ESOPHAGUS

Alvin B. Vibar, M.D.

 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
 DIAPHRAGM, INFERIOR VIEW
 Caval =T8
Inferior vena cava
Right Phrenic nerve
 Esophageal =T10
Esophagus
Vagus nerve
 Aortic =T12
Aorta
Thoracic duct
Azygous vein
 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

 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

 Middle third

 Lower third
 Relations in the Neck
 Anterior:
Trachea , Recurrent
laryngeal nerves

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

 Lateral: Thyroid
gland
 Relations in the Thorax
 Anterior: Trachea,
Left recurrent LN, Left
main bronchus,
Pericardium
 Posterior: Bodies of the
Thoracic vertebrae,
Thoracic duct, Azygous
veins, Right Posterior
intercostal Art, Descending
Thoracic Aorta
 R side: Mediastinal
pleura, Azygous vein
 L side: L Subclavian Art.,
Aortic arch, Thoracic duct,
Mediastinal pleura
 Relations in the Abdomen
 Anterior: Posterior
surface of the left lobe
of liver

 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
Cardiac notch
 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
 Esophageal sphincter
 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

 Middlethird – Descending
thoracic aorta

 Lowerthird – Left gastric artery

from Celiac trunk of Abd’l aorta
 Arterial Supply:
 Inferior Thyroid
artery

 Descending
Thoracic aorta –
esophageal
branch

 Left gastric
 Venous Drainage:
 Upper third – Inferior thyroid
vein

 Middle third – Azygous vein

 Lower third – Left gastric vein

 Venous Drainage:
 Inferior Thyroid
vein

 Azygous vein

 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 vein-
union of maxillary and
superficial temporal
veins

 External carotid artery

 Arranged from
superficial to deepest
 Terminal branches of Facial
nerve from Parotid Plexus
 Temporal

 Zygomatic

 Buccal

 Mandibular

 Cervical
Blood Supply and Drainage:
External carotid artery and branches

Veins drain to the Retromandibular

vein
 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:
 Superficial part  Deep part
 Ant – ant belly of  Ant – Sublingual
Digastric gland
 Post – Stylohyoid,  Post – Stylohyoid,
post belly of post belly of
Digastric and Digastric and
Parotid gland Parotid gland
 Med – Mylohyoid,  Med – Hyoglossus
Hyoglossus, Lingual and Styloglossus
and Hypoglossal  Lat – Mylohyoid
nerves  Sup – Lingual nerve
 Lat –  Inf – Hypoglossal
Submandibular nerve
fossa
 Submandibular duct
 Wharton’s duct

 Emerges 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:
 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  SET B

 1. Esophagus is  1. Esophagus
continuous enters the
above with the esophageal
laryngeal part of opening of the
the pharynx diaphragm
opposite about opposite what
what level of level of thoracic
cervical vertebra?
vertebra?
 Set A  Set B

 2. Give the  2. Give the

arterial supply of arterial supply of
the upper 3rd of the lower 3rd of
the esophagus? esophagus?
 Set A  Set B

 3. Give the  3. Give the

venous drainage venous drainage
of the lower 3rd of the upper 3rd
of the of the
esophagus? esophagus?
 Set A  Set B

 4. Which vagus  4. Which vagus

nerve nerve
accompanies the accompanies the
esophagus in the esophagus in the
diaphragm on its diaphragm on its
posterior anterior surface?
surface?
Left or Right? Left or Right?
 Set A  Set B

 5. The muscle  5. The muscle

layer of the layer of the
lower 3rd of upper 3rd of
esophagus is esophagus is
made up of what made up of what
type of muscle? type of muscle?
 Set A  Set B

 6. Give the  6. Give the

secretion of secretion of
Submandibular Sublingual
gland? gland?
 Set A  Set B

 7. What is the  7. What is the

other name of other name of
Submandibular Parotid duct?
duct?
 Set A  Set B

 8. What CN is  8. What CN is
secretomotor to secretomotor to
the Parotid the
gland? Submandibular
gland?
 Set A  Set B

 9. Give the blood  9. Give the

supply of venous drainage
Submandibular of
gland? Submandibular
gland?
THANK YOU.