1. Pharynx, Larynx & Lung Anatomy
A whistle-stop tour
By filip & James

2. Pharynx
Middle
Ear
Nasopharynx
Muscular region connecting the nasal and oral cavities with larynx and oesophagus
Oropharynx
Laryngopharynx

3. Pharynx is formed by 3x pharyngeal constrictors
Reduce size of pharynx
Squeeze food down pharynx (peristalsis)
Superior constrictor
Middle constrictor
Inferior constrictor
Paralysis causes lack of gag reflex, uncoordinated swallowing and increased risk of aspiration

4. Pharyngeal Constrictors
Constrictors stack inside each other forming a structurally-sound functional unit
Pharyngeal pouch/diverticulum can fill with food causing halitosis or coughing-up of food SC
Midline Raphe
(Similar to a long tendon) MC IC
‘Weak Spot’
Pharyngeal pouch / diverticulum

5. Pharynx – Internal Muscles
Longitudinal (internal) muscles elevate (shorten) & widen pharynx
Salpingopharyngeus SC
Tensor veli palatini
(CN Vc)
Stylopharyngeus
(CN IX)
Palatopharyngeus MC
Levator veli palatini IC
All pharyngeal muscles Motor innervated by CNX except stylopharyngeaus & tensor veli palatini

6. Pharynx– innervation Motor: CNX (Vagus) Sensory:
Superior laryngeal nerve Damage = Monotonous voice
Recurrent (inferior) laryngeal nerve Damage = hoarse/weakened voice
Sensory:
CN IX

7. Lymphoid Tissue - Tonsils
Palatoglossal & paltopharyngeal arches
Palatine tonsil
Tunstall & Shah 2012 Pocket Tutor: Surface Anatomy

8. Tonsillar (lymphoid) tissue sits in the entrances to the pharynx
Pharyngeal
(Adenoid)
Tubal
Palatine
Lingual
Collectively known as Waldeyer ring of lymphoid tissue

9. Larynx What is the function of the larynx? (4)
Prevents entrance of fluid and particles
Allows regulation of intrathoracic & intra-abdominal pressure (Valsava manoeuvre)
Enables phonation (production of sound)
Speech articulation is controlled by the pharynx, tongue & lips

10. Larynx – Bone & Cartilages
Hyoid bone
Epiglottis
(elastic cartilage)
Thyrohyoid membrane
Laryngeal prominence
Arytenoid cartilage
Thyroid cartilage
Cricoid cartilage
Cricoid cartilage
Cricothyroid membrane
(emergency airway)

11. Arytenoids as viewed from above in transverse section
Larynx – Arytenoids & Vocal Folds
Anterior
Vocal Process
Arytenoid cartilages
Articulate with cricoid cartilage via synovial joint that permit pivoting movements
Joint position
Muscular Process
Posterior
Cricovocal membrane
Thickened free edge = vocal ligament
Arytenoids as viewed from above in transverse section

12. Superior Laryngeal Nerve
(Internal laryngeal n.)
(External laryngeal nerve)
Posterior
Anterior
Cricothyroid
Pivots thyroid cartilage forward and down on the cricoid & tenses the vocal folds

13. Lateral cricoarytenoid muscle Posterior cricoarytenoid muscle
Recurrent Layrngeal Nerve
Posterior cricoarytenoid muscle
Lateral cricoarytenoid muscle
Ant.
Lateral cricoarytenoid muscle
(adducts vocal ligaments)
Ant.
Post.
Posterior cricoarytenoid muscle
(abducts vocal ligaments)
Post.

14. Relaxes vocal fold (or parts of it) and lowers pitch of voice
Recurrent Layrngeal Nerve
Ant.
Thyroarytenoid
& vocalis
Pull arytenoid cartilage anteriorly & thyroid cartilage posteriorly and superiorly
Relaxes vocal fold (or parts of it) and lowers pitch of voice
Post.

15. (gap between vocal folds)
Anterior
Epiglottis
Vestibular folds
(false vocal folds)
Aryepiglotic fold
Rima glottidis
(gap between vocal folds)
Vocal Folds
Posterior

16. What makes up the TBT? Trachea Bronchi Bronchioles
Terminal bronchioles
Alveolar ducts
Alveolar sacs
Alveoli

17. LUNGS What do structures entering the lung pass through?
Hilum
What two layers form the pleura of the lungs?
Visceral
Parietal
What holds the pleura together?
Surface tension

18. Right lung has 3 lobes and the left has 2 lobes
Oblique fissure
Oblique fissure
Superior Lobe
Superior Lobe
Middle Lobe
Lingula
Inferior Lobe
Inferior Lobe
Horizontal fissure
Disease/collapse/atelectasis can affect lobes independently

19. Apex sits ~2cm above medial 1/3 of clavicle
Lung Surface Markings
Apex sits ~2cm above medial 1/3 of clavicle
Tunstall & Shah 2012 Pocket Tutor: Surface Anatomy
2cc
Note the tracheal bifurcation at sternal plane or just below T4/T5
Horizontal fissure:
4thcc horizontally back to oblique fissure
6cc
Oblique Fissure:
T3 Spinous Process to 6th cc anteriorly
6rib MCL
8 rib MAL
Costodiaphragmatic recess
The region between the lung and pleura reflection
Lung is soft and compliant so will fill many empty spaces in the thorax

20. Penetrating damage to lung tissue can cause pneumothorax
Lung Surface Markings
Tunstall & Shah 2012 Pocket Tutor: Surface Anatomy
Upper lobe
Oblique Fissure:
T3 Spinous Process to 6th cc anteriorly
Auscultate lower lobe of lung posteriorly
Lower lobe
10 rib PVL - lung
12 rib PVL - pleura
Penetrating damage to lung tissue can cause pneumothorax

21. Auscultate middle lobe of lung laterally Lower lobe
Lung Surface Markings
Tunstall & Shah 2012 Pocket Tutor: Surface Anatomy
Mid-axillary line
Upper lobe
Horizontal fissure:
4thcc horizontally back to oblique fissure
Middle lobe
Auscultate middle lobe of lung laterally
Oblique Fissure:
T3 Spinous Process to 6th cc anteriorly
Lower lobe

22. Right lymphatic duct /subclavian vein
Lymphatic drainage
Lymphatic drainage from the lungs follows the tracheobronchial tree
Right lymphatic duct /subclavian vein
All lymph except left upper lobe
Thoracic duct/left subclavian vein
Left upper lobe
Bronchomediastinal duct
Paratracheal nodes
Hilar/bronchopulmonary nodes
Tracheobronchial nodes