Killian dehiscence
Citation, DOI, disclosures and article data
At the time the article was created Omoleye, Olasubomi Jimmy had no recorded disclosures.
View Omoleye, Olasubomi Jimmy's current disclosuresAt the time the article was last revised Yvette Mellam had no financial relationships to ineligible companies to disclose.
View Yvette Mellam's current disclosures- Killian's triangle
- Killian-Jamieson triangle
- Jamieson triangle
- Pharyngeal dimple
- Killian's dehiscence
- Killian triangle
The Killian dehiscence is a triangular-shaped area of weakness in the muscular wall of the pharynx, between the transverse and oblique bundles of the inferior pharyngeal constrictor 1. It is the most common site of pharyngeal diverticula 5.
On this page:
Gross anatomy
It is located in the posterior wall of the laryngopharynx, slightly above the origin of the esophagus 1.
The Killian dehiscence is a triangular area of weakness formed by the oblique fibers of the inferior pharyngeal constrictor (thyropharyngeus), which attach anteriorly to the oblique lamina at the sides of the thyroid cartilage and posteriorly to the median raphe, and the transverse fibers of the inferior pharyngeal constrictor (cricopharyngeus), which attach to the sides of the cricoid cartilage anteriorly and wind around the pharynx, with no posterior attachment 1,2.
Internal to the inferior constrictor, the relatively strong pharyngobasilar fascia forms the submucosal lining. A relatively weaker buccopharyngeal fascia forms the external lining of the inferior constrictor 2.
Variant anatomy
While not anatomically evident in every individual, it has been found to occur more commonly in males 3. The dimensions of Killian's triangle of weakness have also been shown to correlate with individual anthropometric parameters, consequently being more prominent in males than in females 3.
One study suggests that it is present in ~60% of males, and just ~30% of females 3. This could explain why pharyngeal pouches are more common in males.
Development
Killian dehiscence arises due to the descent of the larynx during development 4. As the pharyngeal constrictors (apart from cricopharyngeus) are attached to the median raphe, which in turn is attached to the skull base, laryngeal descent during development causes the constrictors to assume an oblique course, leaving cricopharyngeus in a transverse orientation, thus creating a potential area of weakness 4.
History and etymology
It is named after Gustav Killian (1860-1921) a German otolaryngologist.
Related pathology
Uncoordinated contraction of the inferior pharyngeal constrictor and spasm, or fibrosis, of cricopharyngeus, have been implicated in the formation of pharyngeal pouches (Zenker diverticula), due to the increased intraluminal pressures these cause during swallowing. The increased intraluminal pressures then lead to herniation through this potential area of weakness 1,5.
Killian dehiscence is the most common site of pharyngeal diverticula 5.
References
- 1. Harold Ellis, Vishy Mahadevan. Clinical Anatomy. (2010) ISBN: 9781405186179
- 2. Keith L. Moore, Arthur F. Dalley, A. M. R. Agur. Clinically Oriented Anatomy. (2013) ISBN: 9781451119459
- 3. Anagiotos A, Preuss SF, Koebke J. Morphometric and anthropometric analysis of Killian's triangle. (2010) The Laryngoscope. 120 (6): 1082-8. doi:10.1002/lary.20886 - Pubmed
- 4. Michael C. Joiner, Albert van der Kogel. Basic Clinical Radiobiology, Fifth Edition. (2016) ISBN: 9780340808931
- 5. Killian's dehiscence - an overview. Science Direct (2018).
Incoming Links
Related articles: Anatomy: Head and neck
- skeleton of the head and neck
-
cranial vault
- scalp (mnemonic)
- fontanelle
-
sutures
- calvarial
- facial
- frontozygomatic suture
- frontomaxillary suture
- frontolacrimal suture
- frontonasal suture
- temporozygomatic suture
- zygomaticomaxillary suture
- parietotemporal suture (parietomastoid suture)
- occipitotemporal suture (occipitomastoid suture)
- sphenofrontal suture
- sphenozygomatic suture
- spheno-occipital suture (not a true suture)
- lacrimomaxillary suture
- nasomaxillary suture
- internasal suture
- basal/internal
- skull landmarks
- frontal bone
- temporal bone
- parietal bone
- occipital bone
- skull base (foramina)
-
facial bones
- midline single bones
- paired bilateral bones
- cervical spine
- hyoid bone
- laryngeal cartilages
-
cranial vault
- muscles of the head and neck
- muscles of the tongue (mnemonic)
- muscles of mastication
-
facial muscles
- epicranius muscle
- circumorbital and palpebral muscles
- nasal muscles
-
buccolabial muscles
- elevators, retractors and evertors of the upper lip
- levator labii superioris alaeque nasalis muscle
- levator labii superioris muscle
- zygomaticus major muscle
- zygomaticus minor muscle
- levator anguli oris muscle
- malaris muscle
- risorius muscle
- depressors, retractors and evertors of the lower lip
- depressor labii inferioris muscle
- depressor anguli oris muscle
- mentalis muscle
- compound sphincter
-
orbicularis oris muscle
- incisivus labii superioris muscle
- incisivus labii inferioris muscle
-
orbicularis oris muscle
- muscle of mastication
- modiolus
- elevators, retractors and evertors of the upper lip
- muscles of the middle ear
- orbital muscles
- muscles of the soft palate
- pharyngeal muscles
- suprahyoid muscles
- infrahyoid muscles
- intrinsic muscles of the larynx
- muscles of the neck
- platysma muscle
- longus colli muscle
- longus capitis muscle
- scalenus anterior muscle
- scalenus medius muscle
- scalenus posterior muscle
- scalenus pleuralis muscle
- sternocleidomastoid muscle
-
suboccipital muscles
- rectus capitis posterior major muscle
- rectus capitis posterior minor muscle
- obliquus capitis superior muscle
- obliquus capitis inferior muscle
- accessory muscles of the neck
- deep cervical fascia
-
deep spaces of the neck
- anterior cervical space
- buccal space
- carotid space
- danger space
- deep cervical fascia
- infratemporal fossa
- masticator space
- parapharyngeal space
- stylomandibular tunnel
- parotid space
- pharyngeal (superficial) mucosal space
- perivertebral space
- posterior cervical space
- pterygopalatine fossa
- retropharyngeal space
- suprasternal space (of Burns)
- visceral space
- surgical triangles of the neck
- orbit
- ear
- paranasal sinuses
- upper respiratory tract
- viscera of the neck
- blood supply of the head and neck
-
arterial supply
-
common carotid artery
- carotid body
- carotid bifurcation
- subclavian artery
- variants
-
common carotid artery
- venous drainage
-
arterial supply
- innervation of the head and neck
-
cranial nerves
- olfactory nerve (CN I)
- optic nerve (CN II)
- oculomotor nerve (CN III)
- trochlear nerve (CN IV)
-
trigeminal nerve (CN V) (mnemonic)
- trigeminal ganglion
- ophthalmic division
- maxillary division
- mandibular division
- abducens nerve (CN VI)
- facial nerve (CN VII)
-
vestibulocochlear nerve (CN VIII)
- vestibular ganglion (Scarpa's ganglion)
- glossopharyngeal nerve (CN IX)
- vagus nerve (CN X)
- (spinal) accessory nerve (CN XI)
- hypoglossal nerve (CN XII)
- parasympathetic ganglia of the head and neck
- cervical sympathetic ganglia
- greater occipital nerve
- third occipital nerve
-
cervical plexus
- muscular branches
- longus capitis
- longus colli
- scalenes
- geniohyoid
- thyrohyoid
-
ansa cervicalis
- omohyoid (superior and inferior bellies separately)
- sternothyroid
- sternohyoid
- phrenic nerve
- contribution to the accessory nerve (CN XI)
- cutaneous branches
- muscular branches
- brachial plexus
- pharyngeal plexus
-
cranial nerves
- lymphatic drainage of the head and neck
- embryological development of the head and neck
Unable to process the form. Check for errors and try again.