Topography of the cervical trachea
The respiratory tube begins as a direct continuation of the larynx at the level of the sixth cervical vertebra. In its upper segment, it is located quite superficially, with a depth of only 1.0–1.5 centimeters. However, as it descends toward the jugular notch of the sternum, it plunges to a depth of up to 4–5 centimeters.
Anteriorly, the cervical part is protected by the superficial (second) and pretracheal (third) cervical fasciae. The latter forms tight sheaths for the pretracheal muscle group.
Syntopy of the anterior wall:
- The thyroid isthmus closely adjoins the uppermost cartilaginous rings.
- Slightly inferior to the isthmus lies the unpaired thyroid venous plexus (plexus venosus thyroideum impar).
- A chain of pretracheal lymph nodes (nodi lymphatici pretracheales) is embedded in the surrounding adipose tissue.
On the lateral surfaces, the respiratory tube is embraced by the right and left lobes of the thyroid gland, which partially extend onto the posterior wall as well. The posterior surface, represented by the membranous part devoid of cartilage, is firmly fused with the anterior wall of the esophagus. It is precisely here, in the longitudinal esophagotracheal grooves on both sides, that the recurrent laryngeal nerves run.
Features of the thoracic trachea
The thoracic segment begins from the level of the superior thoracic aperture (jugular notch). In this zone, major blood vessels adjoin the organ anteriorly and laterally.
Anteriorly, the upper margin of the aortic arch closely adjoins, along with its branching vessels. On the right side, at the level of the sternoclavicular articulation, is the bifurcation zone of the brachiocephalic trunk into the right subclavian and right common carotid arteries. On the left side and slightly anteriorly, the left common carotid artery runs along the wall.
Arterial blood supply to the trachea is provided by branches of the inferior thyroid arteries, and nerve impulses are transmitted via the recurrent laryngeal nerves.
Cervical esophagus
The esophagus is a distensible tube that is highly mobile and capable of shifting sideways. Its cervical part is bounded superiorly by the lower margin of the sixth cervical vertebra (C6) and inferiorly by the third thoracic vertebra (Th3).
Surroundings of the esophageal tube in the neck:
- Posteriorly: The tube rests against the vertebral column and the longus colli muscles, which are securely covered by the prevertebral (fifth) cervical fascia.
- Anteriorly: At the very beginning, the organ is completely hidden by the trachea. Descending lower, it noticeably deviates to the left. Consequently, the left recurrent laryngeal nerve leaves the groove and lies directly on the anterior wall of the esophagus. Furthermore, 1–2 centimeters inferior to the initial segment, the left inferior thyroid artery crosses transversely.
- Laterally: The cervical neurovascular bundles (consisting of the common carotid artery, internal jugular vein, and vagus nerve) are arranged asymmetrically. The left bundle lies closer to the organ wall, whereas the right bundle is situated 1–2 centimeters laterally.
It is at the transition of the pharynx into the esophageal tube that the first anatomical constriction is formed. It is localized at a distance of 12–15 centimeters from the dental line (incisors).
Esophageal branches of the inferior thyroid arteries are responsible for the blood supply to this area. Innervation is provided by the recurrent laryngeal nerves along with the sympathetic trunk. Lymph is collected into paratracheal nodes (nodi lymphatici paratracheales), from which it drains into the deep cervical lymph nodes.
Anatomy of the pharynx and its blood supply
The pharynx (pharynx) is located superior to the esophagus and is anatomically divided into three parts:
- Nasopharynx: The upper part, located posterior to the choanae and superior to the level of the soft palate.
- Oropharynx: The middle division, corresponding to the fauces.
- Laryngopharynx: The lower part, located posterior to the larynx. The entrance to the larynx from this division is securely closed by the epiglottis during swallowing.
The main vessel supplying the pharynx is the ascending pharyngeal artery (a. pharyngea ascendens), a branch of the external carotid artery. The blood supply to the palatine tonsils is of particular clinical significance. They receive branches from the ascending pharyngeal artery and the ascending palatine artery (which is a branch of the facial artery). These arterial trunks pass very close to the pharyngeal wall in the tonsillar fossa zone (fossa tonsillaris), making this area extremely vulnerable and requiring high precision during surgical removal of the tonsils (tonsillectomy).
Briefly: answers to topical questions
Which cervical fasciae according to Shevchenko form fascial sheaths for the trachea and esophagus?
The fascial sheaths for the trachea and esophagus are formed by the visceral layer of the endocervical fascia (the fourth cervical fascia according to Shevchenko).
- Endocervical fascia (fascia endocervicalis): its visceral layer (lamina visceralis) envelops the neck organs, forming a common sheath for them.
Anteriorly, the trachea is also covered by the superficial (2nd) and pretracheal (3rd) fasciae, although the 3rd fascia forms sheaths exclusively for the pretracheal muscles. Posterior to the esophagus lies the prevertebral (5th) fascia.
Which arteries participate in the blood supply to the palatine tonsils?
Branches of several arteries approaching from the external (pharyngeal) side participate in the blood supply to the palatine tonsils.
- Ascending pharyngeal artery (a. pharyngea ascendens): a branch of the external carotid artery.
- Facial artery (a. facialis): gives off branches to the tonsil, including from the ascending palatine artery.
- Descending palatine artery (a. palatina descendens): also participates in the blood supply to the organ.
What anatomical constrictions are distinguished along the entire length of the esophagus?
Three anatomical constrictions are distinguished along the entire length of the esophagus.
- Pharyngeal constriction: located at the junction of the pharynx and esophagus at the level of the cricoid cartilage (12–15 cm from the incisors).
- Aortic constriction: situated in the middle part of the esophagus, at the site where it is crossed by the aortic arch.
- Diaphragmatic constriction: located at the site where the organ passes through the esophageal hiatus of the diaphragm.
A constriction in the region of the left main bronchus is also distinguished, although in sources it is classified as physiological.
Which arteries supply the thoracic part of the esophagus?
Blood supply to the thoracic esophagus is provided by branches of the thoracic aorta. At the level of the tracheal bifurcation, short and large arteries located in the peri-esophageal adipose tissue arise from the aorta. Esophageal branches of the left gastric artery anastomose with esophageal branches of the thoracic aorta.
Rule of boundaries for the cervical esophagus: "C6-Th3". The organ begins at the level of the 6th cervical and ends at the level of the 3rd thoracic vertebra.
Class and exam questions
How are the recurrent laryngeal nerves positioned relative to the trachea and esophagus?
Normally, they run in the right and left esophagotracheal grooves. However, the left nerve ends up on the anterior wall of the esophagus because the esophageal tube shifts to the left in the cervical region.
Where do the trachea and esophagus originate?
Both of these organs share a common upper boundary: they begin at the level of the lower margin of the sixth cervical vertebra (transition of the larynx into the trachea and the pharynx into the esophagus).
Which vessels must be considered during tonsillectomy?
Branches of the ascending pharyngeal artery and facial artery (ascending palatine artery) run near the pharyngeal wall in the region of the tonsillar fossa; damage to these vessels can cause severe bleeding.
What else to study on this topic
- Syntopy of the thoracic esophagus and aortic arch
- Anatomy of the cervical neurovascular bundle
- Cervical fasciae: classification and the fascial spaces formed by them
- Lymphatic drainage pathways from neck organs: paratracheal and deep cervical nodes
- Variant anatomy of the thyroid artery (a. thyroidea ima)
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