Primary tonicity control of the PE-segment

Before skin closure is completed, the final aspect of the tonicity control of the pharyngoesophageal (PE) segment should be carried out. As already mentioned, a short myotomy of the upper esophageal sphincter is performed before closing the pharyngeal mucosa (figure right). A neurectomy of the pharyngeal plexus can be added if desired . The pharyngeal plexus branches innervating the constrictor pharyngeus muscle are localized, cut and partially removed as careful as possible (figure right). Mostly, three to five branches can be identified. This procedure is carried out unilaterally, preferably on the side of the hemi-thyroidectomy and/or neck dissection. A myotomy of the constrictor pharyngeus muscle is not recommended routinely, since this neurectomy largely prevents hypertonicity of this muscle group.

After introduction of wound drains, the skin is closed in two layers: the subcutaneous tissue with 3-0 vicryl interrupted and the skin with 4-0 nylon monofilament running sutures. The end result is shown in the last figure on the right.