|VIEW THE MOBILE VERSION of www.homemedicine.ca|| Informational|
This is an affection of the bowels of the nature of diarrhoea,...
Ablutions And Rubbing With Iced Water Or Snow
In a few very obstinate cases, when no rash would appear afte...
Blood Supply Of
To supply good blood in cases where it is lacking, either from...
The Brain In Its Direction Of The Body
WE come now to the brain and its direction of other p...
This is the accumulation of gases in the body, usually caused ...
In this fever, now known as a form of Typhoid, the disease spr...
The Guidance Of The Body
THE literature relating to the care of the human body...
Colds Consumption And Pneumonia
Disease Germs. In all foul air there are scores of different ...
Breath And The Skin
The organs of breathing remove much waste from the system, but...
Is a disease springing from disordered digestion, and caused s...
The Heart In Pneumonia
As pneumonia heads the list of the causes of death in this co...
The Blood-mesh Of The Skin
The Blood Vessels under the Skin. Not merely the nails and th...
Passing the cricopharyngeus is the most difficult part of es...
Towards The End Of The Period Of Efflorescence When The Rash
declines, fades, disappears, and the skin begins to peal off, a...
Burns Case Xxxiv
Mr. C. aged 51, scalded his leg ten days ago on the instep. H...
Quacks And Quackery Continued
An English physician, who practised during the early part o...
The first sign of such an illness is a brief and slight attack...
Pain Severe In Limbs
This is often not due to any trouble in the joint itself, but ...
Condition Of The Throat And Other Internal Organs
The condition of the _throat_ requires the most constant atte...
Wine And Water If No Reaction Can Be Obtained
Should the patient remain cold in his pack for longer than an...
Category: ANATOMY OF LARYNX, TRACHEA, BRONCHI AND ESOPHAGUS, ENDOSCOPICALLY CONSIDERED
Source: A Manual Of Peroral Endoscopy And Laryngeal Surgery
A few of the anatomical details must be kept especially in mind when
it is desired to introduce straight and rigid instruments down the
lumen of the gullet. First and most important is the fact that the
esophageal walls are exceedingly thin and delicate and require the
most careful manipulation. Because of this delicacy of the walls and
because the esophagus, being a constant passageway for bacteria from
the mouth to the stomach, is never sterile, surgical procedures are
associated with infective risks. For some other and not fully
understood reason, the esophagus is, surgically speaking, one of the
most intolerant of all human viscera. The anterior wall of the
esophagus is in a part of its course, in close relation to the
posterior wall of the trachea, and this portion is called the party
wall. It is this party wall that contains the lymph drainage system of
the posterior portion of the larynx, and it is largely by this route
that posteriorly located malignant laryngeal neoplasms early
metastasize to the mediastinum.
 [FIG 46.--Esophagoscopic and Gastroscopic Chart
BIRTH 1 yr. 3 yrs. 6 yrs. 10 yrs. 14 yrs.ADULTS
23 27 30 33 36 43 53 Cm. GREATER CURVATURE
18 20 22 25 27 34 40 Cm. CARDIA
19 21 23 24 25 31 36 Cm. HIATUS
13 15 16 18 20 24 27 Cm. LEFT BRONCHUS
12 14 15 16 17 21 23 Cm. AORTA
7 9 10 11 12 14 16 Cm. CRICOPHARYINGEUS
0 0 0 0 0 0 0 Cm. INCISORS
FIG. 46.--The author's esophagoscopic chart of approximate distances
of the esophageal narrowings from the upper incisor teeth, arranged
for convenient reference during esophagoscopy in the dorsally
The lengths of the esophagus at different ages are shown
diagrammatically in Fig. 46. The diameter of the esophageal lumen
varies greatly with the elasticity of the esophageal walls; its
diameter at the four points of anatomical constriction is shown in the
Constriction Diameter Vertebra
Cricopharyngeal Transverse 23 mm. (1 in.) Sixth cervical
Antero-posterior 17 mm. (3/4 in.)
Aortic Transverse 24 mm. (1 in.) Fourth thoracic
Antero-posterior 19 mm. (3/4 in.)
Left-bronchial Transverse 23 mm. (1 in.) Fifth thoracic
Antero-posterior 17 mm. (3/4 in.)
Diaphragmatic Transverse 23 mm. (1 in+) Tenth thoracic
Antero-posterior 23 mm. (in.--)
For practical endoscopic purposes it is only necessary to remember
that in a normal esophagus, straight and rigid tubes of 7 mm. diameter
should pass freely in infants, and in adults, tubes of 10 mm.
The 4 demonstrable constrictions from above downward are at
1. The crico-pharyngeal fold.
2. The crossing of the aorta.
3. The crossing of the left bronchus.
4. The hiatus esophageus.
There is a definite fifth narrowing of the esophageal lumen not easily
demonstrated esophagoscopically and not seen during dissection, but
readily shown functionally by the fact that almost all foreign bodies
lodge at this point. This narrowing occurs at the superior aperture of
the thorax and is probably produced by the crowding of the numerous
organs which enter or leave the thorax through this orifice.
The crico-pharyngeal constriction, as already mentioned, is produced
by the tonic contraction of a specialized band of the orbicular fibers
of the lowermost portion of the inferior pharyngeal constrictor
muscle, called the cricopharyngeal muscle. As shown by the author it
is this muscle and not the cricoid cartilage alone that causes the
difficulty in the insertion of an esophagoscope.
This muscle is attached laterally to the edges of the signet of the
cricoid which it pulls with an incomprehensible power against the
posterior wall of the hypopharynx, thus closing the mouth of the
esophagus. Its other attachment is in the median posterior raphe.
Between these circular fibers (the cricopharyngeal muscle) and the
oblique fibers of the inferior constrictor muscle there is a weakly
supported point through which the esophageal wall may herniate to form
the so-called pulsion diverticulum. It is at this weak point that
fatal esophagoscopic perforation by inexperienced operators is most
likely to occur.
The aortic narrowing of the esophagus may not be noticed at all if
the patient is placed in the proper sequential high-low position. It
is only when the tube-mouth is directed against the left anterior wall
that the actively pulsating aorta is felt.
The bronchial narrowing of the esophagus is due to backward
displacement caused by the passage of the left bronchus over the
anterior wall of the esophagus at about 27 cm. from the upper teeth in
the adult. The ridge is quite prominent in some patients, especially
those with dilatation from stenoses lower down.
The hiatal narrowing is both anatomic and spasmodic. The peculiar
arrangement of the tendinous and muscular structure of the diaphragm
acts on this hiatal opening in a sphincter-like fashion. There are
also special bundles of muscle fibers extending from the crura of the
diaphragm and surrounding the esophagus, which contribute to tonic
closure in the same way that a pinch-cock closes a rubber tube. The
author has called the hiatal closure the diaphragmatic pinchcock.
Next: Direction Of The Esophagus
Previous: Dimensions Of The Trachea And Bronchi