Clinical anatomical basis for the development of function preserving cancer operations with special reference the pharyngeal plexus and to the pharyngo-esophageal branches of the recurrent laryngeal nerve

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Clinical anatomical basis for the development of function preserving cancer operations with special reference to the pharyngeal plexus and to the pharyngo-esophageal branches of the recurrent laryngeal nervesIn this study we minutely examined the vagal and sympathetic distribution to the larynx, trachea and esophagus in order to obtain an anatomical basis for the development of new function preserving cancer operations of these areas. Cadaveric dissections were performed from the dorsal aspect after the removal of the vertebral column and the ribs. Above the tracheal bifurcation the tracheal and esophageal branches of the vagus tended to originate as common trunks. These common trunks passed between the trachea and esophagus and divided into the proper twigs just before entering the respective organs : the esophageal branches entered the anterior wall of the esophagus, while the tracheal branches entered the posterior membranous wall of the trachea. Within the latter wall rich communic … More ations between the ipsilateral branches were observed, however, no communications were observed between the right and left tracheal and esophageal branches. At the level of the tracheal bifurcation numerous communications were found between the right and left common trunks of the bronchial and esophageal branches. Each bronchus received supplying branches from the vagus of the same side, however, no branches from the opposite side vagus were detected. Below the tracheal bifurcation the right and left vagi divided into several major branches which communicated and formed the esophageal plexus surrounding the esophagus. This plexus issued numerous esophageal branches which entered the surface of the esophagus ; intramural communications were also observed. As to the lymphatics of the esophagus, communications between the right and left lymph vessels were observed on the posterior surface of the esophagus. According to the accompanying structures these lymphatics were classified into four : 1) lymphatics independent of blood vessels and/or nerves, 2) lymphatics along the bronchial arteries, 3) lymphatics along the hemiazygos vein, and 4) lymphatics along the posterior intercostal arteries. Efferent lymphatics from the lymph nodes of the tracheal bifurcation ran along the communicating branches between the right and left vagi. Less