Pharyngoesophageal Junction Research Articles

140-year history of pharyngoesophageal reconstruction.

For over a century, circumferential pharyngoesophageal junction reconstruction posed significant surgical challenges. This review aims to provide a narrative history of pharyngoesophageal junction reconstruction from early surgical innovations to the advent of modern free-flap procedures. The review encompasses three segments: (1) local and/or locoregional flaps, (2) visceral transposition flaps, and (3) free-tissue transfer, focusing on the interplay between pharyngoesophageal junction reconstruction and prevalent surgical trends. Before 1960, Mikulicz-Radecki's flaps and the Wookey technique prevailed for circumferential pharyngoesophageal junction reconstruction. Gastric pull-up and colonic interposition were favoured visceral techniques in the 1960s-1990s. Concurrently, deltopectoral and pectoralis major flaps were the preferred cutaneous methods. Free flaps (radial forearm, anterolateral thigh) revolutionised reconstructions in the late 1980s, yet gastric pull-up and free jejunal transfer remain in selective use. Numerous pharyngoesophageal junction reconstructive methods have been trialled in the last century. Despite significant advancements in free-flap reconstruction, some older methods are still in use for challenging clinical situations.

Single Institution Experience in the Management of Locally Advanced (pT4) Differentiated Thyroid Carcinomas

BackgroundLocally infiltrating (T4) differentiated thyroid carcinomas (DTC) represent a challenge. Surgical strategy and adjuvant therapy should be planned balancing morbidity and oncologic outcome. A series of patients with T4 DTC who underwent multidisciplinary evaluation and treatment is reported. The main study endpoints were the oncologic outcome, complication rates, and risk factors for tumor recurrence.Patients and MethodsAll DTC cases operated between 2009 and 2021 were reviewed and T4 DTC cases were identified. En bloc resection of inferior laryngeal nerve (ILN), tracheal, and/or internal jugular vein (IJV) was performed in cases of massive infiltration. In cases of pharyngoesophageal junction (PEJ) invasion, the shaving technique was always applied.ResultsAmong 4775 DTC cases, 60 were T4. ILN infiltration was documented in 45 cases (en bloc resection in 9), tracheal infiltration in 14 (tracheal resection in 2), PEJ invasion in 11 (R0 resection in 7 cases and < 1 cm residual tissue in 4 cases), IJV resection in 6, and laryngeal in 2. In total, 11 postoperative ILN palsy, 23 transient hypoparathyroidisms, and 2 hematomas requiring reoperation were registered. Final histology showed 7 pN0, 22 pN1a, and 31 pN1b tumors. Aggressive variants were observed in 47 patients. All but 1 patient underwent radioiodine treatment, 12 underwent adjuvant external beam radiation therapy (EBRT), and 2 underwent chemotherapy. At a median follow-up of 58 months, no tumor-related death was registered, and seven patients required reoperation for recurrence. Tracheal invasion was the only significant factor negatively impacting recurrence (p = 0.045).ConclusionsA multidisciplinary approach is essential for the management of T4 DTC. Individualized and balanced surgical strategy and adjuvant treatments, in particular EBRT, ensure control of locally advanced disease with acceptable morbidity.

Gunshot wound of the neck with a fragment localized in close proximity to the initial p art of the esophagus with development of paraesophageal abscess. surgical tactics

One of the features of the special military operation is the prevalence of fragment wounds with predominant damage to unprotected parts of the body. Wounds and injuries to the neck constitute no more than 4 %; however, with these injuries, irreversible losses amount to up to 13 %. The article describes a clinical case of a patient with a blind gunshot fragment wound to the neck, who was admitted to the surgical (thoracic) department of the 1469 Naval Clinical Hospital of the Russian Ministry of Defense 21 days later. The fragment, located behind the pharyngoesophageal junction in the projection of Killian's triangle, led to the development of an abscess and threatened perforation of the esophagus with subsequent development of mediastinitis. In addition, the article on surgical tactics justifies the access and describes in detail the technical methods of surgical inter vention.

Clinical outcome of endoscopic-assisted transoral surgery for superficial cancer of pharyngo-esophageal junction.

Endoscopic-assisted transoral surgery (TOS) for superficial cancer of the pharyngo-esophageal junction (PEJ) is risk of stricture, and therapeutic outcomes are unclear. This study aimed to evaluate clinical outcomes of endoscopic-assisted TOS for superficial PEJ cancers. We retrospectively compared clinical outcomes of endoscopic-assisted TOS for superficial PEJ cancers (group A) and of other sites in the hypopharynx (group B). The group A comprised 12 lesions in 12 patients, and group B comprised 198 lesions in 146 patients. Group A and group B exhibited en bloc resection rates of 100% and 99%. Median operative times were 82 and 37 min (p < 0.001). The frequency of stricture and local recurrence in group A was significantly higher in group B (42% vs. 1%, p < 0.001; 25% vs. 6%, p = 0.036). All adverse events could be managed with conservative treatments. Endoscopic-assisted TOS is not ideal for treating superficial PEJ cancers compared to other sites.

Iatrogenic esophageal perforation in infants: how to avoid thoracotomy? Two case reports

Background: Esophageal perforation is uncommon and often iatrogenic in the neonatal period, and premature and low birth weight infants (&lt;1500 g) are particularly susceptible. Esophageal injury in neonates usually occurs at the pharyngoesophageal junction and can be confused with esophageal atresia due to respiratory signs and excessive salivation. Diagnostic evaluation and treatment are still debated. &#x0D; Case Presentation: This case report aims to describe two neonatal cases of iatrogenic esophageal perforation. The suspected diagnosis was confirmed only with thoracotomy. Diagnostic difficulties and therapeutic modalities are discussed. &#x0D; Conclusion: These two cases show the importance of the clinical clues (anamnesis and clinical findings) to suspect the diagnosis of esophageal perforation.

A Case of Zenker’s Diverticulum Mimicking a Thyroid Nodule

The Zenker’s diverticulum is the most common diverticulum of the esophagus. It commonly occurs at the pharyngoesophageal junction that can appear in proximity to the thyroid gland. The food remnants or gas bubbles present in the diverticulum may mimic microcalcifications presented in papillary thyroid carcinoma on ultrasonography. Therefore, it is important to be able to differentiate between Zenker’s diverticulum and malignant thyroid nodule. The author reported a case of Zenker’s diverticulum mimicking a thyroid nodule in thyroid ultrasonography.

A-292 SINGLE INSTITUTION EXPERIENCE IN THE MANAGEMENT OF LOCALLY ADVANCED (pT4) DIFFERENTIATED THYROID CARCINOMAS

Abstract Background Locally infiltrating (T4) differentiated thyroid carcinomas (DTC) represent a challenge. Surgical strategy and adjuvant therapy should be planned balancing morbidity and oncologic outcome. A series of T4 DTC who underwent multidisciplinary evaluation and treatment is reported. Methods All DTC cases operated between 2009 and 2021 were reviewed and T4 DTC cases were identified. En bloc resection of inferior laryngeal nerve (ILN), tracheal (TR) and/or internal jugular vein (IJV) was performed in cases of massive infiltration. In case of pharyngoesophageal junction (PEJ) invasion shaving technique was always chosen. Results Among 4775 DTC cases, 60 (1.25%) were T4. ILN infiltration was documented in 45 cases (75% - en bloc resection in 9), TR infiltration in 14 (23.3% - tracheal resection in 2), PEJ invasion in 11 (18.3% - in 7 cases R0 resection, in 4 cases &amp;lt;1cm residual tissue), and IJV resection in 6 (10%). Eleven post-operative ILN palsies, 23 cases with transient hypoparathyroidism and two hematomas requiring reoperation were registered. Final histology showed 7pN0, 22pN1a, 31pN1b tumors. Aggressive variants were observed in 78%. All patients underwent radioiodine treatment and 12 adjuvant external beam radiation therapy (EBRT). At a median follow-up of 47 months, no tumour-related death was registered. Seven patients required re-operation (DFS mean 123.7 months, CI:111.2-136.2). Conclusion Multidisciplinary approach is essential for the management of T4 DTC. Individualised and balanced surgical strategy and adjuvant treatments, in particular EBRT, ensure control of locally advanced disease with acceptable morbidity.

Novel therapeutic thin endoscope facilitates endoscopic submucosal dissection for cervical esophageal cancer involving the pharyngoesophageal junction.

The cervical esophagus, especially the pharyngoesophageal junction, is narrow; thus, the movement of the endoscope is severely limited [1] [2]. This region also has strong flexion to the posterior wall; thus, it is occasionally difficult to approach a lesion with a conventional endoscope with an insufficient downward angle. Recently, a novel therapeutic thin endoscope, EG-840TP (Fujifilm, Tokyo, Japan), has been developed. In this endoscope, despite an outer diameter of 7.9 mm, the working channel diameter is 3.2 mm with a downward angle of 160° ([Fig. 1], [Fig. 2]). Herein, we report a case in which this novel endoscope facilitates endoscopic submucosal dissection (ESD) for cervical esophageal cancer involving the pharyngoesophageal junction ([Video 1]).

A124 PERORAL ENDOSCOPIC MYOTOMY IS THE PREFERRED TREATMENT FOR PATIENTS WITH SYMPTOMATIC ZENKER’S DIVERTICULUM

Abstract Background Zenker’s diverticulum (ZD) is a mucosal herniation at the pharyngoesophageal junction presenting with dysphagia, regurgitation and aspiration. While open surgical myotomy (OSM) is the conventional treatment option, select patients can undergo myotomy using endoscopic techniques. Purpose Evidence on third-space flexible endoscopy with myotomy is lacking, especially in North America. We aimed to assess the safety and efficacy of peroral endoscopic myotomy (POEM) for symptomatic ZD. Method Retrospective cohort study was performed of consecutive patients undergoing OSM and POEM completed in a tertiary hospital from 2010-2020. Only patients with accessible electronic medical records and at least 3 months of follow-up were included in this study. Data collected included: demographics, comorbidities, ZD characteristics, clinical and patient-reported outcomes. Result(s) 14 patients underwent OSM and 18 patients underwent POEM. 10 of the patients undergoing POEM were considered for but were not able to get stapled endoscopic myotomy, the most common reasons were related to the technical limitations (ZD size too small, unable to hyper-extend neck, unable to position suspension laryngoscope). There were no significant differences between groups in age (p=0.35), BMI (p=0.38), Charlson comorbidity index (p=0.26) and size of ZD (p=0.92). Length of stay was significantly lower for POEM (0.4 vs. 3.1, p&amp;lt;0.01). Complications were more common and severe with OSM (36%, n=5) versus POEM (11%, n=2). The only complications post-POEM were contained esophageal perforations. Complications post-OSM included esophageal perforations requiring open cervical drainage, surgical site infections, recurrent laryngeal nerve injury/paresis, esophageal strictures requiring multiple dilatations. All patients undergoing POEM had 100% technical success with post-treatment barium esophagogram showing 100% resolution of obstruction/hang-up. The median follow-up time post-POEM was 11 months. Over the follow-up period there was a significant improvement of patient-reported outcomes, with a mean decrease of Eckardt score (4.7 to 1.1, p&amp;lt;0.001) and mean increase of Dakkak-Watson score (20.7 to 41, p&amp;lt;0.001). Only one patient had persistent ongoing symptoms of dysphagia post-POEM and was subsequently diagnosed with ineffective esophageal motility on high resolution manometry. Conclusion(s) POEM is a minimally invasive treatment option for ZD with high treatment success as well as reduced length of stay and complications. It is less invasive than OSM, more versatile than stapled endoscopic myotomy and is less prone to technical limitations. Please acknowledge all funding agencies by checking the applicable boxes below None Disclosure of Interest None Declared

Endoscopic submucosal dissection using a novel thin-therapeutic endoscope for superficial esophageal squamous cell carcinoma with severe stricture at the pharyngoesophageal junction

Endoscopic submucosal dissection using a novel thin-therapeutic endoscope for superficial esophageal squamous cell carcinoma with severe stricture at the pharyngoesophageal junction

Zenker's Diverticulum in Forestier Disease: Chance or Causality?

Introduction:Zenker's diverticulum is an acquired sac-like outpouching of the mucosa and submucosa layers originating at the pharyngoesophageal junction. The predominant symptom of Zenker’s diverticulum is dysphagia. Videofluoroscopy confirms the diagnosis. Forestier disease is a clinical entity characterized by ossification of anterolateral vertebral ligament and anterior osteophyte formation along the anterolateral spinal column. Its etiopathogenesis remains unknown and common symptoms are dysphagia, dysphonia and airway obstruction. The objective of this study is to identify a pathophysiological correlation between Forestier disease and the onset of Zenker’s diverticulum.Materials and Methods:A retrospective observational study was conducted. The electronic database of our Radiology Unit was analyzed in order to identify patients with hypopharyngeal diverticulum and osteophytes at the cervical vertebrae level, from January 2010 to January 2021. The search was performed using precise keywords.Results:The computerized database search outlined 10 imaging exams: 5 videofluorographies and 5 computed tomography scans. In 100% of the cases, dysphagia was the main symptom that led to the diagnostic assessment; 30% of patients, on the other hand, reported dyspnoea. From the data analysis, the male / female ratio is 1: 1 and the average age of the patients is 64.8 (+/- 11.31) years. Conclusions:We assume that the anatomical abnormalities in Forestier disease may cause an increase of pharyngeal pressure and consequently support the development of the Zenker’s diverticulum. Hence, it is always recommended to investigate the presence of Zenker’s diverticulum in a patient with Forestier disease, especially for the life-threatening complications of Zenker’s diverticulum.

Challenging Airway Management in Patients With Zenker’s Diverticulum

The acquired hypopharyngeal diverticulum (Zenker’s) is characterized by a posterior wall outpouching of the pharyngeal mucosa and submucosa through the vulnerable points of the pharyngoesophageal junction. We describe the case of a 67-year-old male who was recently diagnosed with Zenker's diverticulum and had complaints of dysphagia and halitosis. An endoscopic treatment (diverticulotomy) was performed without difficulties. The anesthetic management included rapid sequence induction, avoiding succinylcholine, and intraoperative infusion of dexmedetomidine. The neuromuscular blockade was reversed using sugammadex, decreasing the risk of failed extubation and possible airway re-intervention. The patient was discharged home the following day without complications.

Cancer of Pharyngoesophageal Junction: A Different Subtype From Hypopharyngeal and Cervical Esophageal Cancer?

BackgroundSquamous cell cancers in the hypopharynx (HP) and cervical esophagus (CE) are different diseases with different staging systems and treatment approaches. Pharyngoesophageal junction (PEJ) tumor involves both the hypopharynx and the cervical esophagus simultaneously, but few reports focused on PEJ tumors. This study aimed to clarify clinical characteristics and the treatment approaches of PEJ tumors.Patients and MethodsA total of 222 patients with squamous cell carcinoma in the HP, PEJ, and CE were collected between January 2008 and June 2018 in Fudan University Shanghai Cancer Center. We compared different lymph node metastatic patterns of three diseases above and the survival of different tumor locations, different lymph node metastasis, and different radiotherapy approaches.ResultsFor HP, PEJ, and CE cancer, the upper and middle cervical lymph node metastatic rates were 85.7%, 47.1%, and 5.8%, respectively; the lower cervical lymph node metastatic rates were 36.7%, 42.9%, and 35.0%, respectively; and the mediastinal lymph node metastatic rates were 2.0%, 72.9%, and 80.6%, respectively. The 3-year overall survival rates were 69.5% in the HP group, 52.0% in the PEJ group, and 69.6% in the CE group (p = 0.024). No survival differences were found between the involved-field-irradiation and elective-node-irradiation subgroups among PEJ tumors (p = 0.717 for OS and p = 0.454 for PFS, respectively).ConclusionHP cancers had a high prevalence in all cervical lymph node metastases, while CE cancers had a lower prevalence in the cervical and mediastinal lymph node metastases. PEJ cancer had the combined metastatic patterns of both HP and CE cancers. Involved field irradiation was feasible in chemoradiotherapy for PEJ cancers.

Transient hypopharyngeal intrabolus pressurization patterns: Clinically relevant or normal variant?

In oropharyngeal dysphagia, impaired pharyngoesophageal junction (PEJ) opening is reflected by an elevated hypopharyngeal intrabolus pressure (IBP), quantifiable using pharyngeal high-resolution manometry with impedance (P-HRM-I). Transient intrabolus pressurization (TP) phenomena are not sustained and last for only a brief period. We hypothesized that TP patterns reflect impaired coordination between timing of hypopharyngeal bolus arrival and PEJ relaxation. A retrospective audit was conducted of P-HRM-I datasets; 93 asymptomatic Controls and 214Patients with differing etiological/clinical backgrounds were included. TP patterns were examined during 10ml liquid swallows. TP was defined by a simultaneous, non-sustained, pressurization wave spanning from the velo-/meso-pharynx to PEJ. The coordination between deglutitive pharyngeal bolus distension and PEJ relaxation timing was assessed using timing variables; (i) Distention-Contraction Latency (DCL, s) and (ii) PEJ Relaxation Time (RT, s). Resultant flow resistance was quantified (IBP, mmHg). TP swallows were observed in 87 (28%) cases. DCL was not significantly different in relation to TP, while PEJ relaxation time was shorter, and IBP was higher during TP swallows. In Patients RT-DCL time difference correlated with IBP (r -0.368, p<0.01). Bolus distension and PEJ relaxation were miss-timed during TP swallows, impeding bolus flow and leading to a brief period of pressurization of the pharyngeal chamber by muscular propulsive forces. While TP swallows were identified in both Controls and Patients, increased IBPs were most apparent for Patient swallows indicating that the extent of IBP increase may differentiate pathological TP swallows.

Thoracoscopic total laryngo-pharyngo-oesophagectomy for the pharyngoesophageal junction cancer: a single-center experience of multidisciplinary team

The aims of this study were to review the surgical experience and evaluate the feasibility of thoracoscopic total laryngo-pharyngo-oesophagectomy by multidisciplinary team in the patients with pharyngoesophageal junction cancer. A total of 31 patients with pharyngoesophageal junction cancer who underwent thoracoscopic total laryngo-pharyngo-oesophagectomy with gastric pull-up reconstruction performed by a collaborative thoracic surgery and otolaryngology surgery team in our department from January 2009 to January 2019 were retrospectively analysed. Surgical experience, Postoperative morbidity, overall survival were evaluated. The median age was 62years old. Among these patients, 20 had hypopharyngeal cancer, 11 had cervical oesophageal cancer. No patients died during the perioperative period, and the median operation time was 4h 30min. The mean hospital stay was 13days. The rate of complications was 32.3%. There were two cases of anastomotic leakage, four cases of moderate pulmonary infection. The median follow-up period was 31months. Four patients were lost to follow-up in the second and fourth years and were considered to have died at that time. The 3- and 5-year overall survival rates were 52.6% and 31.6%, respectively. As a salvage surgery, thoracoscopic total laryngo-pharyngo-oesophagectomy by multidisciplinary team can be performed with an acceptable level of perioperative morbidity and mortality, relatively good recovery, and acceptable survival outcome for patients with pharyngoesophageal junction cancer.

Diagnostic and treatment of foreign bodies of the upper digestive tract

To evaluate the results of diagnosis and treatment of foreign bodies of the upper gastrointestinal tract. There were 1187 patients aged 15-99 years with suspected foreign body of the upper gastrointestinal tract. In 536 patients (266 men, 270 women), foreign bodies were detected. Ingestion of a foreign body was more common in patients aged 46-65 years. In 516 patients, foreign bodies were detected in the esophagus (pharyngo-esophageal junction - 25, upper third of the esophagus - 426, middle third of the esophagus - 34, lower third of the esophagus - 21, esophageal-gastric junction - 10). Four patients admitted with esophageal wall perforation. In 3 cases, foreign bodies were localized in the throat, 15 patients - in the stomach, 2 patients - in the duodenum. In most cases, foreign bodies were organic (n=506). Removal was successful in 530 cases. In 4 patients with esophageal wall perforation and mediastinitis, removal was performed intraoperatively. Flexible endoscope was used in 500 cases. In 86 patients, foreign bode was displaced in the stomach using flexible endoscopy. Foreign body removing wasn't successful in 4 cases. In 2 patients, extraction was followed by esophageal wall damage. In 4 patients, esophagotomy was applied to extract foreign body. Suturing the esophageal wall defect was carried out in 2 cases. Abrasion and erosive esophagitis were the most common injuries of esophageal mucosa. Esophageal diseases were detected in 75 cases after foreign body removal (67 cases - benign esophageal diseases). One patient died from bedsore of innominate artery complicated by acute hemorrhage. Foreign bodies of the upper gastrointestinal tract are observed in 45% of patients at admission. Neck and chest X-ray examination is obligatory before endoscopy. Flexible endoscopy is a gold standard for diagnosis and extraction of foreign bodies. Repeated endoscopy after foreign body extraction should be mandatory. It is necessary to visualize complications associated with foreign body and identify esophageal diseases.

Histomorphogenesis of the Pharyngeal roof in Muscovy Ducks (Cairina moschata)

This study aimed to investigate the morphological characteristics of the pharyngeal roof of the developmental stages of Muscovy ducks from 1 to 60 days old. The statistical analysis revealed that the ratio of the pharyngeal roof to the total length of the oropharynx decreased with advancement of the age, which was recorded 19.44 % at one-day and 15.19% at 60 days age, as well as the infundibular cleft was increased in length approximately by one and half at 15 days and three folds at 60 days when compared with that of one-day-old. SEM in one-day-old showed that, the fine pharyngeal papillae on each side of the infundibular slit, whereas, two types of the papillae at 15 days but numerous different sized and shape caudally directed papillae at 60 days, some of them which were present at the pharyngoesophageal junction were in appearance of the nails of the carnivores. Numerous openings of the sphenopterygoid salivary glands were scattered between these papillae, which were observed in older ages (60 days old) by few numbers in the shallow groove at the caudal commissure of the infundibular slit. The edges of the infundibular cleft were smooth in all developmental stages except at 60 days old where few, fine and caudally directed papillae were recognized. Histologically, the sphenopterygoid salivary glands were compound tubule-alveolar mucous secretory glands which was surrounded by lymphatic aggregation in older ages. In all examined ages, lymphatic accumulation could be observed in the infundibular cavity which was surrounding the intraepithelial mucous glands.

Comparative morphological study of the oropharyngeal floor of squabs and adult domestic pigeons (Columba livia domestica).

The current study compared the morphological features of the oropharyngeal floor of squabs and adult domestic pigeons (Columba livia domestica). Samples from the oropharyngeal floor of both squabs and adult pigeons were collected directly after slaughtering. The collected samples were examined grossly, morphometrically, and by scanning electron microscopy (SEM). The lower beak had triangular shape with pointed rostral end. The tongue did not fill the entire oral floor in squabs as well as adult pigeons. The lingual apex of squabs had a small lingual nail while that of the adult pigeons had a well-developed lingual nail. The lingual body was separated from the lingual root by a transverse papillary crest, which was "V" shaped in squabs but "U"-shaped in adult pigeons. Filiform papillae were distributed on the dorsal surface of lingual apex, as well as, body, but were absent on the root. The lingual root presented fine elevations and low projections in squabs and adult pigeons, respectively. On the other hand, the tongue of adult pigeons had larger number of the lingual salivary glands openings compared to that of squabs. In addition, the edges of the glottis had numerous small projections in squabs bur presented large dome-shaped papillae in adult pigeons. Moreover, adult pigeons had longer pharyngeal papillae at pharyngoesophageal junction than those of squabs. In conclusion, these variations suggest that adult pigeons adapted well to their diet, which might reflect higher efficiency of food prehension.

Morphological features of pharyngeal roof of Egyptian geese (Alopochen aegyptiacus)

The anatomy of the pharyngeal roof of Egyptian geese has been studied to define the structural features which may affect swallowing and food intake, in addition to provide a basis for bird pathology identification in this area. The results showed that the pharyngeal roof of geese was smooth with numerous scattered conical papillae of various sizes and had several openings of the sphenopterygoid salivary glands. Its length was 16.2 mm, about 16.5 percent of the total length of the oropharyngeal roof. A common opening of both ear tubes; infundibular cleft, was measured 8.09 mm and extended caudally to pharyngoesophageal junction through shallow groove. The pharyngeal mucosa contained abundant mucous and serous glands associated with lymphatic nodules, in addition to accumulation of nerve cells. In conclusion there were some anatomical features of the pharyngeal roof of geese that are unique to this species and morphological changes to this area of the digestive tract can reflect adaptations to the bird's environment and mode of feeding.

Morphology of the Upper Esophageal Sphincter or Cricopharyngeus Muscle Revisited: A Study Using Adult and Fetal Specimens.

Histological examination of specimens from 22 donated elderly cadavers and 15 human fetuses revealed that the cricopharyngeus muscle (CPM) provided (1) posterior circular muscle fibers adjacent to the external aspect of the uppermost esophageal circular muscle and (2) a thin anterior sling connecting to that same muscle. Another thick lateral bundle of longitudinal muscle originated independently from a fascia covering the posterior cricoarytenoideus muscle, extended laterally and posteriorly, and occupied a space after the CPM had disappeared at the anterolateral angle of the esophagus below the cricoid. The thick fascia contained abundant elastic fibers along the internal surface of the pharyngeal constrictors (posteromedial elastic lamina), but was interrupted or discontinued near the cricoid origin of the CPM. As no submucosal smooth muscles or elastic fibers were connected to it, the CPM did not accompany a specific elastic structure at the interface between the pharyngeal and esophageal muscles. In fetuses, the medial half of the CPM was inserted into the cricoid while the lateral half continued to the sternothyroideus muscle or ended at a fascia covering the cricothyroideus. These anterolateral ends provided a mechanical load for longitudinal growth of the pharyngeal constrictors. Consequently, the CPM was unlikely to develop and grow to form the upper esophageal sphincter, and the muscle bundle crossing the lateral aspect of the pharyngo-esophageal junction appeared to have a secondary passive role as a sphincter. This situation contrasts with that of another sphincter in the human body formed from striated muscle. Clin. Anat., 33:782-794, 2020. © 2019 Wiley Periodicals, Inc.