A manual of diseases of the throat and nose : including the pharynx, larynx, trachea, œsophagus, nose and naso-pharynx / by Morell Mackenzie.

  • Mackenzie, Morell, 1837-1892.
Date:
1884
Catalogue details

Licence: Public Domain Mark

Credit: A manual of diseases of the throat and nose : including the pharynx, larynx, trachea, œsophagus, nose and naso-pharynx / by Morell Mackenzie. Source: Wellcome Collection.

    17/610 (page 5)
    111 its cervical and thoracic portions the gullet comes into relation with important adjacent structures, which must he borne in mind in the diagnosis and treatment of its diseases. In its brief abdominal course its relations are of minor j)iactical interest. In the cervical region the gnllet is in relation, anteriorly, with the membranous portion of the trachea, to which it is bound by loose areolar tissue. Posteriorly, it is sepaiated from the vertebral column by the longi colli muscles. Laterally, it is in relation with the thyroid gland, esj)ecially its left lobe, with the common carotid arteries, and, more externally, with the pneumogastric nerves and internal jugular veins. In the angle between the trachea and cesophagus lie the two recurrent laryngeal nerves. Owing to its curve to the left, the cesophagns comes into more intimate relations with the left carotid arteiy than with the right, and for the same reason the left recurrent nerve is, at the root of the neck, almost in front of the tube. In the thorax, the cesophagus is contained in the posterior medias- tinum ; it is in relation, anteriorly, from above downwards wdth the following parts; viz., the trachea, the left carotid and subclavian arteries (near their origin from the left side of the transverse portion of the arch of the aorta), the bifurcation of the trachea (opposite the third dorsal vertebra), the left bronchus (which crosses it obli([uely), the bronchial glands; below this the posterior surface of the commence- ment of the arch of the aorta, and the posterior surface of the left auricle, or rather the corresponding part of the pericardium, are in near relation to the gullet. Posteriorly, the cesophagus is at first in close contact with thes])ine and longi colli muscles, but in its descent it becomes separated from these by loose connective tissue, by the right intercostal arteries, the vena azygos, and the thoracic duct as it passes obliipiely ui)wards from right to left. Just before the gullet leaves the thorax and on a level with the eighth dorsal vertebra, it comes into relation, posteriorly, with the descending aorta, the opening for which in the diajjhragm is almost immediately behind that for the cesophagns. Ijiteralhy, the thoracic i)ortion of the ceso- ])hagus is in contact with the idenra;, with the vena azygos major on the right .side, and on the left with the de.scending aorta. The pneumogastric nerves lie at fir.st one on either side of the tube, but in their descent they jiass, the left in front of it, and the right behind it. The abdominal portion of the cesophagus is of very minor imj)or- tauce; it is covere<l by the peritoneum both anteriorly and pos- teriorly. Like the re.st of the alimentary tube, the cesojihagus consists of three coats—mucous, submucous, and muscular. The mucous layer is ol mcMlerate thickne.ss, and is mainly composed of loose connective tissue, which contains a large ])roj)ortion of loose elastic fibres. Its surface is closely studded with delicate jiapilhe, which, together with the inter- vening depressions, arc covered by a laminated pavement-e]iithelium. Between the mucous and submucous coats is a layer of ))lain miiscidai' fibres, the mu.scularis mucosa-., which is im]>erfect in the, u]iper ]'ai't of the tube, but attains a considerable development iid'eriorly, where it forms a continuous investment, arrange<l in longitudinal lolds. The .submucous connective ti.ssue is considerably thiekei- than the mucous coat, and so loosely athiehed to it as to allow very Iree move- ment of the latter, and to admit of its being arranged in longi- tudinal fohls when the tube is in its natural stati; of eontraction.