Bad Breath Halitosis Forum

Zenker's diverticulum
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Zenker's diverticulum
Classification & external resources ICD-10 K22.5
ICD-9 530.6
DiseasesDB 31174
eMedicine med/2777
MeSH D016672
In anatomy, Zenker's diverticulum is a diverticulum of the mucosa of the pharynx, just above the cricopharyngeal muscle (i.e. above the upper sphincter of the oesophagus). It was named in 1877 by German pathologist Friedrich Albert von Zenker.




Contents [hide]
1 Epidemiology
2 Mechanisms and manifestations
3 Diagnosis
4 Treatment
5 References
6 Other external links



[edit] Epidemiology
Zenker diverticulum mainly affects older adults.


[edit] Mechanisms and manifestations
In simple words, when there is excessive pressure within the lower pharynx, the weakest portion of the pharyngeal wall balloons out, forming a diverticulum which may reach several centimetres in diameter.

More precisely, while traction and pulsion mechanisms have long been deemed the main factors promoting development of a Zenker's diverticulum, current consensus considers occlusive mechanisms to be most important: uncoordinated swallowing, impaired relaxation and spasm of the cricopharyngeus muscle lead to an increase in pressure within the distal pharynx, so that its wall herniates through the point of least resistance (variously known as Killian's triangle, Laimer's triangle, or more accurately Killian-Laimer triangular dehiscence). The result is an outpouching of the posterior pharyngeal wall, just above the oesophagus.[1]

While it may be asymptomatic, Zenker diverticulum often causes clinical manifestations such as dysphagia (difficulty swallowing), and sense of a lump in the neck; moreover, it may fill up with food, causing regurgitation (reappearance of ingested food in the mouth), cough (as some food may be regurgitated into the airways) and halitosis (smelly breath, as stagnant food is digested by microrganisms). It rarely causes any pain.


[edit] Diagnosis
A simple barium swallow will normally reveal the diverticulum. This may be coupled with oesophageal endoscopy.


[edit] Treatment
If small and asymptomatic, no treatment is necessary. Larger, symptomatic cases of Zenker's diverticulum have been traditionally treated by neck surgery to resect the diverticulum and incise the cricopharyngeus muscle. However, in recent times non-surgical endoscopic techniques have gained more importance (as they do not require general anaesthesia and allow for much faster recovery), and the currently preferred treatment is endoscopic stapling[2][3] (i.e. closing off the diverticulum via a stapler inserted through a tube in the mouth). This may be performed through a fibreoptic endoscope[4]. Other non-surgical treatment modalities exist, such as endoscopic laser, which recent evidence suggests it less effective than stapling.[5]


[edit] References
^ PMID 12903677 Pathogenesis and methods of treatment of Zenker's diverticulum, Ann Otol Rhinol Laryngol. 2003 Jul;112(7):583-93
^ PMID 15453934 Endoscopic stapling of pharyngeal pouch, J Laryngol Otol. 2004 Aug;118(8):601-6
^ PMID 12782805 Endoscopic staple diverticulostomy for Zenker's diverticulum: review of literature and experience in 159 consecutive cases, Laryngoscope. 2003 Jun;113(6):957-65
^ PMID 15966520 Fiberoptic endoscopic-assisted diverticulotomy: a novel technique for the management of Zenker's diverticulum, Ann Otol Rhinol Laryngol. 2005 May;114(5):347-51
^ PMID 16954989 The Endoscopic Management of Zenker Diverticulum: CO2 Laser versus Endoscopic Stapling, Laryngoscope. 2006 Sep;116(9):1608-11

[edit] Other external links
Duke University
Columbia University
ZenkersInfo.org
389349395 at GPnotebook
synd/2461 at Who Named It

has anyone been tested for this yet?

I think I have a couple of years ago... U drink a liquid, and the doctor is looking at ure Xrays, while u are drinking......the special liquid flows down the throatto ure stomach, and if tit stops somewhere u haave Zenkers diverticulum

along with HH, I plan to get tested for this. It seems to fit the symptoms of my BB.

BUMP - for awareness (:

yeh i created a thread about this a while ago. no one seemed to give a shit then.

it does seem a little unlikely though. But if this is the case for some people, then it is easily fixed at least.

austuser if you don't mind me asking what do you think is the cause of your BB?

personally, i would sway towards the post nasal drip which is due to allergies. Also tonsil stones on occasion, but this is maybe once a week or so when i get a tonsil stone my mouth will taste like feces and my breath will be bad from meters away, but if i take care of the stones its ok.

Maybe my acid reflux has a little to do with it i dont know.

All i know is that my tongue gets very dirty and coated and dry, and when that is left untouched my breath is not nice for someone who is talking close to me or kissing me. But with effective tongue cleaning and the use of smartmouth i can prevent the bad bacteria from running amok in my mouth for at least 12 hours at a time, so i am quite content with that. However i still want to get to the root of the problem, waiting on getting my tonsils out soon, and seeing if the desensitization therapy i am undergoing will clear up my constant hayfever.