Pharynx & esophagus Mazidi MD

Anatomy Pharynx: nasopharynx oropharynx hypopharynx

Nasopharyngeal SCC Risk factors: China , FH+ , diet, EBV,male,30-60 y, Not smoking Neck mass , bloody PND(not epistaxis), OME, nasal obstruction, cranial nerve palsy(6) Dx : endoscopy biopsy CT,MRI Rx: radiotherapy +_chemotherapy

Oropharynx SCC Etiology: tobacco ,alcohol , betel nut , HPV Vegetable & fruits are supportive factors Sore throat , Dysphagia , odynophagia , hemorrhage, neck mass , OME Dx: imaging,biopsy Rx : surgery +_ radiotherapy

Hypopharynx SCC Pyriform sinus , pos wall , post cricoid Male , black Presentation : neck mass , no manifestation, GERD ,sore throat ,dyspnea , otalgia Dx : CT , MRI , PET Etiology: alcohol , tobacco , poor socioeconomic , diet , genetic , plumer-vinson syn. Rx : surgery +_ radiotherapy

Esophagus :Anatomy UES : inf constrictor m.+ cricopharyngeous m. LES Esophagus length:18-26 cm, pos mediastinum Layers : mucosa submucosa muscularis propria : circular & longitudinal m.

Innervation: smooth m……vagus n. skeletal m……myenteric or auerbach plexus ( pristaltism) meissner plexus (sensory) UES : closed because of neural excitation (in sleep & GA : open) LES : closed as a result of muscular tonicity open in swallowing & esophageal or gastric distention

Esophageal symptoms heartburn Dysphagia Odynophagia Regurgitation

Esophageal testing Endoscopy : mucosal & structural disorders Manometer : motility disorders ( gold standard) PH monitoring : R/O GERD efficacy of therapy abnormal test : reflux episodes >4.2%

neoplasm RF :alcohol , tobacco , male , caustic injury , achalasia , plummer-vinson Hx of H & N SCC , HPV Pathology; SCC : mid esophageal Adenocarcinoma : distal Ph.E :dysphagia , weight loss

Staging Rx : T1 T2………surgery T3 T4…….neoadjoant chemo radiation + surgery