Name:
05 Cervical Esophagus
Description:
05 Cervical Esophagus
Thumbnail URL:
https://cadmoremediastorage.blob.core.windows.net/4c98b462-94d8-477f-ac10-ac85ded68830/thumbnails/4c98b462-94d8-477f-ac10-ac85ded68830.jpg?sv=2019-02-02&sr=c&sig=KE6iCkTU%2BhLQe8SNlUGSKJqZMUieDwMLtaw8IIoULrY%3D&st=2024-12-21T14%3A35%3A34Z&se=2024-12-21T18%3A40%3A34Z&sp=r
Duration:
T00H05M28S
Embed URL:
https://stream.cadmore.media/player/4c98b462-94d8-477f-ac10-ac85ded68830
Content URL:
https://cadmoreoriginalmedia.blob.core.windows.net/4c98b462-94d8-477f-ac10-ac85ded68830/0520Cervical20Esophagus.mov?sv=2019-02-02&sr=c&sig=wUzreefywA6ndctnHa%2FTXxCJytbJGSFd%2BSOxPGRqGfM%3D&st=2024-12-21T14%3A35%3A34Z&se=2024-12-21T16%3A40%3A34Z&sp=r
Upload Date:
2022-03-03T00:00:00.0000000
Transcript:
Language: EN.
Segment:0 .
In this video we will discuss the proper technique to expose the cervical esophagus.
Segment:1 Objectives.
We will begin by discussing the relevant anatomy, the necessary instruments and positioning, followed by the proper techniques for exposure, and, finally, the tips and pitfalls of this exposure.
Segment:2 Anatomy.
The cervical esophagus is approximately 5-7 cm in length, and extends from the cricopharyngeus muscle to the thoracic inlet.
The external landmark of the pharyngeal-esophageal junction is the cricoid cartilage. The cervical esophagus lies between the cervical vertebra and the trachea. It is important to remember that the posterior wall of the trachea is membranous and can easily be injured during this exposure. In the trachea-esophageal groove lies the recurrent laryngeal nerve, which should be preserved during exposure.
The major blood supply to the cervical esophagus is the inferior thyroid artery, however, there is considerable collateral circulation in the inferior thyroid artery and may be ligated unilaterally with little consequence, if necessary, for exposure. The patient is positioned supine with the arms tucked,
Segment:3 Instrumentation and Positioning.
and if the cervical spine is cleared the neck is extended and turned to the contralateral side. The preparation should include the neck, including the mandible and ear, and should also include the chest.
A standard instrument tray is required. A rigid and/or flexible endoscope should also be available, as well as a standard chest tray should thoracic exposure be required. In addition, a 40 French Bougie should be available, as this size will generally allow repair with no stenosis and result in dysphagia. The skin incision is made in an oblique fashion along the anterior border of the sternocleidomastoid muscle, extending from the mastoid process, to the suprasternal notch.
The incision is carried through the skin and the platysma to expose the sternocleidomastoid muscle. The anterior border of the sternocleidomastoid muscle is then mobilized along its length using electrocautery. Once the sternocleidomastoid muscle is mobilized, it is retracted laterally and the omohyoid muscle is exposed. This is then divided using the electrocautery in order to provide exposure to the deep structures of the neck.
Next, the internal jugular vein is encountered and mobilized along its length so that it may be retracted laterally. Division of the middle thyroid vein is often necessary in order to gain adequate exposure to the esophagus. Similarly, the carotid artery just anterior to the internal jugular vein is mobilized and retracted laterally.
With the vessels retracted laterally, the lateral border of the distal cervical esophagus is exposed. In order to gain exposure to the remainder of the cervical esophagus, the inferior thyroid artery often needs to be ligated. While this is the main source of blood supply to the cervical esophagus, there is adequate collateral circulation that it may be ligated unilaterally with little consequence.
The recurrent laryngeal nerve is found in the paraesophageal fat of the trachea esophageal groove. Care must be taken to preserve this nerve during this dissection. The trachea is now easily visible anterior to the esophagus, and the esophagus can now be encircled using a Penrose drain to aid in exposure. Great care should be taken to avoid injury due to the membranous posterior wall of the trachea.
Once esophageal repair has been completed, it may be buttressed by mobilizing the strap muscles, or sternocleidomastoid muscle, and suturing it over the repair.
Segment:4 Tips and Pitfalls.
During exposure of the cervical esophagus, one must always keep in mind the location of the recurrent laryngeal nerve and the tracheal-esophageal groove to prevent injury. In addition, the posterior wall of the trachea is membranous, and care must be taken to avoid injury during the dissection. Repairs of the esophagus must include re-approximation of the mucosal layer.
Repairs should be performed over a 40 French Bougie to prevent stenosis and result in dysphagia. When one injury is found, always consider a second injury. And closed suction drains should be left on closure. Thank you.
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