Alvin B. Vibar, M.D.

8/14/2019 Alvin B. Vibar, M.D.

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ESOPHAGUSESOPHAGUS

Alvin B. Vibar, M.D.Alvin B. Vibar, M.D.


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Straight muscular tubeStraight muscular tube

23 25 cm23 25 cm longlong

Extends from pharynx toExtends from pharynx to

stomachstomach Propels swallowed foodPropels swallowed food

to stomachto stomach

Contains mucous glandsContains mucous glands

for lubricationfor lubrication

Follows the curve of theFollows the curve of the

vertebral column as itvertebral column as it

descends thru the neckdescends thru the neck

and posterior mediastinumand posterior mediastinum

Enters stomach at cardiaEnters stomach at cardia


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Continuous above with the laryngealContinuous above with the laryngeal

part of the pharynx opposite thepart of the pharynx opposite the 66ththcervical vertebracervical vertebra

Passes through the diaphragm at thePasses through the diaphragm at the

level of thelevel of the 1010thth thoracic vertebrathoracic vertebrato join the stomachto join the stomach


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CavalCaval =T8=T8

Inferior vena cavaInferior vena cavaRight Phrenic nerveRight Phrenic nerve

EsophagealEsophageal ==T10T10 EsophagusEsophagus

Vagus nerveVagus nerve

AorticAortic =T12=T12

AortaAortaThoracic ductThoracic duct

Azygous veinAzygous vein

DIAPHRAGM, INFERIOR VIEW


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Esophageal constrictionsEsophageal constrictions

Level of:Level of:

Arch of aortaArch of aorta

Where it is crossed by theWhere it is crossed by theLeft bronchusLeft bronchus

Where it pierces theWhere it pierces thediaphragmdiaphragm


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SegmentsSegments

CervicalCervical

begins at the lowerbegins at the lower

end of pharynx (levelend of pharynx (levelofof66thth cervical vertebracervical vertebra) and extends to the) and extends to the

thoracic inletthoracic inlet((suprasternal notchsuprasternal notch))


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SegmentsSegments

ThoracicThoracic

Upper thoracicUpper thoracic::

fromfrom thoracic inletthoracic inlet toto

level oflevel oftrachealtracheal

bifurcationbifurcation


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SegmentsSegments

Mid thoracicMid thoracic

fromfrom trachealtracheal

bifurcationbifurcation midwaymidwaytoto gastroesophagealgastroesophageal

junctionjunction


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SegmentsSegments

Lower thoracicLower thoracic

from midway betweenfrom midway between

tracheal bifurcationtracheal bifurcation

and gastroesophagealand gastroesophageal

junction to GEjunction to GE

junction, includingjunction, including

abdominal esophagusabdominal esophagus


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SegmentsSegments

Upper thirdUpper third

Middle thirdMiddle third

Lower thirdLower third


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Relations in the NeckRelations in the Neck

AnteriorAnterior::Trachea , RecurrentTrachea , Recurrent

laryngeal nerveslaryngeal nerves

PosteriorPosterior::Prevertebral layer ofPrevertebral layer of

deep cervical fascia,deep cervical fascia,

Longus colli, VertebralLongus colli, Vertebral

columncolumn

LateralLateral:: ThyroidThyroidglandgland


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Relations in the ThoraxRelations in the Thorax

AnteriorAnterior:: Trachea,Trachea,Left recurrent LN, LeftLeft recurrent LN, Leftmain bronchus,main bronchus,PericardiumPericardium

PosteriorPosterior:: Bodies of theBodies of theThoracic vertebrae,Thoracic vertebrae,Thoracic duct, AzygousThoracic duct, Azygousveins, Right Posteriorveins, Right Posteriorintercostal Art, Descendingintercostal Art, DescendingThoracic AortaThoracic Aorta

R sideR side:: MediastinalMediastinalpleura, Azygous veinpleura, Azygous vein

L sideL side:: L Subclavian Art.,L Subclavian Art.,Aortic arch, Thoracic duct,Aortic arch, Thoracic duct,Mediastinal pleuraMediastinal pleura


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Relations in the AbdomenRelations in the Abdomen

AnteriorAnterior:: PosteriorPosteriorsurface of the left lobesurface of the left lobeof liverof liver

PosteriorPosterior:: Left crusLeft crusof the diaphragmof the diaphragm Vagus nerveVagus nerve

accompanies theaccompanies theEsophagus through theEsophagus through theDiaphragmDiaphragm

Left and Right Vagi lieLeft and Right Vagi lieon its anterior andon its anterior andposterior surfaces.posterior surfaces.

RememberRemember:: LARPLARP


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EsophagusEsophagus Right borderRight border ofof

esophagus isesophagus is

continuous w/ lessercontinuous w/ lesser

curvature of stomachcurvature of stomach

Left borderLeft border

ofof

esophagus isesophagus is

separated from theseparated from the

fundus of thefundus of the

stomach by thestomach by the

cardiac notchcardiac notch

Cardiac

notch


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Esophageal sphincterEsophageal sphincter Located at inferior end ofLocated at inferior end of

esophagusesophagus

Within esophagogastricWithin esophagogastric

junctionjunction

Contracts and relaxesContracts and relaxes

When one is not eating,When one is not eating,

ES is closed to preventES is closed to preventreflux of food or stomachreflux of food or stomach

juices to esophagusjuices to esophagus

Food momentarily stopsFood momentarily stops

here before enteringhere before entering

stomachstomach


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Arterial Supply:Arterial Supply:

Upper thirdUpper third Inferior thyroid artery Inferior thyroid arteryfrom Subclavian arteryfrom Subclavian artery

Middle thirdMiddle third Descending thoracic Descending thoracicaortaaorta

Lower thirdLower third Left gastric artery from Left gastric artery fromCeliac trunk of Abdl aortaCeliac trunk of Abdl aorta


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Arterial Supply:Arterial Supply:

Inferior ThyroidInferior Thyroid

arteryartery

DescendingDescendingThoracic aorta Thoracic aorta

esophagealesophageal

branchbranch

Left gastricLeft gastric


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Venous Drainage:Venous Drainage:

Upper thirdUpper third Inferior thyroid Inferior thyroid

veinvein

Middle thirdMiddle third Azygous vein Azygous vein

Lower thirdLower third Left gastric vein Left gastric vein


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Venous Drainage:Venous Drainage:

Inferior ThyroidInferior Thyroid

veinvein

Azygous veinAzygous vein

Left GastricLeft Gastric


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Lymphatic DrainageLymphatic Drainage Left gastric lymphLeft gastric lymph

nodesnodes


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Nerve SupplyNerve Supply

Vagal trunksVagal trunks

ThoracicThoracic

sympathetic trunkssympathetic trunks

Greater and lesserGreater and lesser

splanchnic nervessplanchnic nerves


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Salivary GlandsSalivary Glands


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Salivary GlandsSalivary Glands

Parotid glandParotid gland

Stensens ductStensens duct

SubmandibularSubmandibular

glandgland

Whartons ductWhartons duct

Sublingual glandSublingual gland

-- Bartholins ductBartholins duct

- Duct of Rivinus- Duct of Rivinus


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Parotid gland isParotid gland is

located belowlocated below

and in front ofand in front of

the externalthe externalauditory meatusauditory meatus

and also liesand also lies

behind the ramusbehind the ramusof the mandibleof the mandible


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LargestLargest of theof the major salivary glandmajor salivary glandParotid sheathParotid sheath-- dense capsule of thedense capsule of the

parotid gland derived from investingparotid gland derived from investing

layer of deep cervical fascialayer of deep cervical fasciaRoughlyRoughly wedge shapewedge shape with its apexwith its apex

towards the angle of mandibletowards the angle of mandiblePurely serous glandPurely serous glandDivided into superficial and deep lobesDivided into superficial and deep lobes

by theby the facial nervefacial nerve..


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Stensens ductStensens duct

Passes forwardPasses forwardover the lateralover the lateralsurface ofsurface ofmasseter turnsmasseter turnsmedially andmedially andpierces thepierces thebuccinator opensbuccinator opensinto the vestibuleinto the vestibule

of the mouthof the mouthopposite theopposite the upperupper22ndnd molar toothmolar tooth


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Facial NerveFacial Nerve

Retromandibular vein-Retromandibular vein-union of maxillary andunion of maxillary andsuperficial temporal veinssuperficial temporal veins

External carotid arteryExternal carotid artery

Arranged from superficialArranged from superficialto deepestto deepest

Structures within the ParotidStructures within the Parotid

GlandGland


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Terminal branches of FacialTerminal branches of Facial

nerve from Parotid Plexusnerve from Parotid Plexus TemporalTemporal

ZygomaticZygomatic

BuccalBuccal

MandibularMandibular

CervicalCervical


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External carotid artery and branchesExternal carotid artery and branches

Veins drain to the RetromandibularVeins drain to the Retromandibularveinvein

Blood Supply and Drainage:Blood Supply and Drainage:


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Innervation:Innervation:

Parasympathetic secretomotor fibersParasympathetic secretomotor fibers

from the Inferior salivary nucleus offrom the Inferior salivary nucleus of

thethe CN IX - GlossopharyngealCN IX - Glossopharyngeal


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Clinical notes:Clinical notes:

Parotid neoplasm causes facialParotid neoplasm causes facial

palsypalsy

Parotid gland infection Parotid gland infection MumpsMumps

gland is swollen, painfulgland is swollen, painful

Parotid duct injury facial or surgicalParotid duct injury facial or surgical

lacerationslacerations


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Submandibular GlandSubmandibular Gland

Submaxillary glandSubmaxillary gland

Mixed secretionMixed secretion

predominantlypredominantly

serousserous Located within theLocated within the

digastric /digastric /

submandibularsubmandibular

triangletriangle


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Submandibular glandSubmandibular gland

Lies partly underLies partly undercover of the bodycover of the bodyof the mandibleof the mandible

Divisible intoDivisible intosuperficial andsuperficial anddeep partsdeep parts, which, whichare continuous withare continuous witheach other aroundeach other aroundthe posteriorthe posteriorborder ofborder ofMylohyoidMylohyoid


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Relations:Relations:

Superficial partSuperficial part Ant ant belly ofAnt ant belly of

DigastricDigastric Post Stylohyoid,Post Stylohyoid,

post belly ofpost belly ofDigastric andDigastric andParotid glandParotid gland

Med Mylohyoid,Med Mylohyoid,Hyoglossus, LingualHyoglossus, Lingualand Hypoglossaland Hypoglossal

nervesnerves Lat Lat

SubmandibularSubmandibularfossafossa

Deep partDeep part Ant SublingualAnt Sublingual

glandgland Post Stylohyoid,Post Stylohyoid,

post belly ofpost belly ofDigastric andDigastric andParotid glandParotid gland

Med HyoglossusMed Hyoglossusand Styloglossusand Styloglossus

Lat MylohyoidLat Mylohyoid

Sup Lingual nerveSup Lingual nerve Inf HypoglossalInf Hypoglossal

nervenerve


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Submandibular ductSubmandibular duct

Whartons ductWhartons duct

Emerges from the anterior end of theEmerges from the anterior end of thedeep part passes forward along thedeep part passes forward along the

side of tongue opens into theside of tongue opens into the

mouth on a small papilla situated atmouth on a small papilla situated at

thethe side of the frenulum of theside of the frenulum of thetonguetongue


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Blood supply and VenousBlood supply and Venous

drainage:drainage:

Facial and Lingual arteriesFacial and Lingual arteries

Facial and Lingual veinsFacial and Lingual veins


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Parasympathetic secretomotorParasympathetic secretomotor

supply from the superior salivarysupply from the superior salivary

nucleus of thenucleus of the 77thth CN - FacialCN - Facial


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Sublingual GlandSublingual Gland

SmallestSmallest

Mixed secretionMixed secretion

predominantlypredominantly

mucousmucous Lies beneath theLies beneath the

mucous membranemucous membrane

of the floor of theof the floor of the

mouthmouth


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Relations:Relations:

Ant gland of theAnt gland of theopposite sideopposite side

Post deep part ofPost deep part ofthe Submandibularthe Submandibularglandgland

Med Genioglossus,Med Genioglossus,Lingual nerve,Lingual nerve,Submandibular ductSubmandibular duct

Lat SublingualLat Sublingualfossafossa

Sup SublingualSup Sublingualfoldfold

Inf - MylohyoidInf - Mylohyoid


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Sublingual ductsSublingual ducts

Around 8 to 20 in numberAround 8 to 20 in number

Open into the mouth on the summitOpen into the mouth on the summit

of the sublingual foldof the sublingual fold


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Blood supply and VenousBlood supply and Venous

drainage:drainage:

Facial and Lingual arteriesFacial and Lingual arteries

Facial and Lingual veinsFacial and Lingual veins


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Parasympathetic secretomotorParasympathetic secretomotor

supply from the superior salivarysupply from the superior salivary

nucleus of thenucleus of the 77thth CN - FacialCN - Facial


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THANK YOU.THANK YOU.

in due time wein due time we

shallshall

reap.reap.

if we dont loseif we dont lose

heart.heart.


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QUIZQUIZ

SET ASET A

1. Esophagus is1. Esophagus is

continuouscontinuousabove with theabove with thelaryngeal part oflaryngeal part ofthe pharynxthe pharynx

opposite aboutopposite aboutwhat level ofwhat level ofcervicalcervicalvertebravertebra??

SET BSET B

1. Esophagus1. Esophagus

enters theenters theesophagealesophagealopening of theopening of thediaphragmdiaphragm

oppositeopposite

whatwhat

level of thoraciclevel of thoracicvertebravertebra??


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Set ASet A

2. Give the2. Give the

arterial supplyarterial supply ofofthethe upper 3upper 3rdrd ofof

the esophagus?the esophagus?

Set BSet B


arterial supplyarterial supply ofofthethe lower 3lower 3rdrd ofof

esophagus?esophagus?


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Set ASet A


venous drainagevenous drainageof theof the lower 3lower 3rdrd ofof


Set BSet B


venous drainagevenous drainageof theof the upper 3upper 3rdrd ofof



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Set ASet A

4. Which4. Which vagusvagus

nervenerveaccompanies theaccompanies theesophagus in theesophagus in thediaphragm on itsdiaphragm on its

posteriorposteriorsurfacesurface??

Left or Right?Left or Right?

Set BSet B

4. Which4. Which vagusvagus

nervenerveaccompanies theaccompanies theesophagus in theesophagus in thediaphragm on itsdiaphragm on its

anterior surfaceanterior surface

??

Left or Right?Left or Right?


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Set ASet A

5. The muscle5. The muscle

layer of thelayer of thelower 3lower 3rdrd ofof

esophagusesophagus isis

made up ofmade up ofwhatwhat

type of muscletype of muscle??

Set BSet B

5. The muscle5. The muscle

layer of thelayer of theupper 3upper 3rdrd ofof

esophagusesophagus isis

made up ofmade up ofwhatwhat

type of muscletype of muscle??


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Set ASet A


secretionsecretion ofofSubmandibularSubmandibular

glandgland??

Set BSet B


secretionsecretion ofofSublingualSublingual

glandgland??


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Set ASet A

7. What is the7. What is the

other nameother name ofofSubmandibularSubmandibular

ductduct??

Set BSet B

7. What is the7. What is the

other nameother name ofofParotid ductParotid duct??


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Set ASet A

8. What8. What CNCN isis

secretomotorsecretomotor totothethe ParotidParotid

glandgland??

Set BSet B

8. What8. What CNCN isis

secretomotorsecretomotor totothethe


glandgland??


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Set ASet A

9. Give the9. Give the bloodblood

supplysupply ofofSubmandibularSubmandibular

glandgland??

Set BSet B


venous drainagevenous drainageofof


glandgland??


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THANK YOU.THANK YOU.

Alvin B. Vibar, M.D.

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