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Zenker's Diverticulectomy

last modified on: Mon, 10/22/2018 - 11:08

See Example Cases:

Zenker's Diverticulectomy - Open approach
Zenker's Diverticulectomy (Harmonic Scalpel) - Case Examples
Zenker's Diverticulectomy - Case Examples (CO2 Laser)
Zenker's Diverticulectomy - Flexible Fiberoptic Approach with Diathermy - Case Example

see also: Esophageal Perforation Treatment

  1. GENERAL CONSIDERATIONS
    1. Anatomy
      1. All 3 constrictors pass around and insert into a midline raphe on the posterior pharynx and vary in where they originate. This raphe suspends the pharynx from the base of skull at the pharyngeal tubercle, which is a palpable bump.
        1. Superior Constrictor-
          1. From pterygomandibular raphe, posterior to buccinator (also to sphenoid bone).
        2. Middle Constrictor-
          1. From the greater and lesser horns of the hyoid bone, and a portion of the stylohyoid ligament deep to hyoglossus.
        3. Inferior Constrictor-
          1. From thyroid cartilage and small area of adjacent cricoid. (the lower portion is sometimes called the cricopharyngeus)
      2. Structures entering pharynx pass through gaps between the muscles
        1. above superior constrictor - eustachian tube and levator veli palatine muscle
        2. between superior and middle constrictor - stylopharyngeus muscle blends into pharyngobasilar fascia, and the Glossopharyngeal travels along this muscle.
        3. below inferior constrictor (cricopharyngeus part) - the recurrent laryngeal nerve enters the larynx
        4. The mucous membrane may herniate through any of these gaps due to increased pressure. These outpouchings are referred to as Zenker Diverticuli (pl).  Zenker diverticuli are usually located in the posterior hypopharyngeal wall. Small Zenker diverticuli may not cause symptoms but larger ones may collect food and obstruct the esophagus.
    2.  Historical
      1. This was first described in 1867:
        1. F. A. Zenker and Hugo Wilhelm von Ziemssen: Krankheiten des Oesophagus. Leipzig, 1867.
    3. By The original uploader was Hermannthomas at German Wikipedia [Public domain or Public domain], via Wikimedia Commons
      1. The first repair was performed in 1887:
         
        1. W. I. De Courcy Wheeler: Cases of pharyngotomy. London and Dublin, 1887.

"Zenker" by Gianlorenzo Dionigi et al - World Journal of Surgical Oncology 2006, 4:17doi:10.1186/1477-7819-4-17. Licensed under CC BY 2.0 via Wikimedia Commons - https://commons.wikimedia.org/wiki/File:Zenker.jpg#/media/File:Zenker.jpg