Alvin B. Vibar, M.d.

ESOPHAGUS

Alvin B. Vibar, M.D.

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Straight muscular tube 23 – 25 cm long Extends from pharynx to stomach Propels swallowed food to stomach Contains mucous glands for lubrication Follows the curve of the vertebral column as it descends thru the neck and posterior mediastinum Enters stomach at cardia

 Continuous

above with the laryngeal part of the pharynx opposite the 6th cervical vertebra

 Passes

through the diaphragm at the level of the 10th thoracic vertebra to join the stomach

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Caval =T8 Inferior vena cava Right Phrenic nerve

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Esophageal =T10 Esophagus Vagus nerve

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Aortic =T12 Aorta Thoracic duct Azygous vein

DIAPHRAGM, INFERIOR VIEW

Esophageal constrictions  Level

of: Arch of aorta

Where it is crossed by the Left bronchus Where it pierces the diaphragm

Segments 

Cervical – begins at the lower end of pharynx (level of 6th cervical vertebra ) and extends to the thoracic inlet (suprasternal notch)

Segments 

Thoracic

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Upper thoracic: – from thoracic inlet to level of tracheal bifurcation

Segments 

Mid thoracic – from tracheal bifurcation midway to gastroesophageal junction

Segments 

Lower thoracic – from midway between tracheal bifurcation and gastroesophageal junction to GE junction, including abdominal esophagus

Segments 

Upper third

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Middle third

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Lower third

Relations in the Neck 

Anterior:

Trachea , Recurrent laryngeal nerves 

Posterior:

Prevertebral layer of deep cervical fascia, Longus colli, Vertebral column 

Lateral: gland

Thyroid

Relations in the Thorax 

Anterior:

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Posterior:

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R side:

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L side:

Trachea, Left recurrent LN, Left main bronchus, Pericardium Bodies of the Thoracic vertebrae, Thoracic duct, Azygous veins, Right Posterior intercostal Art, Descending Thoracic Aorta Mediastinal pleura, Azygous vein L Subclavian Art., Aortic arch, Thoracic duct, Mediastinal pleura

Relations in the Abdomen 

Anterior: Posterior surface of the left lobe of liver

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Posterior:

Left crus of the diaphragm Vagus nerve accompanies the Esophagus through the Diaphragm Left and Right Vagi lie on its anterior and posterior surfaces. Remember: LARP

Esophagus Right border of esophagus is continuous w/ lesser curvature of stomach  Left border of esophagus is separated from the fundus of the stomach by the cardiac notch 

Cardiac notch

Esophageal sphincter 

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Located at inferior end of esophagus Within esophagogastric junction Contracts and relaxes When one is not eating, ES is closed to prevent reflux of food or stomach juices to esophagus Food momentarily stops here before entering stomach

Arterial Supply:  Upper

third – Inferior thyroid artery from Subclavian artery

 Middle

aorta

 Lower

third – Descending thoracic

third – Left gastric artery from Celiac trunk of Abd’l aorta

Arterial Supply: 

Inferior Thyroid artery

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Descending Thoracic aorta – esophageal branch

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Left gastric

Venous Drainage:  Upper

vein

third – Inferior thyroid

 Middle  Lower

third – Azygous vein third – Left gastric vein

Venous Drainage: 

Inferior Thyroid vein

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Azygous vein

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Left Gastric

Lymphatic Drainage 

Left gastric lymph nodes

Nerve Supply Vagal trunks  Thoracic sympathetic trunks  Greater and lesser splanchnic nerves 

Salivary Glands

Salivary Glands Parotid gland Stensen’s duct Submandibular gland Wharton’s duct Sublingual gland - Bartholin’s duct - Duct of Rivinus

Parotid

gland is located below and in front of the external auditory meatus and also lies behind the ramus of the mandible

Largest

of the major salivary gland Parotid sheath- dense capsule of the parotid gland derived from investing layer of deep cervical fascia Roughly wedge shape with its apex towards the angle of mandible Purely serous gland Divided into superficial and deep lobes by the facial nerve.

Stensen’s duct 

Passes forward over the lateral surface of masseter – turns medially and pierces the buccinator – opens into the vestibule of the mouth opposite the upper 2nd molar tooth

Structures within the Parotid Gland Facial Nerve 

 Retromandibular

veinunion of maxillary and superficial temporal veins

 External

carotid artery

 Arranged

from superficial to deepest

Terminal branches of Facial nerve from Parotid Plexus 

Temporal

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Zygomatic

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Buccal

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Mandibular

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Cervical

Blood Supply and Drainage: External Veins

vein

carotid artery and branches

drain to the Retromandibular

Innervation:  Parasympathetic

secretomotor fibers from the Inferior salivary nucleus of the CN IX - Glossopharyngeal

Clinical notes:  Parotid

neoplasm – causes facial

palsy  Parotid gland infection – “Mumps” – gland is swollen, painful  Parotid duct injury – facial or surgical lacerations

Submandibular Gland Submaxillary gland  Mixed secretion predominantly serous  Located within the “digastric / submandibular” triangle 

Submandibular gland Lies partly under cover of the body of the mandible  Divisible into superficial and deep parts, which are continuous with each other around the posterior border of Mylohyoid 

Relations:   

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Superficial part Ant – ant belly of Digastric Post – Stylohyoid, post belly of Digastric and Parotid gland Med – Mylohyoid, Hyoglossus, Lingual and Hypoglossal nerves Lat – Submandibular fossa

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Deep part Ant – Sublingual gland Post – Stylohyoid, post belly of Digastric and Parotid gland Med – Hyoglossus and Styloglossus Lat – Mylohyoid Sup – Lingual nerve Inf – Hypoglossal nerve

Submandibular duct  Wharton’s  Emerges

duct

from the anterior end of the deep part – passes forward along the side of tongue – opens into the mouth on a small papilla situated at the side of the frenulum of the tongue

Blood supply and Venous drainage:  Facial

and Lingual arteries

 Facial

and Lingual veins

Innervation:  Parasympathetic

secretomotor supply from the superior salivary nucleus of the 7th CN - Facial

Sublingual Gland Smallest  Mixed secretion predominantly mucous  Lies beneath the mucous membrane of the floor of the mouth 

Relations:  

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Ant – gland of the opposite side Post – deep part of the Submandibular gland Med – Genioglossus, Lingual nerve, Submandibular duct Lat – Sublingual fossa Sup – Sublingual fold Inf - Mylohyoid

Sublingual ducts  Around

8 to 20 in number  Open into the mouth on the summit of the sublingual fold

Blood supply and Venous drainage:  Facial

and Lingual arteries

 Facial

and Lingual veins

Innervation:  Parasympathetic

secretomotor supply from the superior salivary nucleus of the 7th CN - Facial

THANK YOU. 

“ in due time we shall reap…. if we don’t lose heart”.

QUIZ 

SET A

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SET B

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1. Esophagus is continuous above with the laryngeal part of the pharynx opposite about what level of cervical vertebra?

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1. Esophagus enters the esophageal opening of the diaphragm opposite what level of thoracic vertebra?

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Set A

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Set B

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2. Give the arterial supply of the upper 3rd of the esophagus?

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2. Give the arterial supply of the lower 3rd of esophagus?

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Set A

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Set B

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3. Give the venous drainage of the lower 3rd of the esophagus?

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3. Give the venous drainage of the upper 3rd of the esophagus?

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Set A

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Set B

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4. Which vagus nerve accompanies the esophagus in the diaphragm on its posterior surface? Left or Right?

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4. Which vagus nerve accompanies the esophagus in the diaphragm on its anterior surface? Left or Right?

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Set A

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Set B

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5. The muscle layer of the lower 3rd of esophagus is made up of what type of muscle?

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5. The muscle layer of the upper 3rd of esophagus is made up of what type of muscle?

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Set A

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Set B

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6. Give the secretion of Submandibular gland?

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6. Give the secretion of Sublingual gland?

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Set A

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Set B

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7. What is the other name of Submandibular duct?

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7. What is the other name of Parotid duct?

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Set A

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Set B

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8. What CN is secretomotor to the Parotid gland?

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8. What CN is secretomotor to the Submandibular gland?

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Set A

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Set B

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9. Give the blood supply of Submandibular gland?

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9. Give the venous drainage of Submandibular gland?

THANK YOU.