The innervation of the human upper esophageal sphincter

The neuroanatomy and physiology of the human upper esophageal sphincter (UES) has long been controversial. As a result, there has been little progress in diagnosing and treating dysphagias involving this area. In this study, three specimens of the UES obtained from human autopsies were examined by Sihler's stain. This stain clears soft tissue while counterstaining the nerves, thereby allowing nerve supply to each muscle of the UES to be demonstrated. It was found that the nerve supply to each component of the UES is substantially different. The inferior pharyngeal constrictor (IPC) is supplied by a dense linear plexus which is about 1.0-1.5 cm wide and 10 cm long and located about 1.5 cm lateral to the attachment of the IPC on the thyroid lamina. The cricopharyngeal (CP) muscle receives its innervation from below via the recurrent laryngeal nerve (RLN) and from above via the pharyngeal plexus. Neural connections between the RLN and the pharyngeal plexus were observed. Finally, the upper esophagus (UE) is innervated by the RLN. The innervation pattern of each component of the UES suggests functional differences between these muscles. These observations help clarify the innervation of the UES. Accurate knowledge of the neuroanatomy of the UES is necessary for advances in diagnosis and treatment of pharyngeal dysphagia.