The distribution of malignant lesions’ origins is shown. The metastatic lesions originating below the clavicle typically present in a low supraclavicular (Virchow’s) node or in the scalene nodal packet beneath the origins of the sternocleidomastoids.
The most common benign pharyngeal lesion is a pulsion pseudodiverticulum (mucosa and submucosa only) arising between the lower components of the inferior pharyngeal constrictor posteriorly. The lowest portion of the constrictor, the cricopharyngeus, is thought to be dysfunctionally hypertonic or dyscoordinated in its contraction, resulting in increased intrapharyngeal pressure during swallowing. The progressive protrusion of the diverticulum is associated with dysphagia and foul breath from stagnation of pouch contents.
Surgical resection is sometimes required for a large diverticulum. In such a case, access to the posterior pharynx is obtained by incision along the anterior border of sternocleidomastoid, division of middle thyroid vein, lateral reflection of carotid sheath, and medial rotation of the visceral compartment.