Cricopharyngeal spasm and Zenker's diverticulum represent disorders of the pharyngoesophageal junction for which a unifying theory of etiology has yet to be established. There is, however, a large body of evidence that supports an association with gastroesophageal reflux. Cricopharyngeal myotomy is the key to successful management of both disorders. Newer transoral endoscopic techniques of management have a lower overall morbidity than traditional open approaches in appropriately selected patients and are therefore gaining popularity as the preferred method of treatment.

Zenker's diverticulum is a relatively common problem encountered by head and neck surgeons. Careful review of the available literature regarding its pathogenesis indicates that Zenker diverticulum likely occurs as a result of increased intrabolus pressures during swallowing secondary to cricopharyngeal spasm. Rational treatment for Zenker diverticulum therefore addresses cricopharyngeal spasm. The traditional approach to diagnosis and management of Zenker diverticulum has been based on standard techniques and principles. For example, diverticulectomy with concurrent cricopharyngeal myotomy is an acceptable form of treatment with a high success rate. However, recent advances in endoscopic stapling and carbon dioxide laser technologies have added new options to the therapeutic armament of the otolaryngologist. For appropriately selected patients, endoscopic staple-assisted diverticulostomy is a minimally invasive, safe, and effective procedure associated with shorter hospital stays, more rapid postoperative recovery, decreased time to resumption of oral intake, and high levels of patient satisfaction.

When ultrasound or sestamibi are unsuccessful, CT imaging can provide valuable preoperative localizing information before surgery for hyperparathyroidism, particularly in patients with recurrent or persistent disease.

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