Is there an accessory sphincter of the cervical oesophagus?

Abstract

The transition between the pharynx proper and cervical oesophagus, the pharyngo-oesophageal segment, has received considerable attention. It corresponds roughly to the upper oesophageal sphincter and has specific anatomic and physiological functions pertinent to swallowing, respiration and posture (Bosma, 1957). With the aid of cineradiography or video techniques, it is possible to distinguish several different morphological and functional characteristics and abnormalities within this segment resulting in a more precise knowledge of its nature. Within this region, there are several well defined functional and morphodynamic abnormalities,e.g., Zenker diverticula, Kilian-Jamieson diverticula as well as cricopharyngeal incoordination, to the understanding of which radiology has contributed greatly. The purpose of this report is to describe a new radiological finding, namely, a circumscribed transient circular narrowing within the cervical oesophagus, in patients with dysphagia. A transient narrowing in the cervical oesophagus was seen in seven dysphagic patients, five women and two men, aged 55–74 years. Four of the patients had undergone cricopharyngeal myotomy; in one of these, the myotomy was part of surgical correction of a Zenker diverticulum. One patient had had surgery and radiotherapy for thyroid carcinoma. The radiological observations of the pharyngo-oesophageal segment and cervical oesophagus were compared with studies of 150 non-dysphagic volunteers: 79 men, 71 women, aged 20–82 years (mean, 52 years). These examinations were approved by the Ethical Committee of the University of Lund and Malmö General Hospital on December 13, 1979 (ref. no. 144/79).