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212 THE LARYNX, BRONCHI AND OESOPHAGUS
suggest that the early diagnosis of bronchial cancer will be vastly improved
using this method. To use it successfully, however, a detailed knowledge of the
anatomy of the whole bronchial tree is required.
ANATOMY. The oesophagus extends from the termination of the pharynx at the
lower border of the cricoid cartilage at the level of C6 to the oesophagogastric
junction, or the cardia, at the level of Til. The wall consists of muscle,
submucosa and the mucosa which presents numerous folds which sharp
pointed foreign bodies may readily penetrate. It is also covered by an
adventitious coat by which it is loosely attached to surrounding structures.
The nerve supply is from the vagus and the cervical plexus. In the adult, the
length of the oesophagus is about 25 cm. The lumen shows great variation in
size and presents four constrictions: (1) The cricopharyngeal constrictions at
its mouth opposite C6; (2) At the crossing of the aorta opposite T4; (3) At the
bifurcation of the trachea opposite T5; (4) As it passes through the diaphragm
opposite T10. As the oesophagus is not very muscular, these constrictions,
with the exception of the cricopharyngeal one, are easily distensible.
From incisor teeth to opening of the oesophagus
From incisor teeth to bifurcation of the trachea
From incisor teeth to the cardia
Adult male Child of 7 yrs Infant
15cm • 10cm » 7cm
26cm % 18cm 13cm .
40cm 27cm 18cm
ANAESTHESIA. Although oesophagoscopy can be done under local anaesthesia
it is preferable to use general anaesthesia if any biopsy or dilatation is required.
OPERATION. The commonly used size of oesophagoscope (Fig. 107, 7) for
adults is 9 mm x 30 or 50 cm but some surgeons use the much wider 16 mm x
45 cm. A fibreoptic oesophagoscope or gastroscope may also be used, but
although biopsies can be done, no dilatation can be performed. For examina-
tion of the pharynx and upper oesophagus the Lynah oesophageal speculum
(Fig. 107,3) is used. The oesophagus is entered behind the endotracheal tube.
When the posterior border of the cricoid is reached the beak of the oesophago-
scope is used to lift it forwards thus opening the mouth of the oesophagus.
The various constrictions should be identified and care must be taken in
passing the oesophagoscope through them. It is often helpful to drop the
head of the table progressively as the oesophagoscope is passed down the
A full description of oesophagoscopy is beyond the scope of this book, but
mention will be made of perforation of the oesophagus which can occur during
any biopsy or dilatation, or if force is used at any point of an oesophagoscopy.
PERFORATION OF THE OESOPHAGUS
This is the single most dangerous complication of oesophagoscopy and
carries with it a significant mortality. A number of other causes of perforation