CE Article #1
Cricopharyngeal Dysphagia in
Dogs:The Lateral Approach for
Surgical Management
Lysimachos G. Papazoglou, DVM, PhD, MRCVS*
F. A. Mann, DVM, MS, DACVS, DACVECC
Jennifer J. Warnock, DVM
Kug Ju Eddie Song, DVM
University of Missouri–Columbia
ABSTRACT: Cricopharyngeal dysphagia occurs in dogs when there is achalasia or asynchrony of the
cricopharyngeal muscle. Differentiation of other causes of dysphagia and preoperative stabilization
of the patient are essential for a successful outcome. Cricopharyngeal myectomy or myotomy using
a lateral or ventral approach is the preferred treatment.
T
he swallowing process may be divided into
oropharyngeal, esophageal, and gastro-
esophageal phases.1 The oropharyngeal
phase of swallowing may be further subdivided
into oral, pharyngeal, and cricopharyngeal
phases. Impairment of any part of the oropha-
ryngeal phase of swallowing may result in dys-
phagia. 2 In the oral phase of swallowing,
prehension and formation of a food bolus (which
is moved to the tongue base) occur.1,2 Oral dys-
phagia is characterized by decreased tongue
movements and difficulty in bolus accumula-
tion.2 During the pharyngeal phase of swallow-
ing, the bolus is delivered to the caudal pharynx
by coordinated contraction of the pharyngeal
muscles.1 Pharyngeal dysphagia is characterized
by interrupted movement of the bolus from the
oropharynx to the hypophar-
Send comments/questions via email to ynx and by impaired initiation
editor@CompendiumVet.com of the involuntary portion of
or fax 800-556-3288. the swallowing reflex.2 During
Visit CompendiumVet.com for *Dr Papazoglou is now affiliated
full-text articles, CE testing, and CE with Aristotle University of
test answers. Thessaloniki, Greece.
COMPENDIUM 696
the cricopharyngeal phase of swallowing, the
thyropharyngeal muscle contracts while the cri-
copharyngeal muscle relaxes, allowing passage of
the bolus from the pharynx to the esophagus.1
At other times, and as soon as the bolus is com-
pletely transported into the esophagus, the
cricopharyngeal muscle constricts continuously,
thereby closing the proximal esophagus to pre-
vent entrance of air into the esophagus during
respiration and to prevent gastroesophageal
reflux into the pharynx.
Cricopharyngeal dysphagia (CPD) is an
upper esophageal sphincter abnormality that
occurs with inadequate relaxation of the
cricopharyngeal muscle (achalasia) or failure of
synchronization between pharyngeal contraction
and cricopharyngeal relaxation (asynchrony)
during swallowing. 2–5 Esophageal dysphagia
occurs when there is difficulty transporting the
bolus through the esophageal body.2 Gastro-
esophageal dysphagia results when there is a
problem transporting the bolus through the cau-
dal esophageal sphincter.2
CPD is uncommon in dogs, and its underly-
October 2006
 Cricopharyngeal Dysphagia in Dogs: The Lateral Approach for Surgical Management CE
Case Report
A 1-year-old castrated English cocker spaniel
weighing 24.2 lb (11 kg) was referred to the Veterinary
Medical Teaching Hospital, University of Missouri–
Columbia, with a history of chronic coughing and
regurgitation after eating. The dog had a low body
condition score (i.e., 2 of 9). The complete blood count
and serum biochemistry profile results included slight
neutrophilia and lymphocytosis. The result of a serologic
examination for Ehrlichia canis infection was positive. A
neurologic examination disclosed no abnormalities. An
acetylcholine antibody titer was within normal limits.
Thoracic radiography detected a bronchial and
interstitial pattern that was most evident in the left
caudal lung lobe. Barium swallow videofluoroscopy
showed normal movement of the barium from the oral
cavity to the pharynx. Attempts to propel the bolus into
the esophagus were unsuccessful because the upper
esophageal sphincter was not adequately relaxed. A
diagnosis of CPD was made, and the dog was prescribed
doxycycline (50 mg PO bid for 3 weeks) and discharged
from the hospital.
Seven days later, the dog was readmitted to the
hospital to undergo surgery for CPD. Results of a
clinical examination of the oral cavity and larynx, with
the patient under light anesthesia, were normal. Results
of an intraoperative electromyographic examination of
ing causes have been attributed to neuromuscular dys-
functions.6–10 The following should be included in the
differential diagnosis of dysphagia: space-occupying
masses, foreign bodies, cleft palate, strictures, traumatic
lesions, and neuromuscular diseases.11 Pharyngeal dys-
phagia has clinical signs similar to those of CPD, and
differentiation between these two types of dysphagia is
very important because surgical intervention for CPD
may worsen pharyngeal dysphagia.12 Positive-contrast
videofluoroscopy is reliable in confirming the diagnosis
of CPD and in differentiating the condition from other
causes of dysphagia.8,13
According to the literature, 45 dogs ranging in age
from 5 weeks to 10 years have reportedly had surgery for
CPD. 1,6,8–10,14–20 The disorder has reportedly affected
mostly young dogs, but cases of older dogs with CPD
have also been reported.8,21 In a recent study21 of 14 dogs
undergoing surgery for CPD, the median age was 15
months at initial evaluation compared with a median age
of 5.5 months for dogs in previous reports.1,6,8–10,14–20 This
age difference as described in the study has been attrib-
uted to the concurrent existence of acquired disorders,
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697
the left pelvic limb and pharyngeal muscles were within
normal limits. A percutaneous endoscopic gastrostomy
tube was placed on the left side, and the dog underwent
left lateral cricopharyngeal myectomy as already
described.10,20 The resected cricopharyngeal muscle was
submitted for histopathologic examination. The
specimen was stained with hematoxylin–eosin, modified
trichrome, periodic acid–Schiff, ATPase at pH levels of
9.8 and 4.3, esterase, nicotinamide adenine
dinucleotide–tetrazolium reductase, acid phosphatase,
alkaline phosphatase, oil red O, and staphylococcal
protein A conjugated with horseradish peroxidase. The
results of histopathology showed moderate variability in
myofiber size, with scattered, round atrophic fibers.
Abundant endomysial, perimysial, and adipose
connective tissues were seen. Necrotic fibers were also
present, and intramuscular nerve branches moderately
depleted of myelinated fibers were seen. The dog
recovered uneventfully from anesthesia and started
enteral feeding via the gastrostomy tube.
The dog was offered ice cubes 12 days after surgery
and had canned food and water 14 days after surgery
without showing signs of regurgitation. Forty-five days
after surgery, the owner reported that the dog was eating
canned and dry food normally, without regurgitation or
coughing.
including myasthenia gravis, laryngeal paralysis, and
esophageal stricture.21 Of the 45 dogs reported on to
date, 65% were female and 35% were male. The most
common breeds identified included the cocker spaniel
(20%), springer spaniel (9%), Bouvier des Flandres (9%),
golden retriever (6.5%), miniature poodle (4%), and
standard poodle (4%). A genetic component of CPD has
been identified in golden retrievers22 and has been sug-
gested to exist in cocker spaniels.8,18 In addition, muscu-
lar dystrophy of hereditary origin has been proposed as a
cause of dysphagia in Bouvier des Flandres.9
SURGICAL ANATOMY
The cranial esophagus is dorsal to the larynx and left
of the midline. The upper esophageal sphincter is
formed by the thyropharyngeal and cricopharyngeal
muscles. The thyropharyngeal muscles originate from
the lateral surface of the thyroid cartilage lamina and
course dorsally and cranially over the dorsal border of
the thyroid lamina and insert on the median dorsal sur-
face of the pharynx in a bilaterally symmetric fashion.
The cricopharyngeal muscle originates from the lateral
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698 CE Cricopharyngeal Dysphagia in Dogs: The Lateral Approach for Surgical Management
Figure 1. Positioning for the left lateral approach for
cricopharyngeal myectomy or myotomy. The dog is placed
in right lateral recumbency with a rolled towel under its neck.
The dog’s head is to the left in this figure.The arrows indicate the
jugular vein, and the dotted line indicates the proposed skin
incision just ventral to the jugular vein.
surface of the cricoid cartilage and spreads over the dor-
sal surface of the esophagus across the midline and ends
by narrowing its belly to the contralateral aspect of the
cricoid cartilage. The borders of the cricopharyngeal and
thyropharyngeal muscles are obscured as the fibers
blend together. 5,23 In contrast to what has been
reported,23 recent studies5 in normal puppies and adult
dogs have shown that the cricopharyngeal muscle is
unpaired (i.e., single). The cricopharyngeal muscle is
innervated by the glossopharyngeal nerve and the pha-
ryngeal branch of the vagus nerve.24 The cricopharyn-
geal muscle receives its blood supply primarily from
branches of the cranial thyroid artery.
SURGICAL MANAGEMENT
Preoperative Considerations and Care
Preoperative stabilization of dehydrated and debili-
tated patients is mandatory for a successful outcome4
and includes administration of intravenous fluids and
electrolytes as well as antimicrobials to prevent aspira-
tion pneumonia. To obtain optimal nutritional status, a
percutaneous endoscopic gastrostomy tube should be
placed in dogs with persistent dysphagia. Electromyog-
raphy of the pharyngeal and laryngeal muscles is useful
in excluding other abnormalities associated with the
pharyngeal phase of swallowing or laryngeal paralysis
that may adversely affect the outcome.9,21 Preoperative
electromyographic recordings in four Bouvier des Flan-
COMPENDIUM
Figure 2. The sternocephalicus muscle (SC) and the
jugular vein (arrow) are retracted dorsally. The
sternothyroideus muscle (ST) can be visualized in the ventral part
of the incision.
dres with muscular dystrophy undergoing surgery for
CPD showed incoordination in the pharyngeal phase of
swallowing in addition to CPD.9 Aspiration pneumonia
and/or bronchitis has been reported in 46% of the 45
dogs that underwent surgery for CPD.1,8,10,15–18,21 Laryn-
geal paralysis and masticatory myositis have also been
reported preoperatively in dogs with CPD.21
Surgical Technique
Cricopharyngeal myotomy or myectomy, alone or
combined with thyropharyngeal myotomy or myectomy,
is the definitive treatment of dogs with CPD to relieve
clinical signs and facilitate swallowing. 3,4,6,10,16,21,25,26
During cricopharyngeal myotomy, the muscle is tran-
sected along the dorsal midline to the esophageal mus-
cularis.4,6 Cricopharyngeal myectomy involves partial
excision of the cricopharyngeal muscle after elevating
the muscle fibers from the esophageal muscularis. 3
Cricopharyngeal surgery may be performed using the
standard ventral midline approach. 3,4,6 A lateral
approach has recently been described for myotomy or
myectomy of the cricopharyngeal muscle.10,20,21,26 This
approach is similar to that used for cricoarytenoid laryn-
goplasty in dogs with laryngeal paralysis.27
Of the 45 dogs receiving surgical treatment of
CPD,1,6,8–10,14–21 53% had cricopharyngeal myotomy, 25%
had cricopharyngeal myectomy, 9% had cricopharyngeal
and thyropharyngeal myotomy, and 13% had cricopha-
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 Cricopharyngeal Dysphagia in Dogs: The Lateral Approach for Surgical Management CE
Figure 3. The thyroid cartilage is identified (grasped
with forceps).
Figure 5. Cricopharyngeal myectomy by dissection of
the muscle laterally and dorsally to the midline. The
cricopharyngeal muscle has been incised dorsally and is grasped
with hemostats to facilitate further dissection and final incision
(dotted line) laterally.
ryngeal and thyropharyngeal myectomy. Of dogs under-
going myotomy or myectomy of both muscles, three had
partial myotomy and four had partial myectomy. The
ventral midline approach was performed in 82% of the
dogs1,6,8,10,14–21 and the lateral approach in 18%.10,20,21 In
one report,19 a ventral approach with 45° rotation to the
right was used.
In the lateral approach, the dog is placed in lateral
recumbency, and a rolled towel is placed under its neck to
elevate the cricopharynx toward the surgeon (Figure 1).
An orogastric tube is preplaced to aid identification of the
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699
Figure 4. The thyropharyngeal muscle (grasped with
forceps) and cricopharyngeal muscle (CP) can be easily
identified by dissection of the loose connective tissue
around the thyroid cartilage.
esophagus. The head is stabilized on the table by placing
adhesive tape on the nose. An 8- to 10-cm left lateral inci-
sion is made dorsal to the larynx and ventral to the jugular
vein starting at the cranial aspect of the cricoid cartilage
(Figure 1). The platysma muscle and subcutaneous tissue
are incised. With the use of Gelpi retractors, the ster-
nocephalicus muscle and jugular vein are retracted dorsally
and the sternohyoideus muscle is retracted ventrally to
allow identification of the thyroid cartilage (Figures 2 and
3). The loose connective tissue around the thyroid carti-
lage is dissected free to expose the thyropharyngeal mus-
cle, the cricopharyngeal muscle caudal to it, and the
esophagus (Figure 4). The thyroid gland may become visi-
ble between the trachea and the sternohyoideus muscle.
The cricopharyngeal muscle is dissected free laterally and
dorsally down to the midline (Figure 5). Small branches of
the cranial thyroid artery are ligated or electrocoagulated
to control bleeding. Perforation of the esophageal wall is
avoided. A 2- to 2.5-cm portion of the cricopharyngeal
muscle is removed and placed in 10% buffered neutral for-
malin for histopathologic examination. Connective tissue
is apposed with a continuous pattern of 3-0 absorbable
suture. Skin closure may be accomplished with a continu-
ous intradermal pattern using 3-0 absorbable suture, or
the skin may be closed with nylon suture or staples.
Postoperative Care and Complications
The day after surgery, patients should be fed canned
or blenderized food for the first 2 days and gradually
returned to a normal diet over the next 3 to 4 days.28
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700 CE Cricopharyngeal Dysphagia in Dogs: The Lateral Approach for Surgical Management

Table 1. Outcome and Follow-up of 45 Dogs Following Surgery for Cricopharyngeal

Dysphagia
Number
of Dogs Outcome Follow-up Studies
22 Complete resolution of clinical signs 1 wk–8 yr Ladlow and Hardie,1 Sokolovsky,6
(21 dogs) Watrous and Suter,8 Peeters et al,9
Niles et al,10 Rosin and Hanlon,14
Shaw and Dodd,15 Quick et al,16
Carlisle and Egger,17 Weaver,18
Allen,19 Pfeifer,20 Warnock et al21
1 The dog was normal besides an occasional cough 3 mo Ladlow and Hardie1
8 Improvement of clinical signs 1 wk–5 yr Watrous and Suter,8 Weaver,18
(five dogs) Warnock et al21
3 Transient resolution of clinical signs (two dogs 2–36 wk Warnock et al21
were euthanized)
3 Died from aspiration pneumonia and concurrent 2 days Peeters et al9
pharyngeal-phase dysphagia
1 Euthanized; aspiration pneumonia, anesthetic 1 wk Watrous and Suter8
stress, exacerbation of dysphagia after surgery
1 Euthanized; persistent dysphagia due to fibrosis 2 wk Rosin and Hanlon14
and contracture
6 Persistent dysphagia associated with concurrent 12 hr–1 mo Warnock et al21
esophageal sphincter structural disease, laryngeal (three dogs)
paralysis, neuromuscular disorders, pharyngeal
disorders, and poor nutritional support

Tube gastrostomy should be considered in patients that
fail to maintain their body weight after surgery and that
have persistent dysphagia.21 Fluid therapy and antimi-
crobials may be continued in the presence of aspiration
pneumonia. 28 Postoperative complications following
cricopharyngeal myotomy or myectomy may include
laryngeal paralysis, fibrosis, esophageal wall perforation,
recurrence of dysphagia, and pharyngocutaneous fistula-
tion.29 Persistent or recurrent dysphagia and aspiration
pneumonia were the most common short- and long-
term postoperative complications reported in 23 of the
45 dogs that underwent surgery for CPD.8,9,14,18,21 The
management of aspiration pneumonia may include ad-
ministration of intravenous fluids and/or antimicrobials,
positive-pressure ventilation via tracheostomy tube or
oxygen support via nasal tube, nebulization, and
coupage.21 Aspiration pneumonia has been diagnosed in
12 dogs, 10 of which died or were euthanatized as a
result of the complication 12 hours to 4 years after sur-
gery; two dogs survived.8,9,18,21 Aspiration pneumonia
may be difficult to manage effectively in the presence of
esophageal hypomotility and megaesophagus. 21 In a
study9 of 24 Bouvier des Flandres with dysphagia asso-
ciated with muscular dystrophy, four had surgery for
CPD and three died 2 days after surgery because of
aspiration pneumonia. The concurrent presence of pha-
ryngeal dysphagia in those three dogs may have been
responsible for the unfavorable outcome. One dog expe-
rienced dysphagia attributed to fibrosis and contracture
after undergoing cricopharyngeal myotomy for CPD.
The dog underwent endoscopic bougienage without
much success and was euthanized. 14 Thus some au-
thors 3,5,18 support performing myectomy rather than
myotomy to ensure complete removal of the muscle
fibers and prevent the previously described complica-
tion. However, others4 favor myotomy as long as muscle
fibers are all recognized and transected. Two dogs have
had revision of previous CPD surgery because of partial
or transient resolution of dysphagia. One dog under-
went cricopharyngeal, thyropharyngeal, and hyopharyn-

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702 CE Cricopharyngeal Dysphagia in Dogs: The Lateral Approach for Surgical Management
Key Points
• Diagnosis of cricopharyngeal dysphagia is made with
positive-contrast videofluoroscopy.
• Cricopharyngeal myectomy via a lateral approach
provides more rapid and easier access than does a
ventral approach for surgical management of
cricopharyngeal dysphagia.
• Accurate preoperative differentiation of
cricopharyngeal dysphagia from pharyngeal
dysphagia and esophageal hypomotility may decrease
the possibility of surgical failure and aspiration
pneumonia.
geal myectomy after previously having cricopharyngeal
and thyropharyngeal myotomy with partial resolution of
dysphagia, and the other dog had cricopharyngeal
myotomy twice but experienced recurrent dysphagia 9
months after the second surgery.21 Other reported18,21
complications have included seroma in two dogs, inci-
sional swelling in two dogs, and pharyngeal swelling
and stridor in one dog.
OUTCOME
Of the 45 dogs that had surgery for CPD, 49%
showed complete resolution of clinical signs of dyspha-
gia; follow-up was available for 38 dogs and ranged
from 12 hours to 8 years.1,6,8–10,14–21 The outcome and fol-
low-up of 45 dogs are presented in Table 1. Myotomy
achieved complete resolution of clinical signs in 12 dogs
and myectomy in 11 dogs. However, the type of surgical
procedure (myotomy versus myectomy) has reportedly
not had an effect on the outcome,21 nor has surgeon ex-
perience (diplomates versus residents).21
CONCLUSION
Surgery is the preferred treatment of dogs with CPD,
and several techniques to resolve clinical signs of CPD
have been discussed in the literature. A lateral approach
has been described for myotomy26 and myectomy10,20,21 of
the cricopharyngeal muscle. With the lateral approach,
identification of the cricopharyngeal muscle is straight-
forward and the procedure is quicker and easier com-
pared with the ventral approach, in which rotation of the
larynx by 180˚ and placement of stay sutures to maintain
rotation are necessary to identify the cricopharyngeal
muscle. In addition, with the lateral approach, access to
the dorsal midline of the muscle can be easily achieved
and the muscle can be laterally and dorsally undermined
COMPENDIUM
and excised without difficulty if the esophageal wall is
not traumatized. Five dogs with CPD that had cricopha-
ryngeal muscle myectomy through the lateral approach
had complete resolution of clinical signs for 2 to 8 years
after surgery.10 Before surgery, CPD should be accurately
differentiated from other causes of dysphagia (e.g., oral
or pharyngeal-phase dysphagia and esophageal hypo-
motility) to eliminate the possibility of surgical failure
and to decrease the chance of aspiration pneumo-
nia.8,9,21,30 Preoperative stabilization of the patient and
enteral feeding with a percutaneous endoscopic gastros-
tomy tube are essential for a favorable outcome.
REFERENCES
1. Ladlow J, Hardie RJ: Cricopharyngeal achalasia in dogs. Compend Contin
Educ Pract Vet 22:750–755, 2000.
2. Watrous BJ: Clinical presentation and diagnosis of dysphagia. Vet Clin North
Am 13:437–453, 1993.
3. Rosin E: Cricopharyngeal dysphagia, in Bojrab MJ (ed): Current Techniques
in Small Animal Surgery, ed 4. Baltimore, Williams & Wilkins, 1998, pp
145–147.
4. Goring RL, Kagan KG: Cricopharyngeal achalasia in the dog: Radiographic
evaluation and surgical management. Compend Contin Educ Pract Vet 4:438–
447, 1982.
5. Hyodo M, Aibara R, Kawakita S, Yumoto E: Histochemical study of the
canine inferior pharyngeal constrictor muscle: Implications for its function.
Acta Otolaryngol 118:272–279, 1998.
6. Sokolovsky V: Cricopharyngeal achalasia in a dog. JAVMA 150:281–285, 1967.
7. Pearson H: The differential diagnosis of persistent vomiting in the dog. J
Small Anim Pract 11:403–415, 1970.
8. Watrous BJ, Suter PF: Oropharyngeal dysphagias in the dog: A cinefluoro-
graphic analysis of experimentally induced and spontaneously occurring swal-
lowing disorders. Vet Radiol 24:11–24, 1983.
9. Peeters ME, Venker-van Haagen AJ, Goedegebuure SA, Wolvekamp WT:
Dysphagia in Bouviers associated with muscular dystrophy; evaluation of 24
cases. Vet Q 13:65–73, 1991.
10. Niles JD, Williams JM, Sullivan M, et al: Resolution of dysphagia following
cricopharyngeal myectomy in six dogs. J Small Anim Pract 42:32–35, 2001.
11. Shelton GD: Swallowing disorders in the dog. Compend Contin Educ Pract
Vet 4:607–613, 1982.
12. Willard MD: Dysphagia and swallowing disorders, in Kirk RW (ed): Current
Veterinary Therapy XI. Philadelphia, WB Saunders, 1992, pp 572–577.
13. Pollard RE, Marks SL, Davidson A, et al: Quantitative videofluoroscopic
evaluation of pharyngeal function in the dog. Vet Radiol Ultrasound
41:409–412, 2000.
14. Rosin E, Hanlon GF: Canine cricopharyngeal achalasia. JAVMA 160:1496–
1499, 1972.
15. Shaw DG, Dodd RR: Cricopharyngeal achalasia. Canine Pract 4:33–34, 1977.
16. Quick CB, Hankes G, Womer R, et al: Cricopharyngeal achalasia. Auburn
Vet 33:90–98, 1977.
17. Carlisle WT, Egger EL: Differential diagnosis of persistent dysphagia and
regurgitation in the young. Iowa State Vet 42:14–18, 1980.
18. Weaver AD: Cricopharyngeal achalasia in cocker spaniels. J Small Anim Pract
24:209–214, 1983.
19. Allen SW: Surgical management of pharyngeal disorders in the dog and cat.
Probl Vet Med 3:290–297, 1991.
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20. Pfeifer RM: Cricopharyngeal achalasia in a dog. Can Vet J 44:993–995, 2003.
21. Warnock JJ, Pollard R, Kyles AE, et al: Surgical management of cricopharyngeal dysphagia in dogs: 14
cases (1989–2001). JAVMA 223:1462–1468, 2003.
22. Davidson AP, Pollard RE, Bannasch DL, et al: Inheritance of cricopharyngeal dysfunction in golden
retrievers. Am J Vet Res 65:344–349, 2004.
23. Hermanson JW, Evans HE: The muscular system, in Evans HE (ed): Miller’s Anatomy of the Dog, ed 3.
Philadelphia, WB Saunders, 1993, pp 258–384.
24. Venker-van Haagen AJ, Hartman W, Wolvekamp WT: Contributions of the glossopharyngeal nerve and
the pharyngeal branch of the vagus nerve to the swallowing process in dogs. Am J Vet Res 47:1300–1307,
1986.
25. Gourley IM, Leighton RL: Surgical treatment for cricopharyngeal achalasia in the dog. Pract Vet
44:11–14, 1972.
26. Smith MM, Waldron DR: Head and neck surgery, in Smith MM, Waldron DR (eds): Atlas of Approaches
for General Surgery of the Dog and Cat. Philadelphia, WB Saunders, 1993, pp 77–121.
27. Lahue TR: Treatment of laryngeal paralysis in dogs by unilateral cricoarytenoid laryngoplasty. JAAHA
25:317–324, 1989.
28. Fossum TW: Surgery of the digestive system, in Fossum TW, Hedlund CS, Hulse DA, et al (eds): Small
Animal Surgery, ed 2. St Louis, Mosby, 2002, pp 274–449.
29. McKenna JA, Dedo HH: Cricopharyngeal myotomy: Indications and technique. Ann Otol Rhinol Laryngol
101:216–221, 1992.
30. Mason RJ, Bremner CG, DeMeester TR, et al: Pharyngeal swallowing disorders: Selection for and out-
come after myotomy. Ann Surg 228:598–608, 1998.

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1. Achalasia refers to
a. failure of the cricopharyngeal muscle to relax.
b. asynchrony of the cricopharyngeal and thyropharyngeal muscles.
c. failure of the cricopharyngeal muscle to contract.
d. failure of the thyropharyngeal muscle to relax.

2. CPD is an abnormality of the

a. upper esophageal sphincter.
b. lower esophageal sphincter.
c. upper pharyngeal sphincter.
d. esophageal muscle.

3. Which is an unpaired muscle?

a. sternohyoideus c. sternocephalicus
b. thyropharyngeus d. cricopharyngeus

4. Which breed has been identified as having a genetic component to

CPD?
a. Labrador retriever c. golden retriever
b. boxer d. standard poodle

COMPENDIUM October 2006

 Cricopharyngeal Dysphagia in Dogs: The Lateral Approach for Surgical Management CE 705

5. Which statement regarding diagnosis of CPD is

incorrect?
a. A diagnosis of CPD can be confirmed by positive-
contrast videofluoroscopy.
b. Positive-contrast videofluoroscopy is not a reliable
method of differentiating CPD from other causes of
dysphagia.
c. Electromyography of pharyngeal muscles may aid in
differentiating CPD from other abnormalities associ-
ated with pharyngeal dysphagia.
d. Electromyography of the laryngeal muscles in dogs
with CPD is useful in excluding laryngeal paralysis,
which may adversely affect patient outcome.

6. The cricopharyngeal muscle originates from the

a. lateral surface of the thyroid cartilage.
b. lateral surface of the cricoid cartilage.
c. medial surface of the thyroid cartilage.
d. medial surface of the cricoid cartilage.

7. Which complication has not been reported in

dogs after surgery for CPD?
a. aspiration pneumonia
b. persistent dysphagia
c. incisional seroma
d. megaesophagus

8. Which statement regarding surgical treatment

of CPD is incorrect?
a. Cricopharyngeal myectomy via a lateral approach has
been reported.
b. Cricopharyngeal myectomy involves resection of the
esophageal mucosa.
c. During cricopharyngeal myotomy, the muscle is tran-
sected along the dorsal midline to the esophageal
muscularis.
d. Thyropharyngeal myotomy has been reported in con-
junction with cricopharyngeal myotomy.

9. Which statement regarding surgical treatment

of CPD is correct?
a. Cricopharyngeal myotomy is more effective than
cricopharyngeal myectomy.
b. Surgeon experience has not been associated with
patient outcome following surgery.
c. Success after surgery is better with Bouvier de Flan-
dres than with cocker spaniels.
d. In dogs, long-term success after surgery is better
with males than with females.

10. During the lateral approach for cricopharyngeal

myectomy or myotomy, which muscle is retracted
dorsally for exposure?
a. sternocephalicus c. sternothyroideus
b. sternohyoideus d. thyropharyngeus

October 2006 COMPENDIUM