PHARYNX Pharynx Prof .Saeed Makarem

DEFINATION It is a muscular tube that extends from the base of the skull to the 6th cervical vertebra. It is continuous below with the esophagus. It is funnel shaped with an upper expanded end and a narrow lower end Prof. Saeed Makarem

SUBDIVISIONS Nasopharynx. Oropharynx. Laryngopharynx. It lies behind the nose, mouth and larynx. It communicates with each of them. It is divided into 3 parts: Nasopharynx. Oropharynx. Laryngopharynx. So, Its anterior wall is deficient where it is related to nose, mouth & larynx. Prof. Saeed Makarem

RELATIONS Posteriorly: Laterally : 1-Auditory tube. It lies infront of the prevertebral muscles and fascia. Laterally : It is related from above downward to: 1-Auditory tube. 2-Styloid process and its muscles. 3-Carotid sheath and its contents. 4-Thyroid gland Prof .Saeed Makarem

STRUCTURE OF THE WALL From inwards outwards The 2 layers of Fascia: 1-Mucous membrane: It is continuous with that of the Nose, Oral cavity, Auditory tube, Larynx ,esophagus. 2- Pharyngobasilar fascia. 3- Muscles. 4- Buccopharyngeal fascia The 2 layers of Fascia: It is thickened internally to form the Pharyngobasilar fascia and externally to form Buccopharyngeal

MUSCLES OF PHARYNX NAME ORIGIN INSERTION ACTION NERVE Superior constrictor Medial pterygoid plate, pterygoid hamulus, pterygoamndibular raphe, mylohyoid line Pharyngeal tubercle, pharyngeal raphe Constricts the pharynx Vagus nerve through the pharyngeal plexus Middle constrictor Greater & lesser horns of hyoid bone & Stylohyoid ligament pharyngeal raphe Inferior constrictor Arch of cricoid cartilage & oblique line of thyroid cartilage Longitudinal Salpingeopharyngeus Cartilage of auditory tube Lateral wall of pharynx Elevate the pharynx in swallowing Palatopharyngeus Posterior border of the hard palate & palatine aponeurosis Thyroid cartilage, lateral wall of pharynx Stylopharyngeus Styloid process Thyroid cartilage Glossopharyngeal nerve Prof.Saeed Makarem

MUSCLES Constrictors: 1- Superior. 2- Middle 3- Inferior. Prof.Saeed Makarem

The three constrictors muscles overlap each others like segment of an antenna. Each one fans out from its anterior attachment and passes posteriorly around the pharynx horizontally. Prof.Saeed Makarem

CONSTRICTORS Each muscle joins its fellow of the opposite side in a fibrous midline Pharyngeal raphe. The raphe extends from the pharyngeal tubercle of the occipital bone to the esophagus. The constrictors propel the bolus of food down into the esophagus. Prof. Saeed Makarem

CONSTRICTORS The lowest fibers of the inferior constrictor forms the Cricopharyngeus muscle. It has a sphincteric action on the lower end of the pharynx and prevents the entry of the air into the esophagus in between swallowing. Prof.Saeed Makarem

LONGITUDINAL MUSCLES 1-Stylopharyngeus. 2-Salpingeopharyngeus. 3-Palatopharyngeus. They are attached to the styloid process . Auditory tube. Soft palate. They elevate the larynx and pharynx and pulls the palatopharyngeal arch medially during swallowing Prof .Saeed Makarem

MOTOR INNERVATION All muscles of the pharyngeal are supplied by the pharyngeal plexus Except the Stylopharyngeus which is supplied by the glossopharyngeal nerve. Prof .Saeed Makarem

SENSORY INNERVATION Nasopharynx: 5-Maxillary nerve. Oropharynx: 9-Glossopharyngeal Laryngopharynx: 10-Vagus nerve Prof.Saeed Makarem

NASOPHARYNX It has a respiratory function. It extends from skull base to the soft palate. Boundaries: Roof: Basilar part of occipital bone. Body of sphenoid. A collection of lymphoid tissue lies in the submucosa at the junction of roof & posterior wall. it is called pharyngeal tonsil Prof.Saeed Makarem

NASOPHARYNX Floor : Sloping upper surface of the soft palate. Posterior wall: Anterior arch of atlas. Pharyngeal isthmus : It is a gap in the floor between the free end of the soft palate and the posterior wall of the pharynx. Prof. Saeed Makarem

NASOPHARYNX LATERAL WALL: it has: 1. Pharyngeal opening of the auditory tube. 2.Tubal elevation: The elevated posterior margin of the tube. 3-Pharyngeal recess: It is a slit like depression behind the tubal elevation. Prof.Saeed Makarem

NASOPHARYNX 4.Salpingo-pharyngeal fold of mucous membrane produced by the salpingopharyngeal muscle. 5.Tubal tonsil It is a collection of lymphoid tissue behind the opening of the auditory tube. Prof.Saeed Makarem

ADENOID Repeated infection of the pharyngeal tonsils leads to its hypertrophy Now it is called adenoids. It causes obstruction of the posterior nares. The patient breathes through his mouth and snores. It can cause deafness and recurrent otitis media due to its close relation to the auditory tube. Prof . Saeed Makarem

OROPHARYNX It has a digestive function. It lies behind the mouth cavity and extends from the soft palate to the upper border of the epiglottis. Roof : It is the under surface of the soft palate and the pharyngeal isthmus. Prof. Saeed Makarem

OROPHARYNX Floor : It is the posterior one third of the tongue and the interval between the tongue and the anterior surface of the epiglottis. Lingual tonsil : A collection of lymphoid tissue on the posterior third of the tongue. Prof .Saeed Makarem

OROPHARYNX The tongue is connected to the epiglottis by one median and two lateral glossoepiglottic folds. VALLECULA : It is a depression on each side of the of the median glossoepiglottic fold. Prof.Saeed Makarem

OROPHARYNX Anterior wall : It opens into the mouth cavity through the oropharyngeal isthmus. Posterior wall : Body of 2nd cervical vertebra and the upper part of the body of the 3rd vertebra. Prof.Saeed Makarem

OROPHARYNX Lateral wall : Palatoglossal arch It is a mucous fold overlying the palatoglossal muscle. Palatopharyngeal arch It is a mucous fold behind the palatoglossal arch. The interval between the two palatopharyngeal arches is the Oropharyngeal isthmus Prof .Saeed Makarem

PALATINE TONSIL It occupies the (Tonsillar Bed). Which is the interval between the palatoglossal & palatopharyngeal Prof.Saeed Makarem

PALATINE TONSIL Structure : It is an oval body of lymphoid tissue. It has an upper and lower poles. Its deep surface is attached to a fibrous capsule. Prof.Saeed Makarem

PALATINE TONSIL RELATIONS : Lateral: Medial : Oropharyngeal isthmus. superior constrictor muscle and fascia. The external palatine vein lies within this fascia. The facial artery is more lateral. Medial : Oropharyngeal isthmus. Prof.Saeed Makarem

PALATINE TONSIL Superior: Soft palate. Here the tonsil is continuous with the lymphoid tissue on its undersurface . Inferior : Posterior third of tongue. It is continuous with the lingual tonsil. Prof.Saeed Makarem

PALATINE TONSIL Arterial Supply : Tonsillar branch of facial artery. Tonsillar branch of ascending palatine. The arteries enter its deep surface. Venous Drainage: The veins pierces the superior constrictor and join the external palatine, the pharyngeal and or the facial veins vein. .

PALATINE TONSIL Lymph Drainage: Jugulodigastric nodes (which lies below and behind the angle of the mandible). Prof .Saeed Makarem

TONSILITIS The tonsils have their maximum size in childhood. They are a common site of infection. This is manifested by sore throat ,pyrexia and tender enlarged jugulodigastric lymph nodes. After tonsillectomy ,the external palatine vein may be the source of postoperative bleeding. Prof.Saeed Makarem

PERITONSILAR ABSCESS QUINSY It is caused by the spread of infection from the palatine tonsil to the loose connective tissue outside the capsule. Prof. Saeed Makarem

LARYNGOPHARYNX It extends from the upper border of the epiglottis to the lower border of the cricoid cartilage (C6). Anterior wall: Inlet of the larynx. Posterior wall: Bodies of 3rd , 4th ,5th and 6th cervical vertebrae. Prof. Saeed Makarem

LARYNGOPHARYNX Lateral wall: Thyroid cartilage. Thyrohyoid membrane. Prof .Saeed Makarem

PIRIFORM FOSSA It is a small depression on either side of the laryngeal inlet. It is separated from the laryngeal inlet by the Aryepiglottic fold. Prof .Saeed Makarem

PIRIFORM FOSSA It is bounded Laterally by the thyroid cartilage and thyrohyoid membrane. Branches of the internal laryngeal and recurrent Laryngeal nerves lie deep to its mucous membrane. Prof. Saeed Makarem

PIRIFORM FOSSA They are liable to be injured when a foreign body ( bony fish) is lodged in the fossa. A foreign body in the fossa causes the patient to gag violently, and needs a physician’s assistance Prof .Saeed Makarem