Constrictors and Approach to Cervical Oesophagus

Inferior Constrictors (64 in 3rd)
Arise from cricoid and thyroid cartilage --> join at midline raphe
Split into cricopharyngeus and thyropharyngeus parts
- lower fibres / cricopharyngeus are in tonic contraction = upper oesophageal constrictor; supply different, ie by RLN vs pharyngeal plexus
Where the constrictor arises from the cricoid (where cricopharyngeus and thyropharyngeus meet) is Killian dehiscence; also oblique line over thyroid cartilage
- pharyngeal diverticulum bulges through here, often to left
- cricopharyngeus must be divided; should include lower fibres of thyropharyngeus
--> undertake myotomy in posterior midline.

Approach to Cervical Oesophagus
Usually incise to L as oesophagus lies more to L
Open anterior to SCM from sternal notch to few cm below ear
- through platysma
- preserve certical cutaneous nerve if possible
- divide myohyoid
Expose carotid sheath
- retract laterally and divide middle thyroid vein
Ansa cervicalis on carotid artery and IJV exposed; branches to straps need to be divided
Divide inferior thyroid artery; inconsequential
Keep close to oesophageal wall and don't go looking for RLN if don't need to.
- begins at inferior cornu of thyroid carilage
- stay away from proximal extent
- mobilize rest by using a swab to bluntly free down to mediastium.
- lift pharyngoesophageal ligament to access R oesophagus & free that as well.

May need to resect head of clavicle in cervical anastomoses after oesophagectomy.
- free muscles and take first half of rib, and portion of manubrium, with a bone cutters and a Gigli saw.
- leave stable clavicle alone; allows a better thoracic inlet.