Abstract
We report the case of a 75-year-old man suffering from Wallenberg's syndrome and dysphagia who was treated using a cricopharyngeal myotomy followed by a gastrostomy.
A videofluorographic study showed an impairment in cricopharyngeal muscle relaxation resulting in aspiration during swallowing. Consequently, bilateral cricopharyngeal muscles were resected. After the cricopharyngeal myotomy, a second videofluorographic study showed good relaxation of the cricopharyngeal muscle, however, the patient repeatedly suffered from aspiration pneumonia and eventually received a gastrostomy.
Wallenberg's syndnome is characterized by an infarction of the lateral medullary oblongata. The lateral medullary oblongata consists of a nucleus ambiguus, nucleus tractus solitarius, and parvocellular reticular formation. The motor nucleus of the vagus which controls the pharyngeal muscles, including the cricopharyngeal muscle is located in the nucleus ambiguous. In addition the tractus solitarius and the parvocellular reticular formation also contain swallowing-related neurons. Therefore, dysphagia as a result of Wallenberg's syndrome cannot be improved by cricopharyngeal myotomy alone.
