How many cm is the esophagus

This type of cancer can occur anywhere along the esophagus, but is most common in the neck region cervical esophagus and in the upper two-thirds of the chest cavity upper and middle thoracic esophagus. Squamous cell carcinoma used to be the most common type of esophageal cancer in the United States. Cancers that start in gland cells cells that make mucus are called adenocarcinomas. Like the rest of the gastrointestinal tract, the esophagus is made of four distinct tissue layers.

The esophagus is involved in the processes of swallowing and peristalsis to move substances from the mouth to the stomach.

The swallowing food begins in the mouth and continues with the contraction of skeletal muscles in the pharynx and esophagus. The upper esophageal sphincter dilates to permit the swallowed substance to enter the esophagus. From this point, waves of muscle contraction called peristalsis move food toward the stomach. In peristalsis, regions of the esophagus closer to the stomach open to permit food to pass through while the region just above the food contracts to push the food onward.

Flexion and extension of the neck or deglutition move these points of fixation craniad the distance of one vertebral body. The general orientation of the esophagus is vertical, with several curves in its course. At its commencement, it is situated in the midline with deviation to the left side as far as the root of the neck. It gradually passes to the midline again at the level of the fifth thoracic vertebra, and finally inclines to the left as it passes forward to the esophageal hiatus in the diaphragm.

The esophagus also demonstrates anteroposterior flexures corresponding to the curvatures of the cervical and thoracic portions of the vertebral column. Radiographic, Endoscopic, and Manometric Anatomy of the Esophagus Radiographically, the appearance of the esophagus corresponds to its normal anatomy.

On the anteroposterior radiograph, the esophagus lies in the midline with a deviation to the left in the lower portion of the neck and upper portion of the thorax. It returns to the midline in the midportion of the thorax near the bifurcation of the trachea Fig. In the lower portion of the thorax, the esophagus again deviates to the left upon entry into the abdominal cavity through the diaphragm. On the lateral radiograph, the esophagus follows the posterior curve of the vertebral column except for the lower thoracic portion, where it curves anteriorly to pass through the diaphragmatic hiatus Fig.

This posterior curve and its terminal left anterior deviation are of particular importance in the performance of rigid diagnostic and therapeutic esophagoscopy. As a result of these anatomic configurations, the distal esophagus is the second most common site of iatrogenic esophageal perforation during rigid endoscopy, the first being the narrow entrance of the esophagus at the level of the cricopharyngeus.

Three areas of normal anatomic narrowing in the esophagus are commonly seen during esophagoscopy or contrast esophagogram. The superiormost narrowing is caused by the cricopharyngeus muscle at the anatomic border of the pharynx and proximal esophagus. This narrowest point of the esophagus with an average luminal diameter of 1.

The crossing of the left mainstem bronchus and the aortic arch results in indentation of the anterior and left lateral esophageal wall, causing the second narrowing of the esophagus, with an average luminal diameter of 1.

The most inferior narrowing of the esophagus is at the diaphragmatic hiatus and is caused by the physiologic lower esophageal sphincter. There is great variation of the luminal diameter at this point, depending upon the normal distention of the esophagus by the passage of a food bolus, with measurements ranging from 1. Transition zone differs in all humans, but mostly upper quarter consists only of striated muscle fibers; second quarter consists of both striated and smooth muscle fibers; and lower half consists of only smooth muscle fibers Aurbach plexus is in this layer.

This layer surrounds most of the esophagus and consists of loose connective tissue. Because no serosa is found on esophagus, infections, and tumors can spread easily [ 5 , 6 ]. Esophagus has seven narrowing points that can be seen using esophagoscopy or barium passage graphy. Four classic narrowings are found in almost all people; three other narrowings are found in certain medical conditions. First classical narrowing is at the beginning point, and oropharyngeal muscle forms it; this part is the second narrowest point after orifice of appendix vermiformis in alimentary tract.

Topographically, this first point corresponds to corpus of 6th cervical vertebra. Anterior and posterior esophageal walls become closer in hyperflexion, and this partial narrowing point occurs. Third narrowing is one of classical narrowings made by aortic arch.

This point corresponds to 4th thoracic vertebra topographically and measures 1. Point is located Fourth narrowing third classical narrowing is located at crossing point of esophagus and left main bronchium.

This point is located at level of 5th dorsal vertebra, and Fifth narrowing point is formed if patient has atrial dilatation caused by mitral stenosis.

This point is located just below bronchial narrowing. This point is located at plane corresponding to upper edge of 10th dorsal vertebral corpus. Laimer narrowing occurs in situation of aortic atherosclerosis. Last narrowing and 4th classical narrowing is made by esophageal hiatus that originates from right crus of diaphragm, and is located at the level of 11th dorsal vertebra and 40 cm after maxillary central incisor teeth; it is 1—1. When a person is not eating, esophageal lumen is closed above lower esophageal sphincter.

Esophagus is primarily median and vertical, but has three slight curves located in neck, behind left bronchus, and at bifurcation of trachea Picture 1. Endoscopic view of esophagus with the permission of Turkish Surgery Association. Esophagus is located at left of midline at level of 1st dorsal vertebra, right of midline at level of 6th dorsal vertebra, and left of midline again at level of 10th dorsal vertebra.

These narrowings and curves are important landmarks for radiological and endoscopic investigation of abnormalities, cancer diagnosis, and stricture formation after swallowing of chemicals [ 2 , 7 ]. Esophagus is anatomically divided into three parts: cervical esophagus, thoracic esophagus, and abdominal esophagus. Cervical esophagus starts at inferior margin of cricoid cartilage that corresponds to corpus of 6th cervical vertebra.

Cervical esophagus ends at inferior edge of first dorsal vertebra that comes up to a horizontal plane of jugular incisura of sternum. The endpoint is the starting point of upper mediastinum, and from this point it is thoracic esophagus. Cervical esophagus is 5—6 cm long, and its luminal diameter is 1. Esophagus runs in deepest fascial plane of neck, leaning between trachea anteriorly and vertebra posteriorly. Esophagus is attached to prevertebral fascia by sagittal septa, which forms retropharyngeal and retro-esophagial spaces.

Esophagus is covered by larynx and trachea anteriorly Figure 3 , but this covering is partial, and an open margin is found on left anterior side, which provides natural surgical access. Esophagus attaches with tracheoesophageal muscle fibers to trachea; it is easy to separate tracheoesophageal plane, except in pathological circumstances. Inferior thyroid artery, thyroid lobes, and recurrent laryngeal nerves are other important contiguities of esophagus, and ductus thoracicus lies on left side of it.

Esophagus connects prevertebral muscles, cervical vertebras, and prevertebral laminas posteriorly. Placement of esophagus relative to other anatomic structures with permission of Turkish Surgery Association. Sagittal septa, which forms retropharyngeal and retro-esophagial spaces, blocks the diffusion of abscess of this area to upper mediastinum, but abscess can diffuse via pretracheal space to the upper mediastinum and can cause a fatal complication.

Pretracheal space is important in that it can be perforated, primarily during an esophagectomy. Recurrent laryngeal nerve RLN lies in tracheoesophageal sulcus, and esophagus is close to this nerve, which is important in case of cervical esophagectomy.

Injury of RLN causes unilateral difficulty in swallowing and hoarseness; bilateral injury causes closure of vocal cords in median position, and a tracheostomy becomes necessary. Especially on left side of esophagus, RLN is so close to esophagus that it is easy to injure a nerve with a careless dissection. Thus, dissection should be made close to esophageal muscle fibers to avoid this complication.

As previously mentioned, thoracic duct connects to left Pirogoff angle, and it makes a slight connection to left side of esophagus. To avoid harm to thoracic duct, a careful dissection should be made, especially in cervical esophagectomy [ 8 , 9 ]. Measuring 16—18 cm in length, thoracic esophagus is in upper and posterior mediastinum.

Running from 1st to 11th dorsal vertebra, it does not fit concavity of vertebral column. However, it changes location to left gradually from start to end.