Review Question - QID 101114

Cricopharyngeal muscle dysfunction is known to cause Zenker's diverticulum.

Zenker's diverticulum is a false diverticulum consisting of a herniation of mucosal tissue at the junction of the pharynx and esophagus. It presents with dysphagia, halitosis (due to trapped, aging food particles), and symptoms of obstruction. Cricopharyngeal muscle dysfunction occurs due to decreased relaxation of pharyngeal muscles during swallowing. The resulting increase in pressure in the oropharynx subsequently causes the herniation known as Zenker's diverticulum.

Zuckerbraun et al. identify cricopharyngeal dysfunction as a common cause of dysphagia and Zenker's diverticulum. They recommend cutting the cricopharyngeal muscle (a "cricopharyngeal myotomy") as the only necessary treatment for Zenker's diverticulum.

Cassivi et al. review esophageal diverticula. The presentation can have very disabling symptoms. The preferred treatment in most cases is a diverticular excision. The addition of a myotomy can improve functional outcomes and reduce recurrence rates.

Illustration A displays an anatomical diagram of Zenker's diverticulum.
Illustration B is a radiology image of a modified barium swallow showing a Zenker's diverticulum.

Incorrect Answers:
Answer 1: GERD can result in halitosis but is not the most likely cause given this patient's history.
Answer 2: Esophageal candidiasis is most common in immunocompromised individuals and is not the most likely cause of this patient's symptoms given the history.
Answer 3: Glossopharyngeal nerve (CN 9) damage would not affect the cricopharyngeal muscle. The cricopharyngeal muscle is innervated by the pharyngeal plexus of CN 10.
Answer 4: Meckel's diverticulum is a true diverticulum found approximately 2 feet from the ileocecal valve. It would not cause halitosis or dysphagia.