Case Example

Following esophagoscopy that should identify and characterize diverticulum and the appropriate treatment strategy, a Maloney dilator (~38-42 Fr) should be placed and left in the esophagus for easy identification of the esophagus in the neck and to prevent possibility of over-resection via open approach. 

Intended incision - palpate level of cricoid - this is the level of cricopharyngeus. Incision is approximately 2 cm to left of midline.

Dissection (following the raising of subplatysmal flaps superiorly to the level of the thyroid notch and inferiorly to the clavicle) takes place medial to SCM and carotid sheath. Staying lateral to straps and thyroid gland the tracheoesophageal groove and RLN can be safely identified with blunt dissection using Kitners. Lateral rotation of the thyroid cartilage is critical to exposure of posterior pharynx where the diverticulum often lies as well as to exposing cricopharyngeus.