Management of Absent Upper Esophageal Sphincter Opening After Neurological Injury

ABSTRACT Objectives To evaluate the effects of swallowing therapy and cricopharyngeus (CP) muscle surgery on upper esophageal sphincter (UES) opening, oral intake, and airway protection in patients with absent UES opening following neurological injury. Methods Retrospective review of seven patients managed between September 2021 and July 2024 with absent UES opening confirmed by Modified Barium Swallow Study (MBSS). All patients underwent swallowing therapy followed by at least one CP‐targeted intervention, including balloon dilation, botulinum toxin injection, and/or myotomy. Swallowing outcomes were assessed using the Functional Oral Intake Scale (FOIS), Mann Assessment of Swallowing Ability (MASA), Penetration‐Aspiration Scale (PAS), and pharyngoesophageal segment (PES) opening scores from the Modified Barium Swallow Impairment Profile. Results CP‐targeted surgeries were associated with improved FOIS, MASA, and PES opening scores. PAS scores did not change substantially, with six patients demonstrating values greater than or equal to 7. Patients who underwent CP‐directed intervention within 6 months of injury demonstrated greater FOIS improvements than those treated later (3.25 vs. 0.33). Conclusion CP interventions can facilitate improved bolus passage and oral intake in patients with absent UES opening following neurological injury. However, persistent aspiration risk remains despite improved mechanical opening, highlighting the need for continued swallowing therapy. Finally, earlier intervention may optimize outcomes, though further research is needed to refine treatment for this rare condition. Level of Evidence 4