Advertisement

Anatomy, Embryology, and Pathophysiology

  • Hayley Born
  • Rebecca J. Howell
Chapter

Abstract

This chapter focuses on the anatomy, embryology, and pathophysiology associated with hypopharyngeal diverticula. It discusses in detail the anatomy, development, and histology of the disease process and examines current knowledge related to cricopharyngeal muscle manometry and disorders of this muscle.

Keywords

Zenker’s diverticula Hypopharyngeal diverticula Manometry Embryology Cricopharyngeal muscle dysfunction Upper esophageal sphincter 

References

  1. 1.
    Achem SR, DeVault KR. Dysphagia in aging. J Clin Gastroenterol. 2005;39:357–71.CrossRefPubMedGoogle Scholar
  2. 2.
    Bloom JD, Bleier BS, Mirza N, et al. Factors predicting endoscopic exposure of Zenker’s diverticulum. Ann Otol Rhinol Laryngol. 2010;119:736–41.PubMedGoogle Scholar
  3. 3.
    Watemberg S, Landau O, Avrahami R. Zenker’s diverticulum: reappraisal. Am J Gastroenterol. 1996;91:1494–8.PubMedGoogle Scholar
  4. 4.
    Belafsky PC, Rees CJ, Allen J, et al. Pharyngeal dilation in cricopharyngeus muscle dysfunction and Zenker diverticulum. Laryngoscope. 2010;120:889–94.CrossRefPubMedGoogle Scholar
  5. 5.
    Undavia S, Anand SM, Jacobson AS. Killian-Jamieson diverticulum. Laryngoscope. 2013;123:414–7.CrossRefPubMedGoogle Scholar
  6. 6.
    Dantas RO, Cook IJ, Dodds WJ, et al. Biomechanics of cricopharyngeal bars. Gastroenterology. 1990;99:1269–74.CrossRefPubMedPubMedCentralGoogle Scholar
  7. 7.
    Kahrilas PJ. Upper esophageal sphincter function during antegrade and retrograde transit. Am J Med. 1997;103:56S–60S.CrossRefPubMedGoogle Scholar
  8. 8.
    Lang IM, Shaker R. Anatomy and physiology of the upper esophageal sphincter. Am J Med. 1997;103:50S–5S.CrossRefPubMedGoogle Scholar
  9. 9.
    Plant RL. Anatomy and physiology of swallowing in adults and geriatrics. Otolaryngol Clin North Am. 1998;31:477–88.CrossRefPubMedGoogle Scholar
  10. 10.
    Sasaki CT. Understanding the motor innervation of the human cricopharyngeus muscle. Am J Med. 2000;108:38–9.CrossRefGoogle Scholar
  11. 11.
    Sivarao D, Goyal RK. Functional anatomy and physiology of the upper esophageal sphincter. Am J Med. 2000;108:27–37.CrossRefGoogle Scholar
  12. 12.
    Rubesin SE, Levine MS. Killian-Jamieson diverticula: radiographic findings in 16 patients. Am J Roentgenol. 2001;177:85–9.CrossRefGoogle Scholar
  13. 13.
    Anagiotos A, Preuss SF, Koebke J. Morphometric and anthropometric analysis of Killian’s triangle. Laryngoscope. 2010;120:1082–8.PubMedGoogle Scholar
  14. 14.
    Stafford ND, Moore-Gillon V, McKelvie P. Handedness and the side on which pharyngeal pouches occur. Br Med J (Clin Res Ed). 1984;288:815–6.CrossRefGoogle Scholar
  15. 15.
    van Overbeek JJ. Pathogenesis and methods of treatment of Zenker’s diverticulum. Ann Otol Rhinol Laryngol. 2003;112:583–93.CrossRefPubMedGoogle Scholar
  16. 16.
    Haidar YM, Handwerker J, Verma S. A patient with cough and dysphagia. JAMA Otolaryngol Head Neck Surg. 2014;140:673–4.CrossRefPubMedGoogle Scholar
  17. 17.
    Verhaegen VJ, Feuth T, van den Hoogen FJ, et al. Endoscopic carbon dioxide laser diverticulostomy versus endoscopic staple-assisted diverticulostomy to treat Zenker’s diverticulum. Head Neck. 2011;33:154–9.CrossRefPubMedGoogle Scholar
  18. 18.
    Rodgers PJ, Armstrong WB, Dana E. Killian-Jamieson diverticulum: a case report and a review of the literature. Ann Otol Rhinol Laryngol. 2000;109:1087–91.CrossRefPubMedGoogle Scholar
  19. 19.
    Udare AS, Mondel PK, Badhe PV. Killian-Jamieson diverticulum. Indian J Gastroenterol. 2014;33:98.CrossRefPubMedGoogle Scholar
  20. 20.
    Ekberg O, Nylander G. Lateral diverticula from the pharyngo-esophageal junction area. Radiology. 1983;146:117–22.CrossRefPubMedPubMedCentralGoogle Scholar
  21. 21.
    Kumoi K, Ohtsuki N, Teramoto Y. Pharyngo-esophageal diverticulum arising from Laimer’s triangle. Eur Arch Otorhinolaryngol. 2001;258:184–7.CrossRefPubMedGoogle Scholar
  22. 22.
    Stewart K, Sen P. Pharyngeal pouch management: an historical review. J Laryngol Otol. 2016;1(30):116–20.CrossRefGoogle Scholar
  23. 23.
    Schindler A, Mozzanica F, Alfonsi E, et al. Upper esophageal sphincter dysfunction: diverticula–globus pharyngeus. Ann N Y Acad Sci. 2013;1300:250–60.CrossRefPubMedGoogle Scholar
  24. 24.
    Klockars T, Sihvo E, Mäkitie A. Familial Zenker’s diverticulum. Acta Otolaryngol. 2008;128:1034–6.CrossRefPubMedGoogle Scholar
  25. 25.
    Björk H. Pathogenesis of hypopharyngeal diverticulum with special reference to heredity. Acta Otolaryngol. 1952;42:202–7.CrossRefGoogle Scholar
  26. 26.
    Kuo B, Urma D. Esophagus-anatomy and development. GI Motility online. 2006. https://www.nature.com/gimo/contents/pt1/full/gimo6.html
  27. 27.
    Hammond CS, Davenport PW, Hutchison A, Otto RL. Motor innervation of the cricopharyngeus muscle by the recurrent laryngeal nerve. J Appl Physiol. 1997;83:89–94.CrossRefPubMedGoogle Scholar
  28. 28.
    Veenker EA, Andersen PE, Cohen JI. Cricopharyngeal spasm and Zenker’s diverticulum. Head Neck. 2003;25:681–94.CrossRefPubMedGoogle Scholar
  29. 29.
    Walters DN, Battle JW, Portera CA, Blizzard JD, Browder IW. Zenker’s diverticulum in the elderly: a neurologic etiology? Am Surg. 1998;64:909–11.PubMedGoogle Scholar
  30. 30.
    Fulp S, Castell D. Manometric aspects of Zenker’s diverticulum. Hepatogastroenterology. 1992;39:123–6.PubMedGoogle Scholar
  31. 31.
    Jackson C, Shallow TA. Diverticula of the oesophagus, pulsion, traction, malignant and congenital. Ann Surg. 1926;83:1–19.PubMedPubMedCentralGoogle Scholar
  32. 32.
    Lund WS. The cricopharyngeal sphincter: its relationship to the relief of pharyngeal paralysis and the surgical treatment of the early pharyngeal pouch. J Laryngol Otol. 1968;82:353–67.CrossRefPubMedGoogle Scholar
  33. 33.
    Asherson N. Achalasia of the cricopharyngeal sphincter: a record of cases, with profile pharyngograms. J Laryngol Otol. 1950;64:747–58.CrossRefPubMedGoogle Scholar
  34. 34.
    Belsey R. Functional disease of the esophagus. J Thorac Cardiovasc Surg. 1966;52:164–88.PubMedGoogle Scholar
  35. 35.
    Cook IJ, Gabb M, Panagopoulos V, Jamieson GG, Dodds WJ, Dent J, Shearman DJ. Pharyngeal (Zenker’s) diverticulum is a disorder of upper esophageal sphincter opening. Gastroenterology. 1992;103:1229–35.CrossRefPubMedPubMedCentralGoogle Scholar
  36. 36.
    Leonard R, Rees CJ, Belafsky P, et al. Fluoroscopic surrogate for pharyngeal strength: the pharyngeal constriction ratio (PCR). Dysphagia. 2011;26:13–7.CrossRefPubMedGoogle Scholar
  37. 37.
    Venkatesan NN, Evangelista LM, Kuhn MA, Belafsky PC. Normal fluoroscopic appearance status post-successful endoscopic Zenker diverticulotomy. Laryngoscope. 2017;127:1762–6.CrossRefPubMedGoogle Scholar
  38. 38.
    Brownlow H, Whitmore I, Willan P. A quantitative study of the histochemical and morphometric characteristics of the human cricopharyngeus muscle. J Anat. 1989;166:67–75.PubMedPubMedCentralGoogle Scholar
  39. 39.
    Kristmundsdottir F, Mahon M, Froes M, Cumming WJ. Histomorphometric and histopathological study of the human cricopharyngeus muscle: in health and in motor neuron disease. Neuropathol Appl Neurobiol. 1990;16:461–75.CrossRefPubMedGoogle Scholar
  40. 40.
    Cook I, Blumbergs P, Cash K, Jamieson GG, Shearman DJ. Structural abnormalities of the cricopharyngeus muscle in patients with pharyngeal (Zenker’s) diverticulum. J Gastroenterol Hepatol. 1992;7:556–62.CrossRefPubMedGoogle Scholar
  41. 41.
    Zaninotto G, Costantini M, Boccu C, Anselmino M, Parenti A, Guidolin D, Ancona E. Functional and morphological study of the cricopharyngeal muscle in patients with Zenker’s diverticulum. Br J Surg. 1996;83:1263–7.CrossRefPubMedGoogle Scholar
  42. 42.
    Venturi M, Bonavina L, Colombo L, et al. Biochemical markers of upper esophageal sphincter compliance in patients with Zenker’s diverticulum. J Surg Res. 1997;70:46–8.CrossRefPubMedGoogle Scholar
  43. 43.
    Gerhardt DC, Shuck TJ, Bordeaux RA, et al. Human upper esophageal sphincter. Gastroenterology. 1978;75:268–74.PubMedGoogle Scholar
  44. 44.
    Stanciu C, Bennett JR. Upper oesophageal sphincter yield pressure in normal subjects and in patients with gastro-oesophageal reflux. Thorax. 1974;29:459–62.CrossRefPubMedPubMedCentralGoogle Scholar
  45. 45.
    Ellis FH, Gibb FP, Williamson WA. Current status of cricopharyngeal myotomy for cervical eSsophageal dysphagia. Eur J Cardiothorac Surg. 1996;10:1033–9.CrossRefPubMedGoogle Scholar
  46. 46.
    Migliore M, Payne H, Jeyasingham K. Pathophysiologic basis for operation on Zenker’s diverticulum. Ann Thorac Surg. 1994;57:1616–20.CrossRefPubMedGoogle Scholar
  47. 47.
    Lerut T, Van Raemdonck D, Guelinckx P, et al. Zenker’s diverticulum: Is a myotomy of the cricopharyngeus useful? How long should it be? Hepatogastroenterology. 1992;39:127–31.PubMedGoogle Scholar
  48. 48.
    Williams RB, Ali GN, Hunt DR, et al. Cricopharyngeal myotomy does not increase the risk of esophagopharyngeal acid regurgitation. Am J Gastroenterol. 1999;94:3448–54.CrossRefPubMedGoogle Scholar
  49. 49.
    Resouly A, Braat J, Jackson A, et al. Pharyngeal pouch: link with reflux and oesophageal dysmotility. Clin Otolaryngol Allied Sci. 1994;19:241–2.CrossRefPubMedGoogle Scholar
  50. 50.
    Wallin L, Boesby S, Madsen T. The effect of HCl infusion in the lower part of the oesophagus on the pharyngo-oesophageal sphincter pressure in normal subjects. Scand J Gastroenterol. 1978;13:821–6.CrossRefPubMedGoogle Scholar
  51. 51.
    Willing J, Davidson G, Dent J, Cook I. Effect of gastro-oesophageal reflux on upper oesophageal sphincter motility in children. Gut. 1993;34:904–10.CrossRefPubMedPubMedCentralGoogle Scholar

Copyright information

© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Department of OtolaryngologyUniversity of CincinnatiCincinnatiUSA

Personalised recommendations