A Case of Zenker’s Diverticulum That Was Resected Under Continuous Intraoperative Nerve Monitoring

Abstract

We performed surgical treatment for a Zenker’s diverticulum which carries the risk of postoperative recurrent laryngeal nerve palsy. The patient was a 71-year-old man who presented with a 6-year history of dysphagia that first developed after the patient underwent thyroid surgery, and was diagnosed as having Zenker’s diverticulum. At first, the patient did not wish to undergo surgery, but after he suffered several recurrent episodes of aspiration pneumonia, we decided to treat him by surgery after obtaining his consent. We performed the surgery under continuous intraoperative nerve monitoring to avoid recurrent laryngeal nerve palsy. The diverticulum was excised after cutting the cricopharyngeal muscle for the purpose of identifying the base of the diverticulum. The patient did not manifest any signs of recurrent laryngeal nerve palsy or any swallowing disorder postoperatively. However, as his swallowing function began to worsen, he was initiated on swallowing rehabilitation. The causes of postoperative deterioration of the swallowing function include disuse changes during the postoperative period of abstention of oral intake and laryngeal edema due to neck manipulation. The patient underwent swallowing rehabilitation and achieved the same level of swallowing function as before the surgery, and showed no evidence of recurrence. Zenker’s diverticulum is more frequently encountered in the elderly. Therefore, it is important to consider the surgical technique based on the risk of complications, such as disease recurrence and recurrent laryngeal nerve palsy.