Which of the following statement(s) concerning pharyngoesophageal disorders is/are true?

a.In neuromuscular diseases, dysphagia is often worse for liquids than for solids

b.Cricomyotomy may be indicated for a wide variety of neuromuscular disorders involving the pharyngoesophageal phase of swallowing

d.Complications of all operations on the cervical esophagus include hematoma formation and recurrent nerve paralysis

Disorders of the pharyngoesophageal phase of swallowing result from a discoordination of the neuromuscular events involved in chewing, initiation of swallowing, and propulsion of the material from the oropharynx to the cervical esophagus. The commonest causes of pharyngoesophageal dysphagia are neuromuscular diseases. The most important are cerebrovascular disease, myasthenia gravis, Parkinson’s disease, multiple sclerosis and muscular diseases such as myotonic dystrophy and polymyositis. In neuromuscular diseases, dysphagia is often worse for liquids than for solids. Choking, repetitive pneumonia, nasal regurgitation and hoarseness are also prominent features. The surgeon’s role in the treatment of cricopharyngeal disorders is to reduce outflow resistance by performing a cricomyotomy. Initially this was recommended only for patients with demonstrable failure of the upper esophageal sphincter relaxation. More recently, a number of reports indicate a wide variety of neuromuscular diseases that may be improved by cricomyotomy. The surgical options in Zenker’s diverticulum are either excision or suspension. Excision is sometimes recommended on the grounds that malignant change in the sac is prevented, but there is no evidence that excision carries any greater protective role than suspension, which effectively prevents stagnation of food material, thus removing the presumed cause of malignant change. Suspension also removes the risk of contamination of the operative site, the risk of subsequent breakdown of the closure site with fistula formation, and the risk of narrowing of the esophagus. In either case, recurrence is likely if cricomyotomy is not performed, because the underlying defect which predisposes to the diverticulum persists. All operations on the cervical esophagus carry the risk of hematoma formation and recurrent nerve paralysis. The venous pumping action of the lung can cause the development of a large hematoma in the mediastinum postoperatively, therefore meticulous hemostasis is critical for the performance of this operation.