Anatomical Localization of Foreign Body at C5 Level
A foreign body at the C5 vertebral level is located in the hypopharynx, not the esophagus. The esophagus begins at the level of the cricopharyngeus muscle (C6), making C5 a hypopharyngeal location.
Anatomical Landmarks for Differentiation
The critical distinction lies in understanding that the hypopharynx extends from the hyoid bone (approximately C3) to the lower border of the cricoid cartilage (C6), where the esophagus begins. 1
- The hypopharynx includes the pyriform sinuses, postcricoid region, and posterior pharyngeal wall down to C6 2
- The cricopharyngeal sphincter and upper esophageal sphincter are located at C6, marking the transition point 2, 3
- Foreign bodies at C5 are therefore positioned in the distal hypopharynx, above the esophageal inlet 1
Clinical Implications for Management
This anatomical distinction fundamentally changes your management approach:
- Hypopharyngeal foreign bodies (C5 level) can often be removed using transnasal flexible laryngo-esophagoscopy under local anesthesia, avoiding general anesthesia 3
- Video laryngoscopy with conscious sedation is highly effective for hypopharyngeal foreign bodies, providing magnified visualization and better patient comfort 2
- Rigid hypopharyngo-esophagoscopy remains the gold standard when flexible approaches fail, as 72% of foreign bodies are localized within the hypopharynx or cervical esophagus 4
Diagnostic Confirmation
Biplanar radiographs (AP and lateral views) should be obtained to confirm the exact anatomical level and distinguish hypopharyngeal from esophageal location 5
- CT scan provides superior localization with 90-100% sensitivity if complications are suspected 6
- The lateral view is particularly useful for determining whether the foreign body is at or above C6 (hypopharynx) versus below C6 (esophagus) 5
Critical Pitfall to Avoid
Do not attempt blind removal or aggressive manipulation of hypopharyngeal foreign bodies, as this can cause iatrogenic migration into the prevertebral space or between major neck vessels, requiring open surgical exploration 7. This complication transforms a straightforward endoscopic procedure into a complex surgical emergency with significant morbidity risk.