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Anatomy · Pharynx: Zenker diverticulum
Sample itemA 70-year-old man has regurgitation of undigested food, halitosis and gurgling in the neck. A barium swallow shows a pouch arising from the posterior pharyngeal wall. Through which interval does the pouch herniate?
Original practice item, not a recalled exam question. Nothing here is recorded.
The answer and the reasoning
D. Between the thyropharyngeus and cricopharyngeus parts of the inferior constrictor
A pharyngeal pouch (Zenker diverticulum) herniates through the area of weakness between the oblique thyropharyngeus fibres and the horizontal cricopharyngeus fibres, called Killian dehiscence. High pressure from an incompletely relaxing cricopharyngeus is thought to drive the herniation. The pouch passes down behind the oesophagus and can compress it.
Option by option
A. Between the middle and inferior constrictors
The gap between the middle and inferior constrictors transmits the internal laryngeal nerve and superior laryngeal vessels, and the recurrent laryngeal nerve enters below the inferior constrictor; it is not the site of the pouch.
B. Through the thyrohyoid membrane
The thyrohyoid membrane is pierced by the internal laryngeal nerve and superior laryngeal vessels, and it does not form a pharyngeal pouch.
C. Between the superior and middle constrictors
The gap between the superior and middle constrictors transmits stylopharyngeus and the glossopharyngeal nerve.
D. Between the thyropharyngeus and cricopharyngeus parts of the inferior constrictor (correct)
Correct. Killian dehiscence lies between the two parts of the inferior constrictor.
Source note: Original NextPrep sample item — pending expert review. This item is original practice material awaiting independent expert review, so confirm important facts in a standard textbook.
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