ABSTRACT
The esophagus is a continuation of the pharynx and ends at the cardia of the stomach. The transition from pharynx to esophagus is at the lower border at the 6th cervical vertebra which corresponds to the cricoid cartilage anteriorly. The esophagus deviates to the left in the lower portion of the neck, then returns to the midline in the mid-portion of the thorax near the bifurcation of the trachea. In the lower portion of the thorax the esophagus again deviates to the left to pass the diaphragmatic hiatus. Hence, the surgical maneuver of a right thoracotomy for a mid-esophageal lesion and a left thoracotomy for a lower esophageal lesion. The optimal exposure of the cervical esophagus is in the left neck not only because the esophagus deviates to the left in the neck, but also because the right recurrent laryngeal nerve is further away from the esophagus than the left recurrent laryn geal nerve. Hence, encircling the esophagus with the gloved finger is less likely to include the right recurrent nerve when dissecting from the left neck than it is to include the left recurrent nerve when dissecting from the right neck.
