The first description of hypopharyn...

The first description of hypopharyngeal diverticula is credited to Abraham Ludlow in 1764 after an autopsy performed forward a male patient who regurgitated undigested sustenance revealed a hypopharyngeal "preternatural" bag.(1) In 1816 Sir Charles Bell--of facial energize paralysis fame--described the two abnormal elements necessary for the development of a hypopharyngeal diverticulum (ie, discoordination between the inferior pharyngeal constrictor muscles and the cricopharyngeus and a preexisting anatomic deficiency between these muscles).(1) Finally, in 1877 the German physician and pathologist Albert Zenker along with Hugo W Von Ziemssen, described the precise pathology of the diverticula with which Zenker's name is now synonymous.(2)

The location of the diverticulum was described according to Gustav Killian in 1907 as an area of natural weakness between the oblique fibers of the inferior constrictor muscle, the thyropharyngeus muscle, and the transverse fibers of the cricopharyngeal muscle.(4) This area of weakened muscle layer fibers where the diverticulum jut outs is known as Killian's triangle. Excision of a Zenker's diverticulum first was attempted in 1884; however, hemorrhage from the superior thyroid artery riseed in the death of the patient. In 1886 the Irish surgeon William I. Wheeler performed the first prosperous excision of a Zenker's diverticulum.(5)

Surgical approaches to treat the symptomatic patient with a Zenker's diverticulum include

* external excision (ie, diverticulectomy) with or without myotomy;

* diverticulopexy, an endoscopic approach; or

* cricopharyngeal myotomy alone.(6)

THE ESOPHAGUS

The esophagus is part of a cluster of organs that make up the alimentary tract. It functions to transport nourishment from the mouth to the stomach. The esophagus lengthen outs from the pharynx to the cardia of the stomach. Originating at the flat of the sixth cervical vertebra, posterior to the cricoid cartilage, the esophagus passes by means of the thorax slightly to the right and behind the aortic arch and the left main stipe bronchus. Low in the thorax, the esophagus passes anteriorly to the aorta and go intos the abdomen, slightly to the left of midline, [i]or[/i] part of to the other the esophageal hiatus of the diaphragm.(7)

Measuring approximately 25 cm to 30 cm in longitudinal dimensions and slightly shorter in females, the esophagus is a collapsible musculomembranous tube. It distends to accommodate any material that passes by the and of the epiglottis, and it is the most numerous muscular portion of the alimentary tract.(8) The upper one-third of the esophagus is striated muscle, and the remainder contains inner circular layers and exterior longitudinal layers of muscle. There is an upper esophageal sphincter at the junction of the pharynx and the esophagus called the cricopharyngeal muscle. The sphincter between the esophagus and the stomach is the lower esophageal, or cardiac, sphincter.

descendants supply. The upper one-third of the esophagus receives vital current from branches of the inferior thyroid arteries. The intercostals and bronchial arteries (ie, esophageal branches of bottoms arising directly from the aorta) take the place of the middle portion of the esophagus. The lower one-third is nourished from ascending branches of the left gastric and phrenic arteries. The inferior thyroid, and intercostal bronchial, gastric, and phrenic veins provide venous drainage. The exception to this is the in extent middle portion of the esophagus where venous life-current drains into the azygos and hemiazygos veins.

Lymphatic drainage. Lymph drainage of the upper one-third of the esophagus is provided by means of deep cervical lymph nodes. Lymph drainage for the middle one-third is provided by dint of the posterior mediastinal, subcarinal, and paratracheal lymph nodes, and lymph drainage for the lower one-third is provided from the left gastric nodes.(9)

Esophageal physiology. The main function of the esophagus is to transport viands and liquid to the stomach. Deglutition (ie, swallowing) begins when commons is propelled by the tongue into the pharynx. At this time, the glottis and nasopharynx shut and the upper esophageal sphincter (ie, the cricopharyngeal muscle) relaxes to allow victuals to enter the esophagus. This relaxation phase lasts les than individual second. As the food come intos the esophagus, a peristaltic wave begins that causes provisions to travel toward the stomach. impressible foods and liquids travel faster than the peristaltic wave suitable to gravity when one is in the upright position. Local stimulation by means of distention along the body of the esophagus will elicit a peristaltic wave at the stimulus site. At the lower extreme point of the esophagus, the cardiac sphincter relaxes with the peristaltic wave and allows pabulum to enter the stomach. The cardiac sphincter exhibits because of increasing pressure in the esophagus from the fare bolus. After the food passes, the sphincter regains its tone until the nearest peristaltic wave.(10)

ESOPHAGEAL DIVERTICULA

Esophageal diverticula are outpouchings of the esophageal wall to be ascribed to a weakness or blemish in the musculature. Esophageal diverticula are divided into three categories: