OESOPHAGUS,

TRACHEA,
THYROID AND
PARATHYROID GLANDS
OESOPHAGUS

•It has 3 parts. Cervical, thoracic and

abdominal parts.
•Extends from pharynx to stomach
•passes through the diaphragm at T
10 vertebral level to enter the
abdomen.
•It continues with the stomach at the
gastroesophageal junction.
OESOPHAGUS STRUCTURE
 The is made of: an outer connective tissue
sheath of areolar tissue.
 Muscular layer of external longitudinal and
internal circular fibres which are striated in
the upper two-thirds and smooth in the lower
one-third.
 Submucous layer containing mucous glands;
 Mucosa of stratified epithelium passing
abruptly into the columnar epithelium of the
stomach.
OESOPHAGUS
 The oesophagus, is 10in (25cm) long, extends
from the level of the lower border of the cricoid
cartilage C6 vertebra to the cardiac orifice of the
stomach.
 It enters the abdomen, passing forwards through
the opening in the right crus of the diaphragm
(T10).
 It comes to lie in the oesophageal groove on the
posterior surface of the left lobe of the liver,
covered by peritoneum on its anterior and left
aspects. Behind it is the left crus of the
diaphragm.
NARROW AREAS OF THE
OESOPHAGEAL LUMEN
 It is narrowed at three sites:
 at the beginning, behind the cricoid
cartilage of the larynx;
 where the left bronchus and the arch of the
aorta cross the front of the oesophagus;
 and where the oesophagus enters the
stomach.
 These three sites may offer resistance to the
passage of a tube down the oesophagus
into the stomach
Oesophageal Constrictions
 Superiorly: level of
cricoid cartilage,
juncture with
pharynx
 Middle: crossed by
aorta and left
main bronchus
 Inferiorly:
diaphragmatic
sphincter
BLOOD SUPPLY
 Blood supply is from
 the inferior thyroid artery, branches of the descending
thoracic aorta and
 the left gastric artery.
 The veins from the cervical part drain into the inferior
thyroid veins,
 from the thoracic portion into the azygos vein and
 from the abdominal portion partly into the azygos and
partly into the left gastric veins.
LYMPHATIC DRAINAGE
 The lymphatic drainage is from a perioesophageal
lymph plexus into the
 posterior mediastinal nodes, which drain both into the
supraclavicular nodes and into nodes around the left
gastric vessels.
 It is not uncommon to be able to palpate hard, fixed
supraclavicular nodes in patients with advanced
oesophageal cancer.
APPLIED ANATOMY
 In oesophagoscopy, measurements are made
from the upper incisor teeth; the three
important levels (17cm), (28cm) and (43cm)
corresponding to
 The commencement of the oesophagus,
 The point at which it is crossed by the left
bronchus and
 its termination respectively.
 These three points also indicate the narrowest
parts of the oesophagus: the sites at which,
 swallowed foreign bodies are most likely to
become impacted and strictures to occur after
swallowing corrosive fluids
APPLIED ANATOMY CONTD
 The anastomosis between the azygos (systemic) and left
gastric (portal) venous tributaries in the oesophageal
veins is of great importance in portal Hypertension.
 These veins distend into large collateral channels,
oesophageal varices, which may then rupture with
severe haemorrhage.
 The oesophagus is crossed solely by the vena azygos on
the right side. This is therefore the side of choice
surgically to approach the oesophagus.
TRACHEA
 A flexible tube also called windpipe.
 The trachea is about 4.5in (11.5cm) in length and
nearly 1 in (2.5cm) in diameter.
 It commences at the lower border of the cricoid
cartilage (C6)
 It terminates by bifurcating at the level of the
sternal angle of Louis (T4/5) to form the right
and left main bronchi.
Trachea
 Extends through the mediastinum and lies
anterior to the oesophagus and inferior to the
larynx.
 Anterior and lateral walls of the trachea
supported by 15 to 20 C-shaped tracheal
cartilages.
 Cartilage rings reinforce and provide rigidity to
the tracheal wall to ensure that the trachea
remains open at all times
 Posterior part of tube lined by trachealis muscle
 Lined by ciliated pseudostratified columnar
epithelium.

Trachea
 At the level of the sternal angle, the trachea
bifurcates into the right and left primary
bronchi.
 Each primary bronchus projects laterally toward
each lung.
 The most inferior tracheal cartilage separates the
primary bronchi at their origin and forms an
internal ridge called the carina.
RELATIONS OF TRACHEA
 Cervical
 Anteriorly— the isthmus of
thyroid gland,
 inferior thyroid veins,
sternohyoid and
sternothyroid muscles;
 laterally—the lobes of
thyroid gland and the
common carotid artery;
 posteriorly—the oesophagus
with the recurrent
laryngeal nerve lying in
the groove between
oesophagus and trachea
RELATIONS (THORACIC)
 Anteriorly:commencemen
tof the brachiocephalic
artery and left carotid
artery, the left
brachiocephalic vein
and the thymus;
 Posteriorly—oesophagus
and left recurrent
laryngeal nerve;
 To the left— arch of the
aorta, left common
carotid and left
subclavian arteries, left
recurrent laryngeal
nerve and pleura;
 To the right—vagus,
azygos vein and pleura .
 Bronchial tree
 It originate from the left and right primary bronchi.
 Progressively branches into narrower tubes before
terminating in terminal bronchioles.
 Incomplete rings of hyaline cartilage support the walls
of the primary bronchi.
 Right primary bronchus is shorter, wider, and more
vertically oriented than the left primary bronchus.
 Foreign particles are more likely to lodge in the right
primary bronchus.
Bronchial tree
 The primary bronchi enter the hilus of each lung
together with the pulmonary vessels, lymphatic
vessels, and nerves.
 Each primary bronchus branches into several
secondary bronchi.
 The left lung has two secondary bronchi. The right
lung has three secondary bronchi.
 They further divide into tertiary bronchi.
 Each tertiary bronchus is called a segmental
bronchus because it supplies a part of the lung
called a bronchopulmonary segment.
Bronchial Tree
 Secondary bronchi tertiary bronchi
bronchioles terminal bronchioles
 with successive branching amount of cartilage
decreases and amount of smooth muscle increases,
this allows for variation in airway diameter during
exertion and when sympathetic division active leads
to bronchodilation
 mediators of allergic reactions like histamine leads to
bronchoconstriction
 Epithelium gradually changes from ciliated
pseudostratified columnar epithelium to simple
cuboidal epithelium in terminal bronchioles
Respiratory Zone of Lower
Respiratory Tract
Respiratory Bronchioles, Alveolar
Ducts, and Alveoli
 Lungs contain small saccular outpocketings called
alveoli.
 They have a thin wall specialized to promote diffusion
of gases between the alveolus and the blood in the
pulmonary capillaries.
 Gas exchange can take place in the respiratory
bronchioles and alveolar ducts as well as in the
alveoli, each lung contains approximately 300 to 400
million alveoli.
 The spongy nature of the lung is due to the packing of
millions of alveoli together.
 APPLIED ANATOMY
 Tracheostomy is
limited to patients
with extensive
laryngeal damage
and infants with
severe airway
obstruction.
Cricothyroidotomy is
preferred. In
cricothyroidotomy, a
tube is inserted in
the interval between
the cricoid cartilage
and the thyroid
cartilage.

THYROID GLAND
 It is the largest endocrine gland in adult
 It normally extends from ~ C-5 through ~ T-1
 It Weighs ~20 - 30 grams it is larger in
women
 Lobes are cone (pyramidal) shaped
 Apex extends to oblique line of thyroid
cartilage
 The Isthmus crosses tracheal cartilages 2-4
 Base located ~4-5th tracheal cartilage

Introduction
 Pyramidal lobe is present in ~ 33% of
population it lies mostly to the left.
 It extends upward from isthmus and lies
anterior to thyroid cartilage.
 It is covered by a fibrous capsule which
sends septa deeply into it.

The Thyroid Gland

 Located in the
anterior region of
the neck
 This gland has an
accessory
(pyramidal) lobe
 usually on the left
side, which
represents a
remnant of the
embryological
descent of the
thyroid.
RELATIONS
 Muscular landmarks
 a. Sternocleidomastoid
muscles lie laterally
 b. Longus colli
(prevertebral) muscles
lie posteriorly
 c. “Strap” muscles lie
anteriorly

Strap Muscles
RELATIONS
 The gland is enclosed in the pretracheal
fascia, covered by the strap muscles
 overlapped by the sternocleidomastoids.
 The anterior jugular veins course over the
isthmus.
 It lies anterorolateral to larynx and trachea
 With the pharynx and oesophagus behind
and the carotid sheath on either side.
 Lobes connected by an isthmus
RELATIONS In the groove

between the
trachea and
oesophagus lies
the recurrent
laryngeal nerve
 and deep to the
upper pole lies the
external branch of
the superior
laryngeal nerve
passing to the
cricothyroid
muscle.
 BLOOD SUPPY
 Three arteries supply and
three veins drain the
thyroid gland
 Superior thyroid artery—
arises from the external
carotid and passes to the
upper pole;
 Inferior thyroid artery—
arises from the
thyrocervical trunk of the
1st part of the subclavian
artery and passes behind
the carotid sheath to the
back of the gland;
 Thyroidea ima artery (10%)
—if present, it arises from
the aortic arch or the
brachiocephalic artery;
usually unpaired.
VENOUS DRAINAGE
 Superior thyroid vein
— drains the upper
pole to the internal
jugular vein;
 Middle thyroid vein—
drains from the
lateral side of the
gland to the
internal jugular;
 Inferior thyroid veins
—often several—
drain the lower
pole to the
brachiocephalic
veins.
LYMPHATICS
 Lymph vessels lie In interlobular connective
tissue between lobes, it connects with network
in wall of gland and terminate in thoracic duct
and right lymphatic ducts.

Innervation
Principally from ANS
 Parasympathetic fibers – from vagus
 Sympathetic fibers – from superior, middle,
and inferior ganglia of the sympathetic
trunk
Enters the gland along with the blood vessels.
APPLIED ANATOMY
 The thyroid gland is invested in a sheath derived
from the pretracheal fascia. This tethers the gland
to the larynx and the trachea and explains why
the thyroid gland follows the movements of the
larynx in swallowing.
 Hyperthyroidism (thyrotoxicosis, Grave’s disease),
is common in middle-aged women, the thyroid
gland is diffusely enlarged.
 Hypothyroidism occurs in two forms: cretinism in
infants and myxedema in adults.

APPLIED ANATOMY
 The developmental anomalies of the thyroid
results in a rare occurrence of the whole
or a part of the gland remaining as a
swelling at the tongue base (lingual
thyroid) and for the much commoner
occurrence of a thyroglossal cyst or sinus
along the pathway of descent.
 Descent of the thyroid may go beyond the
normal position in the neck down into the
superior mediastinum (retrosternal goitre).


APPLIED ANATOMY
 A benign enlargement of the thyroid may
compress or displace any of its close
relations; the trachea and oesophagus may
be narrowed, with resulting difficulty in
breathing and swallowing.
 A carcinoma of the thyroid invades rather
than displacing them — eroding into
trachea or oesophagus, surrounding the
carotid sheath and occasionally causing
severe haemorrhage
APPLIED ANATOMY
 The recurrent laryngeal nerve and the
cervical sympathetic chain may be
involved, producing changes in the voice
and Horner’s syndrome (droopy eye,
dryness, small pupil) respectively.

 APPLIED ANATOMY
 Treatment considerations: The two main arteries
supplying the thyroid gland are closely related to
important nerves that can be damaged during
thyroidectomy operations
a.Superior thyroid artery is accompanied by external
laryngeal nerve
b.Inferior thyroid artery is accompanied by recurrent
laryngeal nerve
c.In partial thyroidectomy, the posterior part of the thyroid
gland is left undisturbed so that the parathyroid
glands are not damaged.
CONGENITAL ANOMALIES
 Agenesis of the Thyroid: Failure of development of the
thyroid gland may occur and is the commonest
cause of cretinism.
 Ectopic thyroid tissue is occasionally found in the
thorax in relation to the trachea or bronchi or even
the oesophagus.
 Persistent Thyroglossal Duct related to a persistence
of the thyroglossal duct usually appear in childhood,
 Thyroglossal Cyst may occur at any point along the
thyroglossal tract
 Thyroglossal Sinus (Fistula) Occasionally, a
thyroglossal cyst ruptures spontaneously, producing
a sinus
 Parathyroid glands
 Usually four – two on each side (2-8)
 ovoid or lentiform structures
 Measures 3-10 mm x 2-6 mm x 1-4 mm
 It is yellow-brown in colour.
 Lie on the posterior surface of thyroid but may
be embedded within the gland.
 Regulate calcium/phosphate levels
 Total weight of parathyroid tissue is about
150mg (each weighs ~ 50 mg.)
 Parathyroid hormone (PTH) is made by these
glands

 Parathyroid Glands (Post. view of
thyroid)

Parathyroid Glands are located on the posterior



aspect of the thyroid; sometimes the tissue is

embedded within thyroid tissue.
Parathyroid Gland
Anatomy
 Four Parathyroid
glands are usually
found posterior to
the thyroid gland
 Position of superior
glands is more
predictable
 Aberrant glands
may lie between
the trachea and
thyroid

Biosynthesis, Storage &
Secretion of PTH


 PTH is synthesized as the preprohormone

(Preproparathyroid Hormone) by
parathyroid gland chief cells
 The active form of PTH is cleaved from the
preprohormone before release from the
gland
 PTH is synthesized continously (it is either
released from the gland or degraded)
 PTH is released by exocytosis in response
to reduced plasma calcium
 Vitamin D feeds back to reduce PTH
secretion as a secondary mechanism
Biological Activity of PTH
 BONE
◦ PTH stimulates bone osteoblasts to increase
growth & metabolic activity
◦ PTH stimulated bone resorption releases
calcium & phosphate into blood
 KIDNEY
◦ PTH increases reabsorption of calcium &
reduces reabsorption of phosphate
◦ Net effect of its action is increased calcium &
reduced phosphate in plasma
 INTESTINE
◦ Increases calcium reabsorption via vitamin D
APPLIED ANATOMY
 Hypoparathyroidism This condition is most
commonly caused by injury to or removal of
the glands during surgical procedures on the
thyroid gland.
 The main symptoms and signs of low blood
calcium are numbness and tingling in the
fingers and toes and cramps of the muscles in
the hands and feet. These cramps are called
carpopedal spasms.
 Hyperparathyroidism This condition is caused
by a benign adenoma or hyperplasia of the
parathyroid glands. It may cause the repeated
occurrence of renal stones.