Complications of ventilation tubes: - Dr. Nassem Talaat

Anatomy:
The Oesophagus
*it is a fibromuscular tube which extends from lower edge of hypo pharynx
(C6) to stomach T11
Consists of mucosa, submucosa & muscular layer (outer longitudinal & inner
circular)
Devoid of serosa exept for abdominal part making healing difficult
*it consists of 3 parts:
*it has 3 narrowings
Physiology
Cervical – thoracic –abdominal
+ At upper end (15 cm from central incisors)
+ At level of crossing of aortic arch & Lt Main bronchus (25 cm)
+ At the diaphragm (40 cm)
Peristaltic movement results in food propulsion towards the stomach
The cricopharyngeus & cardia are normally closed, open on food passage, with
positive pressure at rest (in the rest of esophagus: negative)
Mechanism of swallowing (3 stages):
1-Oral (voluntary): tongue pushed against palate,forcing food into pharynx, triggering
reflex stages
2-Pharyngeal (involuntary): food stimulates afferent in 5 & 9, efferent travel in 5, 9,
10 & 12 to: elevate soft palate, move palatopharyngeal wall medially, close glottis,
elevates the larynx, relax cricopharyngeus & close superior constrictor as bolus
passes into esophagus
3- Esophageal (involuntary): solids falls by gravity, liquids pushed by peristalsis
Clinically :
I. History: dysphagia , pain & regurgitation .
II. Neck examination.
III. Investigations: Plain x ray, barium swallow, Oesophagoscopy.