with a cervical oesophageal web or postcricoid stenosis, the ability to eat normal food was restored. In 7 of 9 patients with neuromuscular diseases affecting swallowing and 2 of 4 patients with cricopharyngeal achalasia, food intake improved after myotomy. Apart from 4 transient palsies of the left recurrent nerve and 2 patients with aspiration pneumonia, no serious complications occurred. Cricopharyngeal myotomy can be a safe and effective method to improve the swallowing and quality of life of patients suffering from cervical oesophageal dysphagia of varied aetiology.
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PMID:Cricopharyngeal myotomy in the treatment of dysphagia. 211 33

Oropharyngeal dysphagia is not a single disease but a symptom complex that is recognized by difficulty in transfer of a food bolus from mouth to esophagus or by signs and symptoms of aspiration pneumonia or nasal regurgitation. Its etiologies are legion, with the most common result of underlying neuromuscular disease, including cerebrovascular accidents, Parkinson's disease, multiple sclerosis, and muscular dystrophy. There are two methods of treatment for oropharyngeal dysphagia; one is specific and directed at the underlying disease and the other is general (supportive) and designed to preserve oral intake for nutrition while preventing aspiration pneumonia. Following a general discussion of the etiology and clinical presentation of orophyarngeal dysphagia, a description of the methods for supportive care is presented as well as the approach to the treatment of cricopharyngeal dysfunction and Zenker's diverticulum.
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PMID:Oropharyngeal dysphagia. 1600 27

Zenker's diverticula commonly occur in the elderly, and quality of life is often impaired by typical symptoms such as dysphagia, regurgitation, halitosis, cough and aspiration pneumonia, malnutrition and weight loss. The "gold standard" treatment for pharyngo-oesophageal diverticula is the resection of the sac via left lateral cervicotomy and cricopharingeal myotomy. In the last decade, with the fast development of minimally invasive techniques, an endoscopic stapled approach has been proposed. This procedure rapidly encountered the favour of gastroenterologists because patients with Zenker's diverticulum often present serious co-morbidities and seem to benefit from the minimally invasive technique; but the crucial point in the treatment of Zenker's diverticula, in addition to the sac resection, is the myotomy of the cricopharyngeal muscle fibres and this could not be safely and completely achieved in endoscopic stapling owing to the risk of vascular lesions and incomplete sectioning of the sac. Moreover, many studies have reported similar results between open and endoscopic procedures in terms of postoperative morbidity and mortality, showing better functional outcomes in surgical patients even if elderly and presenting co-morbidities. In this report, the case of a 95 year-old patient, one of the oldest operated on for this disease and reported in the literature, is described. He was affected by a massive 8 cm Zenker's diverticulum and an oesophageal motility disorder (dyskinesia), with significant co-morbidity. Surgical diverticulectomy combined with cricopharyngeal myotomy was performed with excellent early and late results.
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PMID:Surgical treatment of a severe, massive, symptomatic Zenker's diverticulum in a very elderly patient. 1766 83

Digestive surgeons should form part of the multidisciplinary team managing patients with oropharyngeal dysphagia. These patients can be diagnosed through clinical methods and complementary investigations such as videofluoroscopy and pharyngoesophageal manometry. These techniques also allow specific treatment to be selected. Up to one-third of patients with dysphagia suffer from malnutrition as a result of alterations in food bolus transport. Furthermore, up to two-thirds show alterations in swallowing safety (penetrations and aspirations, especially when swallowing liquids), as well as a high risk of respiratory infections and aspiration pneumonia. Increasing food bolus viscosity to 3500-4000 mPas (pudding viscosity) improves the effectiveness of swallowing and reduces the risk of aspirations. Botulinic toxin injection in the upper esophageal sphincter is indicated in patients with spasticity of neuromuscular origin. Cricopharyngeal myotomy is the basis of treatment for Zenker's diverticulum and is also indicated in patients with alterations in the upper esophageal sphincter and preserved oropharyngeal motor response.
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PMID:[Diagnosis and treatment of functional oropharyngeal dysphagia. Features of interest to the digestive surgeon]. 1778 40

The association between aspiration pneumonias and digestive symptoms is frequent in geriatric patients and is usually attributed to comorbidity, being the most frequent causes cerebrovascular disease or dementia. We present the case of a 90-year-old woman, with malnutrition associated with progressive dysphagia and episodes of aspiration pneumonia, due to Zenker's diverticulum, which was treated surgically. We provide a review of this disease and analyze the criteria that can be applied when considering surgical indication in the oldest-old with dementia.
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PMID:[Zenker's diverticulum as a cause of aspiration pneumonia and dysphagia in nonagenarian with moderate dementia]. 1868 22

Zenker diverticulum is known as an adult disease which occurs as result of outpouching of pharyngeal mucosa through a weak zone in the posterior wall of the pharynx. It is a very rare disorder in childhood, and only a few pediatric cases of Zenker diverticulum have been reported. Here, we report a 10-year-old boy with Zenker diverticulum who presented with aspiration pneumonia, dysphagia, regurgitation, and halitosis. The radiologic evaluation of the patient included chest radiography, ultrasonography, esophagography, and chest computed tomography which clearly demonstrated the pathological findings and confirmed the diagnosis.
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PMID:A pediatric case of Zenker diverticulum: imaging findings. 1972 68

The management of Zenker's diverticulum remains controversial, as both external and endoscopic procedures are potentially associated with post-operative complications and risks. The endoscopic approach is based on cricopharyngeal myotomy or myectomy by laser, cautery or stapling. A retrospective chart review has been made from December 1994 to April 2009 of all patients with Zenker's diverticulum treated by endoscopic cricopharyngeal myectomy using CO(2) laser at the Department of Otorhinolaryngology - Head and Neck Surgery of the University of Brescia, Italy. Of the 28 patients (19 males, 9 females; mean age, 64 years; range, 46-95) scheduled for the trans-oral procedure, 27 (96%) were endoscopically treated. Diagnosis was based on the patient's history, flexible fiberoptic examination of the larynx, hypopharynx, and oesophagus, and videofluoroscopy with barium. Exclusion criteria included severe medical co-morbidities, impossibility to endoscopically expose the diverticulum, and small (< 2 cm) or large (> 6 cm) diverticula. The endoscopic procedure was performed using a CO(2) laser to section the cricopharyngeal muscle and remove the posterior part in order to obtain partial myectomy. Major complications occurred in 2 (7%) patients. No cases of recurrent nerve paralysis, pharyngo-cutaneous fistula, neck emphysema, post-operative bleeding, mediastinitis or aspiration pneumonia were observed in the present series. A swallow survey was obtained by telephone: 85% of patients reported improved swallowing (without symptoms in 11 and with moderate dysphagia in 7). Based on the present series, endoscopic CO(2) laser cricopharyngeal myectomy for Zenker's diverticulum can be considered an effective and safe procedure, with reduced hospitalization time and complication rate.
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PMID:Endoscopic treatment of Zenker's diverticulum by carbon dioxide laser. 2055 66

The cricopharyngeal diverticulum or Zenker's diverticulum is the most frequent type of diverticulum of the upper gastrointestinal tract. It occurs mostly in elderly patients. The predominant symptoms are dysphagia and regurgitation which may result in malnutrition and aspiration pneumonia, the latter eventually being life threatening. The underlying cause of Zenker's diverticulum is a dysfunction of the cricopharyngeal muscle and the upper esophageal sphincter, the most common finding being a decreased compliance. The treatment consists in a myotomy of the upper esophageal sphincter and cricopharyngeal muscle combined with a diverticulopexy or diverticulectomy. This procedure is performed via a limited left cervicotomy. Results are excellent to very good in 94% of the patients in our own experience.
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PMID:Zenker's diverticulum. 2441 52

Although spinal cord injury (SCI) damages the spinal cord, physiological changes due to SCI can affect many organs and systems of the human body. While respiratory problems are common following cervical SCI, dysphagia is a relatively uncommon secondary complication that occurs after cervical SCI. We report a case of recurrent aspiration pneumonia due to Zenker diverticulum in 26-year-old tetraplegic patient with a chronic history of silent aspirations and dysphagia contributing to functional disability.
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PMID:A Rarely Seen Complication That Causes Increase in Morbidity in Tetraplegic Patients: Zenker Diverticula. 2808 Oct 29


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