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Innervation of the human cricopharyngeal muscle by the recurrent laryngeal nerve and external branch of the superior laryngeal nerve

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Abstract

Purpose

The major component of the upper esophageal sphincter is the cricopharyngeal muscle (CPM). We assessed the contribution of the laryngeal nerves to motor innervation of the CPM.

Methods

We performed an intraoperative electromyographic study of 27 patients. The recurrent laryngeal nerve (RLN), vagus nerve, external branch of the superior laryngeal nerve (EBSLN), and pharyngeal plexus (PP) were stimulated. Responses were evaluated by visual observation of CPM contractions and electromyographic examination via insertion of needle electrodes into the CPM.

Results

In total, 46 CPMs (24 right, 22 left) were evaluated. PP stimulation produced both positive visual contractions and electromyographic (EMG) responses in 42 CPMs (2080 ± 1583 μV). EBSLN stimulation produced visual contractions of 28 CPMs and positive EMG responses in 35 CPMs (686 ± 630 μV). Stimulation of 45 RLNs produced visible contractions of 37 CPMs and positive EMG activity in 41 CPMs (337 ± 280 μV). Stimulation of 42 vagal nerves resulted in visible contractions of 36 CPMs and positive EMG responses in 37 CPMs (292 ± 229 μV). Motor activity was noted in 32 CPMs by both RLN and EBSLN stimulation, 9 CPMs by RLN stimulation, and 3 CPMs by EBSLN stimulation; 2 CPMs exhibited no response.

Conclusions

This is the first study to show that the EBSLN contributes to motor innervation of the human CPM. The RLN, EBSLN, or both of the nerves innervate the 90, 75, and 70 % of the CPMs ipsilaterally, respectively.

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Authors’ contributions

Study conception and design: Mehmet Uludag

Acquisition of data: Nurcihan Aygun

Analysis and interpretation data: Mehmet Uludag, Nurcihan Aygun, Adnan Isgor

Drafting of manuscript: Mehmet Uludag, Nurcihan Aygun

Critical revision of manuscript: Mehmet Uludag, Adnan Isgor

Author information

Authors and Affiliations

  1. General Surgery, Sisli Hamidiye Etfal Training and Research Hospital, Department of General Surgery, Istanbul, Turkey

    Mehmet Uludag & Nurcihan Aygun

  2. General Surgery, Bahcesehir University Medical Faculty, Department of General Surgery, Istanbul, Turkey

    Adnan Isgor

Authors
  1. Mehmet Uludag
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  2. Nurcihan Aygun
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  3. Adnan Isgor
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Corresponding author

Correspondence to Mehmet Uludag.

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All authors have agreed to the manuscript’s content. All authors warrant that the submitted article is original and has not been submitted to another journal for publication, has not been published elsewhere, or if published in whole or in part, all permissions were granted for publication in Langenbeck’s Archives of Surgery.

Conflicts of interest

The authors declare that they have no conflict of interest.

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None.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. This article does not contain any studies with animals performed by any of the authors. This prospective study was approved by the Institutional Review Board of Sisli Hamidiye Etfal Training and Research Hospital.

Informed consent

Informed consent was obtained from all individual participants included in the study.

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Uludag, M., Aygun, N. & Isgor, A. Innervation of the human cricopharyngeal muscle by the recurrent laryngeal nerve and external branch of the superior laryngeal nerve. Langenbecks Arch Surg 402, 683–690 (2017). https://doi.org/10.1007/s00423-016-1376-5

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  • DOI: https://doi.org/10.1007/s00423-016-1376-5

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