Cervical internal organs

1. Cervical Viscera
By
Saad Datti

2. Viscera of the Neck
• The cervical viscera are arranged in three
layers, named for their primary function.
Superficial to deep, they are the:
I. Endocrine layer: the thyroid and parathyroid
glands.
II. Respiratory layer: the larynx and trachea.
III. Alimentary layer: the pharynx and
esophagus.

3.  Endocrine, butterfly shaped
gland.
 Consists of right & left
lobes.
 The 2 lobes are connected
together by a narrow
isthmus.
 The isthmus overlies the 2nd
3rd & 4th tracheal rings.
 The gland is surrounded
by a facial sheath derived
from the pretracheal
layer of the deep cervical
fascia.
Thyroid gland
3

4. • Each lobe is pear-
shaped, with its apex
reaches up to the
oblique line of the
thyroid cartilage.
• Its base lies at the
level of 4th or 5th
tracheal rings.
• Inside the pretracheal
facial sheath, there is
facial capsule.
• So, it is surrounded by
2 membranes.
Thyroid gland
4

5. Each lobe is pear shape,
with its apex directed
upward as far as the oblique
line of the thyroid cartilage;
its base lies at the 4th or 5th
tracheal ring.
The isthmus
extends across
the midline in
front of the 2nd
3rd & 4th rings of
the trachea.
Anterior
Posterior
5

6. A 3rd small pyramidal
lobe is often present
which projects from
the upper border of
the isthmus slightly
to left of middle line.
The Pyramidal lobe is
connected to the
hyoid bone by a
fibrous or muscular
band called levator
glandulae
thyroideae.
This represents the
fibrosed &
obliterated
thyroglossal duct.
Levator
glandulae
thyroideae
6

7. Anterolaterally: (4 S).
1. Sternohyoid.
2. Sternothyroid.
3. Superior belly of
omohyoid
4. Sternomastoid.
RELATION
OF THE
THYROID GLAND
7

8. Posteriorly:
Carotid sheath &
its contents.
Medially:
Above:
Larynx & pharynx.
Below:
Trachea &
esophagus.
Recurrent
laryngeal nerves in
between.
Cricothyroid
muscle & external
laryngeal nerve. 8

9. • The rounded
posterior border
is related to the
superior &
inferior
Parathyroid
glands.
• It is also related
to anastomosis
between
superior &
inferior thyroid
arteries.
9
Posterior border

10.  :
1-Superior thyroid artery:
It is a branch from the
external carotid artery.
It descends to the upper
pole of the lobe, with
the external laryngeal nerve.
It runs along the upper
border of the isthmus to
anastomosis with that of
the opposite side.
2- Thyroidea ima artery:
If present, it arises from
aortic arch or from the
brachiocephalic artery.
It ascends in front of the
trachea to reach
the isthmus.
ARTERIAL SUPPLY
10

11. 3-Inferior thyroid artery:
From thyrocervical trunk
of the 1st part of the
subclavian artery,
It ascends behind the
gland to the level of the
cricoid cartilage.
Then it curves medially
behind the carotid sheath.
Then it reaches the
posterior aspect of the
gland & descends
downwards.
The recurrent laryngeal
nerve crosses either in
front or behind it.!
11

12. 1-Superior thyroid vein internal jugular vein
2- Middle thyroid vein internal jugular vein
3- Inferior thyroid vein left brachiocephalic vein
Veins of Thyroid Gland
Lymph Of the
Thyroid
Gland:
Deep cervical
& paratracheal
lymph nodes.
12

13. Parathyroid glands
4 small ovoid bodies,
about 6 mm. long.
They lie within the facial
capsule of the gland,
(between the 2
membranes).
2 superior parathyroid
has a constant
position at the middle
of the posterior
border of the gland.
2 inferior parathyroid
usually at the level of
the inferior pole.
They lie within the
thyroid tissue or
sometimes outside
the facial capsule.
13

14. PARATHYROID
GLANDS
• They are supplied by
superior and inferior
thyroid arteries.
• Their veins are
drained to superior,
middle and inferior
thyroid veins.
• Lymph nodes:
• Deep cervical &
paratracheal lymph
nodes.
• Nerve supply:
• Superior & middle
cervical sympathetic
ganglia.
14

17. Innervation

18. Lymphatic Drainage

19. 1. Agenesis of the
thyroid gland.
2. Persistence of
thyroglossal
duct.
3. Thyroglossal cyst.
4- Ectopic thyroid
gland.
5- Accessory thyroid
tissue.
Congenital
Anomalies
19

20. 20

21. Ectopic Thyroid tissue
• The thyroid glands
develops high up close
to foramen cecum of
the developing tongue.
• Then it descends along
the thyroglossal duct to
reach its final position
by the 7th week.
• Descent of the thyroid
could be arrested at
any point, or extends
down behind the
sternum in the thorax.
21

22. 22
 The external laryngeal nerve runs close to
the superior thyroid artery before turning
medially to supply the cricothyroid muscle.
 High ligation of the superior thyroid artery
during thyroidectomy places this nerve at risk
of injury, so it should be ligated within the
upper pole of the gland. Its lesion will cause
horsiness of voice.
 The inferior thyroid artery is closely
associated with the recurrent laryngeal
nerve. This nerve can be found , in a triangle
bounded laterally by the common carotid
artery, medially by the trachea, and
superiorly by the thyroid lobe.
 The relationship of the recurrent laryngeal
nerve and the inferior thyroid artery is
highly variable in that the nerve can lie deep
or superficial to the artery, or between the
branches of the artery, and be different on
either side of the neck.
 Consideration of this nerve and its branches
must be given during thyroidectomy.
Clinical notes

23. Respiratory Layer of the Cervical
Viscera
• The viscera are the larynx and trachea, contribute to the
respiratory functions of the body.
• The main functions of the cervical respiratory viscera are as
follows:
 Routing air and food into the respiratory tract and esophagus,
respectively.
 Providing a patent airway and a means of sealing it off
temporarily.
 Producing voice.

24. Larynx
 It is the part of respiratory
tract containing the vocal
cords.
 A tube-shaped organ.
 2-inch-long
 It opens into the laryngeal
part of the pharynx above.
 It is continuous below with
the trachea.
 It is functioning in:
 Deglutition (swallowing).
 Respiration (breathing).
 Phonation (phonation).

25. Relations
• The larynx is related to
major critical structures in
the neck:
 Carotid arteries ,
jugular veins, and vagus
nerve.
 Superior and inferior
thyroid arteries.
 Superior and recurrent
laryngeal nerves.

26. Structure
• The larynx consists
of four basic
components:
1. A cartilaginous
skeleton.
2. Membranes
and ligaments.
3. Muscles
(intrinsic and
extrinsic).
4. Mucosal lining.

27. Cartilages
• The cartilaginous skeleton is
comprised of :
1. Thyroid.
2. Cricoid. Single
3. Epiglottis.
4. Arytenoid.
5. Corniculate. Paired
6. Cuneiform.
• All the cartilages are hyaline ,
except the epiglottis.
• Epiglottis is formed of elastic
cartilage.
• The cartilages are:
 Connected by joints,
ligaments & membranes.
 Moved by muscles.
1
3
2
2
3
1 4
4

29. Membranes & Ligaments
1. Thyrohyoid
membrane, (one
median & two lateral
thyrohyoid ligaments).
2. Median
cricothyroid
ligament.
3. Cricotracheal
membrane.
4. Hyoepiglottic
ligament.
5. Thyroepiglottic
ligament.

30. • Quadrangular membrane:
• Extends between the
epiglottis and the
arytenoid cartilages.
• Its lower free margin
forms the vestibular
ligament that lies
within the vestibular
fold.
• Cricothyroid membrane
(conus elasticus):
• Attached to upper
border of the cricoid
cartilage.
• Its upper free margin
forms vocal ligament.

31. Laryngeal Inlet
• It is the upper opening of
the larynx.
• It is directed upward and
backward and opens into
the laryngeal part of the
pharynx.
• Bounded by:
• Anteriorly: by the upper
margin of epiglottis (E).
• Posteriorly & below by
arytenoid cartilages (A)
• Laterally by aryepiglottic
folds (AEF)
• Piriform fossa: The area of the
pharynx that surrounds the
inlet of larynx.
E
A

32. Laryngeal Cavity
• Extends from laryngeal inlet to the
lower border of the cricoid cartilage.
• Narrow in the region of the vestibular
folds (rima vestibuli).
• Narrowest in the region of the vocal
folds (rima glottidis).
• Divided into three parts:
A. Supraglottic part, the part above the
vestibular folds, is called the
vestibule.
B. Ventricle: The part between the
vestibular & the vocal folds.
C. Infraglottic part, the part below the
vocal folds.
Rima
vestibuli
Rima
glottidis
B
A
C
A
B
C

33. Mucous Membrane
• The cavity is lined with
ciliated columnar
epithelium
• The surface of vocal folds,
is covered with stratified
squamous epithelium
because of exposure to
continuous trauma during
phonation,
• Contains many mucous
glands, more numerous in
the saccule (for lubrication
of vocal folds)
Muscles
Divided into two groups:
• Extrinsic muscles: divided into
two groups
• Elevators of the larynx
• Depressors of the larynx
• Intrinsic muscles: divided into
two groups
• Muscles controlling the
laryngeal inlet
• Muscles controlling the
movements of the vocal
cords

34. Elevators of the Larynx
• The Suprahyoid Muscles:
1. Digastric.
2. Stylohyoid.
3. Mylohyoid.
4. Geniohyoid.
• The Longitudinal Muscles
of the Pharynx:
1. Stylopharyngeus.
2. Salpingo-pharyngeus.
3. Palatopharyngeus.
Depressors of Larynx
• The Infrahyoid Muscles:
1. Sternohyoid.
2. Sternothyroid.
3. Omohyoid.

35. Muscles Controlling the
Laryngeal Inlet
• Oblique arytenoid
• Aryepiglottic
muscle

36. • Muscle decreasing the
Length & Tension of
Vocal Cords
• Thyroarytenoid (vocalis)
• Muscle increasing the Length
& Tension of Vocal Cords
• Cricothyroid: It is the only
intrinsic muscle that present
in the outer surface of the
larynx.

37. • Movements of the Vocal
Cords
Adduction Abduction
Adductors
• Lateral cricoarytenoid
• Transverse arytenoid
Abductor
• Posterior cricoarytenoid

38. Blood Supply
• Arteries:
 Upper half: Superior
laryngeal artery, branch of
superior thyroid artery.
 Lower half: Inferior
laryngeal artery, branch of
inferior thyroid artery.
• Veins:
 Accompany the
corresponding arterie.s
• Lymphatics:
 The lymph vessels drain
into the deep cervical
lymph nodes.
Nerve Supply
• Sensory
 Above the vocal cords:
Internal laryngeal nerve,
branch of the superior
laryngeal of vagus.
 Below the vocal cords:
Recurrent laryngeal, of
vagus.
• Motor
 All intrinsic muscles of the
larynx are supplied by the
recurrent laryngeal except
cricothyroid, which is
supplied by the the external
laryngeal of superior
laryngeal of vagus.

39. Trachea (windpipe)
• Mobile, fibrocartilginous tube, 5
inches long, 1 inch in diameter.
• Begins: In the neck below the cricoid
cartilage of the larynx (at the level of
C6).
• Ends: below in the thorax at the
level of sternal angle (lower border
of T4), by dividing into right and left
principal (main, primary) bronchi.
• The ridge at the bifurcation is called
carina. It is the most sensitive part of
the tract and is associated with the
cough reflex.

40. Relations in the Superior Mediastinum
Posterior
• Esophagus.
• Left recurrent laryngeal
nerve.
Anterior
• Sternum.
• Thymus.
• Left brachiocephalic
vein.
• Brachiocephalic artery.
• Left common carotid a.
• Arch of aorta.
Left side
• Arch of aorta.
• Left common
carotid artery.
• Left subclavian a.
• Left vagus & left
phrenic nerves.
• Pleura.
Right side
• Azygos vein.
• Right vagus
nerve.
• Pleura.

41. Nerve Supply
• Branches of vagus and the
recurrent laryngeal nerves.
(from vagus) supply
sensory fibers to the
mucous membrane.
• Branches from the
sympathetic trunks supply
the trachealis muscle and
the blood vessels.
Blood Supply
• Arteries: Branches from the
inferior thyroid and bronchial
arteries.
• Veins: Drain to inferior thyroid
veins.
Lymphatic Drainage
• Into the pre- & paratracheal
lymph nodes.

42. Right Principal Bronchus
• About one inch long
• Wider, shorter and more vertical than
the left ( foreign bodies).
• Gives superior lobar bronchus before
entering the hilum of the right lung
• On entering the hilum it divides into
middle and inferior lobar bronchi
Left Principal Bronchus
• About two inches long
• Narrower, longer and more horizontal than the right
• Passes to the left below the arch of aorta and in front of
esophagus
• On entering the hilum of the left lung it divides into superior and
inferior lobar bronchi

43. Bronchial Divisions
Conduction zone branches
• Primary (main) bronchi
• Secondary (lobar)
bronchi
• Tertiary (segmental)
bronchi (supply the
bronchopulmonary
segment)
• Smaller bronchi
• Bronchioles
• Terminal bronchioles
• Within the lung each bronchus
divides into number of
branches that can be divided
into two groups:
Respiratory zone
branches
• Respiratory
bronchioles
• Alveolar ducts
• Alveolar sacs
• Alveoli

44. Alimentary Layer of the Cervical
Viscera
• It takes part in the digestive functions of the body.
• Although the pharynx conducts air to the larynx,
trachea, and lungs, its constrictor muscles direct (and
the epiglottis deflects) food to the esophagus.
• The esophagus, also involved in food propulsion, is
the beginning of the alimentary canal (digestive
tract).

45. Pharynx
• Muscular tube lying behind the
nose, oral cavity & larynx
• Extends from the base of the
skull to level of the 6th cervical
vertebra, where it is continuous
with the esophagus
• The anterior wall is deficient and
shows (from above downward):
 Posterior nasal apertures
 Opening of the oral cavity
 Laryngeal inlet
N
OC
L

46. Pharyngeal Wall
• It is a musculo-membranous wall,
composed of:
 Mucosa & submucosa
 Pharyngobasilar fascia
 Muscles: circular &
longitudinal
 Buccopharyngeal fascia
• The buccopharyngeal fascia is
separated from the prevertebral
fascia by the retropharyngeal
space.

47. Retropharyngeal Space
• A potential space between the buccopharyngeal
fascial lining of the pharynx and the prevertebral
fascia
• Contains loose areolar tissue
• Closed:
 Superiorly (by the base of the skull) and
 Laterally (by the carotid sheath)
• Open inferiorly into the superior mediastinum
• Allows movement of pharynx, larynx, trachea and
esophagus during swallowing

48. Circular (Constrictor) Muscles
• Three in number: Superior,
Middle & Inferior
• Extend around the pharynx and
are inserted posteriorly into a
fibrous raphe that extends from
the pharyngeal tubercle on the
occipital bone to the esophagus
• The three muscles overlap each
other
• The gap between the superior
border of the superior constrictor
and the occipital bone is filled by
thickened pharyngobasilar fascia
M
S
I

49. • Superior constrictor
 Origin: medial pterygoid plate,
pterygoid hamulus,
pterygomandibular ligament,
mylohyoid line
 Insertion: pharyngeal tubercle,
pharyngeal raphe
• Middle constrictor
 Origin: lower part of stylohyoid
ligament, greater & lesser
cornu of hyoid bone
 Insertion: pharyngeal raphe

50. • Inferior constrictor
 Origin: lamina of thyroid
cartilage, cricoid cartilage
 Insertion: pharyngeal raphe
• Functions:
• The constrictor muscles propel
the bolus of food down into the
esophagus
• Cricopharygeus (lower fibers of
the inferior constrictor) act as a
sphincter, preventing the entry
of air into the esophagus
between the acts of swallowing

51. Longitudinal Muscles
• Three in number:
• Stylopharyngeus
• Salpingopharyngeus
• Palatpharyngeous
• Function:
 Elevate the larynx &
pharynx during
swallowing

52. • Stylopharyngeus
 Origin: styloid process
 Insertion: posterior border of
thyroid cartilage
• Salpingopharyngeus
 Origin: auditory tube
 Insertion: blends with
palatoglossus
• Palatopharyngeus
 Origin: palatine aponeurosis
 Insertion: posterior border of
thyroid cartilage

53. Division
• Pharynx is divided into three
parts:
 Nasopharynx:
 Superior part, communicates
with the nasal cavity through
posterior nasal apertures
 Oropharynx:
 Middle part, communicates
with the oral cavity through
the oropharyngeal isthmus
 Laryngopharynx:
 Inferior part, communicates
with the larynx through the
laryngeal inlet

54. Nasopharynx
• Boundaries:
• Roof: body of sphenoid &
basal part of the occipital
bone. Pharyngeal tonsils
(adenoides) present in the
submucosa
• Floor: upper surface of soft
palate & the pharyngeal
isthmus (opening between
the free margin of soft palate
and posterior pharyngeal
wall)

55. • Anterior wall: shows posterior
nasal apertures
• Posterior wall: supported by
anterior arch of atlas (C1)
• Lateral wall shows:
 Opening of auditory tube
 Tubal elevation (produced
by posterior margin of
tube)
 Pharyngeal recess
 Tubal tonsil
 Salpingopharyngeal fold
(raised by salpingo-
pharyngeus muscle)

56. Oropharynx
• Lies behind the mouth
• Extends from soft palate to
upper border of epiglottis
• Boundaries:
• Roof: soft palate and
pharyngeal isthmus
• Floor: posterior one third of
tongue, median & lateral
glossoepiglottic folds, and the
valleculae

57. • Anterior wall: opening of
the oral cavity
• Posterior wall: supported
by body of C2 and upper
part of body of C3
vertebra
• Lateral wall shows:
 Palatopharyngeal folds
posterior to the
palatoglossal folds.
 Palatine tonsil located
between them in the
 Tonsillar fossa

58. Palatine Tonsil
• Paired masses of lymphoid tissue
• Located in the palatine
fossa/sinus, in the lateral wall of
the oropharynx
• Reaches its maximum size during
early childhood, but after puberty
diminishes in size
• Lateral surface: covered by a
fibrous capsule
• Medial surface:
• Projects into the cavity of
oropharynx
• Covered by mucous
membrane
• Shows multiple depressions,
the tonsillar crypts and one
deep intratonsillar cleft

59. Relations
• Anteriorly: Palatoglossal fold
(palatoglossus muscle covered
by mucous membrane)
• Posteriorly: Palatopharyngeal
fold (palatopharyngeus muscle
covered by mucous membrane)
• Superiorly: Soft palate
• Inferiorly: Posterior third of the
tongue
• Medially: Cavity of the
oropharynx

60. • Laterally:
 The capsule separates it from
the structures forming the
tonsillar bed:
• Loose areolar tissue
• External palatine vein
• Tonsillar branch of facial artery
accompanied by branches of
the glossopharyngeal nerve
• Superior constrictor muscle of
the pharynx
• Styloglossus muscle
 More laterally are the facial
artery & internal carotid
artery

61. Palatine Tonsil cont’d
• Arterial supply: Tonsillar branch of facial artery
(and twigs from ascending pharyngeal,
palatine & lingual arteries)
• Venous drainage: Veins pierce the superior
constrictor muscle and join the external
palatine, the pharyngeal or the facial veins
• Lymphatics join the upper deep cervical lymph
nodes (jugulodigastric node)

62. Laryngopharynx
• Lies behind the laryngeal inlet
& the posterior surface of
larynx
• Extends from upper border of
epiglottis to lower border of
cricoid cartilage
• Boundaries:
• Anterior wall: has opening of
the larynx in the upper part
and below that is the mucosa
covering the posterior surface
of larynx

63. • Posterior wall:
supported by bodies of
C3, 4, 5, 6 vertebrae
• Lateral wall:
 Supported by thyroid
cartilage and
thyrohoid membrane.
 On each side of
laryngeal inlet, lies
the piriform fossa

64. Piriform Fossa
• A small depression situated on either side
of the laryngeal inlet
• Leads obliquely backward and downwrd
from the region of the back of the tongue
to the esophagus
• It is a common site for the lodging of
foreign bodies
• Bounded:
 Medially by the aryepiglottic fold
 Laterally by the lamina of thyroid
cartilage & the thyrohyoid membrane.
• Branches of internal laryngeal (&
recurrent laryngeal) nerve lie deep to the
mucous membrane of the fossa and are
vulnerable to injury during removal of a
foreign body

65. Nerve Supply
• Sensory Nerve Supply:
 Nasopharynx: Maxillary nerve
 Oropharynx: Glossopharyngeal nerve
 Laryngopharynx: Internal laryngeal branch of the
vagus nerve
• Motor Nerve Supply:
 All the muscles of pharynx, except the
stylopharyngeus, supplied by the pharyngeal plexus
 The stylopharyngeus is supplied by the
glossopharyngeal nerve

66. Blood Supply & Lymphatics
• Arterial supply is derived from branches of:
• Ascending pharyngeal artery
• Ascending palatine artery
• Facial artery
• Maxillary artery
• Lingual artery
• The Veins drain into pharyngeal venous plexus, which
drains into the internal jugular vein
• The lymphatics drain into the deep cervical lymph
nodes either directly, or indirectly via the
retropharyngeal or paratracheal lymph nodes

67. Waldeyer's Tonsillar Ring
• It is a lymphoid tissue ring
located in the pharynx
• Function as a barrier to
infection especially in the first
few years of life
• Consists of (from superior to
inferior):
 Adenoids (pharyngeal
tonsils)
 Tubal tonsil
 Palatine tonsil
 Lingual tonsil

68. Clinical Notes
• Adenoides (enlarged pharyngeal
tonsils) & adenoidectomy. Adenoids
results in obstruction to nasal
breathing and make mouth
breathing necessary. The patient
develops a typical facial expression
called the ‘adenoid facies’. May
also cause impaired hearing
• Otitis media (middle ear infection),
secondary to infection of
nasopharynx
• Tonsillitis & Tonsillectomy
Adenoid facies

69. • Peritonsillar abcess (quinsy), is a
complication of tonsillitis and consists
of a collection of pus beside the tonsil
(peritonsillar space).
• Piriform fossa: a common site for the
lodging of foreign bodies
• Pharyngeal pouch, posteromedial
herniation of mucosal diverticulum
between thyropharyngeal and
cricopharyngeal parts of the inferior
constrictor muscle leading to dysphagia
(difficulty in swallowing) . It occurs
mainly in older people
• Retropharyngeal abcess , may spread to
the superior mediastinum

70. ESOPHAGUS
• It is a tubular structure about
25 cm long.
• It begins as the continuation
of the pharynx at the level of
the 6th cervical vertebra.
• It pierces the diaphragm at
the level of the 10th thoracic
vertebra to join the stomach.
• It is divided into 3 parts:
• 1- Cervical.
• 2- Thoracic.
• 3- Abdominal.
Abdominal
thoracic
Cervical
70

71. 71
CERVICAL PART
• Posteriorly:
• Vertebral column.
• Laterally:
• Lobes of the thyroid
gland.
• Anteriorly:
• Trachea and the
recurrent laryngeal
nerves.
RELATIONS

72. 72
THORACIC PART
• In the thorax, it passes
downward and to the left
through superior then to
posterior mediastinum
• At the level of the sternal
angle, the aortic arch pushes
the esophagus again to the
midline.

73. 73
ANTERIOR
RELATIONS
• Trachea
• Left recurrent
laryngeal nerve
• Left principal
bronchus
• Pericardium
• Left atrium
Thoracic part

74. By Prof. Saeed Abuel Makarem & Dr.
Jamila El Medany
74
POSTERIOR
RELATIONS
• Bodies of the
thoracic
vertebrae
• Thoracic duct
• Azygos vein
• Right posterior
intercostal
arteries
• Descending
thoracic aorta (at
the lower end)
Thoracic part

75. LATERAL RELATION
• On the Right side:
• Right mediastinal
pleura
• Terminal part of the
azygos vein.
• On the Left side:
• Left mediastinal
pleura
• Left subclavian
artery
• Aortic arch
• Thoracic duct
By Prof. Saeed Abuel Makarem & Dr. Jamila
El Medany 75

76. 76
RELATIONS IN THE ABDOMEN
• In the Abdomen, the esophagus
descends for 1.3 cm and joins the
stomach.
• Anteriorly, left lobe of the liver.
• Posteriorly, left crus of the
diaphragm.
• Fibers from the right crus of the diaphragm
form a sling around the esophagus.
• At the opening of the diaphragm, the
esophagus is accompanied by:
– The two vagi
– Branches of the left gastric vessels
– Lymphatic vessels.

77. ESOPHAGEAL
CONSTRICTIONS
• The esophagus has 3 anatomic
constrictions.
• The first is at the junction with the
pharynx(pharyngeoesophageal
junction).
• The second is at the crossing with
the aortic arch and the left main
bronchus.
• The third is at the junction with
the stomach.

78. By Prof. Saeed Abuel Makarem & Dr.
Jamila El Medany
78
ARTERIAL SUPPLY
• Upper third by the
inferior thyroid
artery.
• The middle third by
the thoracic aorta.
• The lower third by
the left gastric
artery.

79. VENOUS
DRAINAGE
• The upper third
drains in into the
inferior thyroid veins.
• The middle third into
the azygos veins.
• The lower third into
the left gastric vein,
which is a tributary
of the portal vein.
• NB. Esophageal
varices.

80. By Prof. Saeed Abuel Makarem & Dr.
Jamila El Medany
80
LYMPH
DRAINAGE
• The upper third is
drained into the
deep cervical
nodes.
• The middle third
is drained into the
superior and
inferior
mediastinal
nodes.
• The lower third is
drained in the
celiac lymph
nodes in the
abdomen.

81. By Prof. Saeed Abuel Makarem & Dr.
Jamila El Medany
81
NERVE SUPPLY
• It is supplied by
sympathetic fibers from
the sympathetic trunks.
• The parasympathetic
supply comes form the
vagus nerves.
• Inferior to the roots of
the lungs, the vagus
nerves join the
sympathetic nerves to
form the esophageal
plexus.
• The left vagus lies
anterior to the
esophagus.
• The right vagus lies
posterior to it.