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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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Innervation:Innervation:
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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Innervation:Innervation:
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
2. Give the2. Give the
arterial supplyarterial supply ofofthethe lower 3lower 3rdrd ofof
esophagus?esophagus?
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Set ASet A
3. Give the3. Give the
venous drainagevenous drainageof theof the lower 3lower 3rdrd ofof
the esophagus?the esophagus?
Set BSet B
3. Give the3. Give the
venous drainagevenous drainageof theof the upper 3upper 3rdrd ofof
the esophagus?the esophagus?
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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
6. Give the6. Give the
secretionsecretion ofofSubmandibularSubmandibular
glandgland??
Set BSet B
6. Give the6. Give the
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
SubmandibularSubmandibular
glandgland??
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Set ASet A
9. Give the9. Give the bloodblood
supplysupply ofofSubmandibularSubmandibular
glandgland??
Set BSet B
9. Give the9. Give the
venous drainagevenous drainageofof
SubmandibularSubmandibular
glandgland??
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THANK YOU.THANK YOU.
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