1. PHARYNX, CRANIO VERTEBRAL JOINTS, AND PREVERTEBRAL REGION DENTAL & OPTOMETRY STUDENTS -George Salter, Ph.D

2. is a 15 cm. long tube connecting inferiorly with the oesophagus
is a 15 cm. long tube connecting inferiorly with the oesophagus. It is 5 cm. wide
superiorly, and it is only 1.5 cm
wide as it merges with
the oesophagus. This point is the
most narrow diameter of the
GI tract.
PHARYNX:
PHARYNX
ESOPHAGUS

3. SUBDIVISIONS OF PHARYNX

4. Nasopharynx
Oropharynx
Laryngopharynx

5. Nasal Cavity
Nasopharynx
Oral Cavity
Oropharynx
Laryngo-
pharynx or
Hypopharynx
Laryngeal Cavity

6. in the form of four layers
WALLS OF PHARYNX-
in the form of four layers
Mucous membrane-including “tonsil”
Pharyngobasilar fascia = Submucosa
Muscle layer
Buccopharyngeal fascia

7. Cross Section, (Oral Pharynx) for example:
Mucosa;
Submucosa or Pharyngobasilar Fascia (including
the palatine tonsil);
(3) Muscular; and
(4)Buccopharyngeal
Fascia

8. PHARYNX IN POSTERIOR VIEW
Submucosa extended superiorly
as the pharyngobasilar fascia
Use scissors in lab

9. ANTERIOR
RELATIONSHIPS
Nasal cavity
Oral cavity
Laryngeal cavity

10. Choanae
Soft Palate &
Uvula
Aditus

11. CHARACTERISTICS OF EACH OF THE THREE PARTS OF THE PHARYNX

12. (1) NASOPHARYNX (MUCOSA INTACT)
Pharyngeal tonsil
Auditory tube orifice
Choana
Pharyngeal recess
Torus tubarius
Salpingopharyngeal fold
Uvula
Pharyngeal
isthmus

13. NASOPHARYNX – with mucosa removed
Torus Tubarius
Tensor (veli) palatini
Levator (veli) palatini
Salpingopharyngeus

14. Torus Tubarius
Naso-
pharynx
Middle
Ear
Pharyngo-
Tympanic
Tube

15. SOFT PALATE --comprised of glands & muscle & separates nasopharynx
from oral pharynx
Uvula

16. (2) OROPHARYNX (MUCOSA INTACT)
Pharyngeal
Isthmus
Palato-
glossal
fold
Palato-
pharyn-geal
fold
Palatine
Tonsil Bed

17. TONSILLAR BED I-with mucosa removed
Palatoglossus
Pharyngobasilar
Fascia -
Palatopharyngeus
Area between the 2 muscles or folds is the throat or fauces.

18. TONSILLAR BED (WITH MUCOSA & SUBMUCOSA REMOVED) Palatoglossus
Superior Constrictor
(forming the bed)
Palatopharyngeus

19. ? TONSILLAR BED- II Tonsillar br. of facial a. External palatine
Superior constrictor
with inferior part re-
moved
Tonsillar br. of facial a.
External palatine
(paratonsillar) v. ?
Glossopharyngeal
n. (IX)
Middle constrictor

20. A notable relationship:
Styloglossus—lying
lateral to superior
constrictor & joining
with hyoglossus

21. Hard palate
Uvula
Soft palate

22. (3)Laryngopharynx (with mucosa intact) Aryepiglottic fold-
forming part of the
aditus
Piriform recess-with mucosal fold
indicating the location of the internal laryngeal n.
Indicates aditus or opening to larynx
Bulge indicating location of cricoid cartilage

23. MUSCLES OF PHARYNX

24. Outer Layer
(circular)-
constrictors-3
Inner Layer
(longitudinal)-3
(1)
(1)
(2)
(2)
(3)
(3)
Now, let’s blow
these longitudinal
muscles up

25. Inner, Longitudinal Mm (3):
(1) Salpingopharyngeus
(2) Palatopharyngeus
(3) Stylopharyngeus –
in reality only its in-
ferior fibers are shown

26. Outer, Circular Ms.-3
(1) Superior Constrictor
(2) Middle Constrictor
(3) Inferior Constrictor

27. Inner
Longitudinal
Muscle Layer
Outer Circular
Muscular Layer
(3)
(3)
Salpingo-
pharyngeus
Superior Constrictor
Palato-
pharyngeus
Middle Constrictor
Stylo-
Pharyngeus
(inferior
fibers)
Inferior Constrictor

28. Three
Constrictor
Muscles:
Insertions:

29. Constrictor Muscles Insertion(s)-all insert posteriorly
Pharyngeal tubercle
Midline Raphe
Origins of constrictors-
next:

30. Origins of the three constrictor muscles (all arise anteriorly):
Superior constrictor
Pterygomandibular raphe
& bone at either end
Middle constrictor
Stylohyoid ligament, body & lesser horn of hyoid bone
Inferior constrictor
Thyroid and cricoid
cartilages
Esophagus

31. GAPS ABOVE, BETWEEN,& BELOW CONSTRICTORS:
Superior constrictor
Middle constrictor
Inferior constrictor
Esophagus

32. Gap superior
to Sup. Const.
Gap between
Sup. & Inf. Const.
Gap between
Middle & Inferior
Constrictor
Gap inferior to
Inferior Constrictor

33. Structures related
to the gaps
Pharyngobasilar
Fascia pierced by
Levator palati m.
& Auditory Tube
Stylopharyngeus, Stylo-
hyoid Ligament & IX N.
Thyrohyoid Membrane
pierced by the ____ ?
Region of Killian’s
Dehiscence
Recurrent Laryngeal N

35. NERVES OF PHARYNX

36. Afferent Fibers From Pharynx:
Red (Crimson)= V2- naso-pharyngeal n.
Blue = IX n.—pharyngeal brs.
Auburn = X n.-internal laryngeal brs.

37. Motor Innervation of Pharynx
And Pharyngeal Plexus
Br. Of IX to
Stylopharyn-
geus (SVE)
Pharyngeal brs.
of X (SVE)
--disruption of
these fibers leads
to dysphagia
Add these sensory
fibers and the to-
tal equals the
pharyngeal plexus
Pharyngeal brs.
of sympathetic
tr. (GVE)

38. BLOOD SUPPLY
& LYMPHATICS

39. Ascending palatine br. of facial artery
S A L F O P S M
Ascending palatine br. of facial artery
A=Ascending
Pharyngeal A.
Pos

41. Retropharyngeal
Lymph Nodes
Drain to
Deep
Cervical
Lymph
Nodes

42. PALATINE
TONSIL

43. Jugulodigastric
or Tonsillar
Node

44. ATLANTO-OCCIPITAL & ATLANTO-AXIAL JTS.

45. Atlanto-occipital Joints (Ellipsoid)
Atlas and Axis
(superior view)
C1-C4 Vertebrae
Dens
Facet for
occipital
condyle C1 C2
Facet for
transverse
ligament C3
1. The joints between the sup. articular facets of the atlas and the occipital condyles are the ATLANTOOCCIPITAL (AO) JOINTS. Together the two joints act as an ELLIPSOID JOINT. They permit flexion and extension of the head, as well as lateral flexion (bending to the side). There are three ATLANTOAXIAL (AA) JOINTS. The TWO LAT. AA JOINTS are between the inf. articular facets of the atlas and the sup. articular facets of the axis. These are GLIDING JOINTS. The MEDIAN AA JOINT is a PIVOT JOINT. It is formed by the articulation between the dens and the ant. arch of the atlas, and between the dens and the transverse lig. of the atlas . When one rotates the head from side to side (eg, shaking the head "no"), the skull + atlas rotate together around a central stationary pivot --- the dens. C4
Atlanto-occipital Joints (Ellipsoid)
Allow flexion/extension of head (nodding “yes”)
Allow lateral flexion of head
Lateral atlanto-axial joints (gliding)
Median atlanto-axial joint (pivot)-
(shaking “No”)

46. MUSCLES PRODUCING MOVEMENT OF THE ATLANTO-OCCIPITAL (AO) JOINTS
1. Bilateral action of the longus capitis, rectus capitis anterior, anterior fibers of SCM, and suprahyoid and infrahyoid mm. produce flexion of the AO joints.

47. MUSCLES PRODUCING MOVEMENT OF THE ATLANTO-OCCIPITAL (AO) JOINTS
1. Bilateral action of the rectus capitis posterior major and minor, superior oblique of head, trapezius (and others) all produce extension of the AO joints.
2. Lateral flexion of the AO joints (not shown) is produced by the unilateral action of the rectus capitis lateralis, superior oblique of head, SCM (and others).

48. Posterior longitudinal ligament
Tectorial membrane
Posterior longitudinal ligament
Alar ligaments
1. The POST. LONGITUDINAL LIG. runs along the post. surfaces of the vertebral bodies within the vertebral canal. Its upward continuation (above the axis) is the TECTORIAL MEMBRANE. Deep to the tectorial membrane are some imp. ligaments related to the median AA joint. The thick TRANSVERSE LIG. OF THE ATLAS holds the dens against the ant. arch of the atlas. The SUP. & INF. LONGITUDINAL FIBERS pass to the ant. margin of the f. magnum and the body of the axis (resp.). The transverse lig. + the sup. and inf. longitudinal fibers form the CRUCIFORM LIG. The strong ALAR LIGS. pass superolaterally from the dens to the med. aspects of the occipital condyles.
Superior longitudinal band
CRUCIATE
LIGAMENT
Transverse ligament of atlas
Inferior longitudinal band

49. HYPEREXTENSION OF THE HEAD ON THE NECK
FRACTURE OF THE AXIS (HANGMAN’S FRACTURE)
1. With the knot placed beneath the chin, hyperextension of the head on the neck occurs when the body drops suddenly through the gallows floor.
2. The resulting fracture of the axis is called a hangman’s fracture.
3. Note that the pars interarticularis (between the superior and inferior articular processes) of the axis is fractured.
Pars inter-
articularis

50. ORIGINALLY, THERE WERE 8 CERVICAL SYMPATHETIC GANGLIA, ONE ASSOCIATED WITH EACH CERVICAL SPINAL NERVE.
BUT, THESE GANGLIA COALESCED INTO 3 (4) GANGLIA.
THEREFORE, THESE REMAINING CERVICAL SYMPATHETIC GANGLIA WERE LEFT TO SEND POSTSYNAPTIC FIBERS (VIA GRC) TO SEVERAL SPINAL NERVES EACH.

51. I. Carotid n
postgang. fibers
The sympathetic trunk is located posterior to the carotid sheath on the prevertebral fascia
Superior Cervical Ganglion
(upper 4 ganglia)
Ext. Carotid N.
internal carotid a
hyoid
Middle cervical ganglion
(ganglia 5 & 6)
Superior cervical ganglion – found at the levels of C2&3 vertebrae
Middle cervical ganglion – found at C6 vertebra
Inferior cervical ganglion – found between the base of the TP of C7 vertebra & neck of the 1st rib
Inferior cervical ganglion
(ganglia 7 & 8)
R. Common Carotid A
1st rib (cut)
R. subclavian a. (cut)
K. Kryger

52. Overview of Sympathetics to Head
Postganglionic axons distributed via Ext. & Int. carotid ns.( carotid plexus)
Target tissue
smooth muscle in vessel walls,
dilator pupillae m, & sweat glands.
superior cervical ganglion
(in neck)
Preganglionic axons ascend
in the sympathetic trunk
Functions:
1) vasoconstriction
2) dilate pupils
3) stimulate sweat glands
Preganglionic fibres enter the sympathetic trunk
Lateral horns of cord levels T1-2
K. Kryger

53. NOW, LET’S CONSIDER SYMPATHETIC FIBERS TO THE CERVICAL VISCERA

54. Sympathetic fibers to the neck viscera, eg
Sympathetic fibers to the neck viscera, eg. the pharynx, would ascend as presynaptic fibers to reach the cervical sympathetic ganglia. Synapse would then occur, and postsynaptic fibers would pass to the viscera via direct branches or via the blood vessels.

55. Cervical Viscera
Origin
T1-L2

56. LAB

57. 1. REMOVE ALL MUSCULATURE FROM OCCIPITAL BONE &
POSTERIOR ARCH OF ATLAS.

58. 2. REMOVE WEDGE OF OCCIPITAL BONE

59. REMOVE POST. ARCH OF ATLAS, TRANSECT & REMOVE
CERVICAL SPINAL CORD & ASSOCIATED MENINGES

60. 4. CUT & REFLECT TECTORIAL MEMBRANE INFERIORLY.
5. CUT ALAR LIGS. & SUP. LONGITUDINAL BAND.
6. DISARTICULATE AO JOINTS (Indicated by the vertebral
artery ) W/ HAMMER & CHISEL.
Tectorial membrane
Tectorial
Membrane
Posterior longitudinal ligament
Alar ligaments
1. The POST. LONGITUDINAL LIG. runs along the post. surfaces of the vertebral bodies within the vertebral canal. Its upward continuation (above the axis) is the TECTORIAL MEMBRANE. Deep to the tectorial membrane are some imp. ligaments related to the median AA joint. The thick TRANSVERSE LIG. OF THE ATLAS holds the dens against the ant. arch of the atlas. The SUP. & INF. LONGITUDINAL FIBERS pass to the ant. margin of the f. magnum and the body of the axis (resp.). The transverse lig. + the sup. and inf. longitudinal fibers form the CRUCIFORM LIG. The strong ALAR LIGS. pass superolaterally from the dens to the med. aspects of the occipital condyles.
Superior longitudinal band
CRUCIATE
LIGAMENT
Transverse ligament of atlas
Inferior longitudinal band

61. 7. WORK YOUR HANDS INTO RETROPHARYNGEAL SPACE,
AND PULL CERVICAL VISCERA AND HEAD FORWARD AWAY FROM
VERTEBRAL COLUMN.

62. ??? 8. Cut prevertebral muscle attachment into the capitus
Rectus capitis
lateralis
???

63. HAPPY TRAILS
TO YOU….

64. Lymph drainage
review
Superficial cervical
Nodes of head & face – in
the shape of
a collar (red line) around head and located in relationship
to E.J.V. in Neck
Superficial
Cervical
Nodes
Deep Cervical Nodes –
located in relation-
ship to the I.J.V.
Division of deep cervical
nodes into superior &
inferior groups by omo-
hyoid tendon

65. AXIS (C2): POSTEROSUPERIOR VIEW
Dens
Facet for dens
Tubercle for
transverse lig.
Sup. facet for
occipital condyle
Axis-Anterior view
Groove for vertebral a.
ATLAS (C1): SUPERIOR VIEW
Post. facet for
transverse lig.
Post. tubercle
Post. arch
Sup. facet for atlas
1. Atlas:
a. Atlas is essentially a ring of bone, consisting of two lateral masses connected by ant. and post. arches.
b. Transverse processes project further laterally than other cervical vertebrae (giving mechanical advantage to muscles that attach to it (eg., inf.
oblique). Transverse foramen for passage of vertebral a.
c. Ant. tubercle is for attachment of ant. longitudinal lig. and upper end of longus colli m.
d. Atlas has no spine, just a post. tubercle on post. arch.
e. Post. arch has groove for vertebral a.
f. Lateral masses have concave, kidney-shaped facets superiorly for reception of the occipital condyles.
g. Each lateral mass also has a tubercle for attachment of the transverse ligament of the atlas which runs from one lateral mass to the other.
h. Anterior arch has a facet on its posterior aspect for articulation w/ the dens.
2. Axis
a. Strongest of cervical vetebrae.
b. Has two large, flat bearing surfaces, superior articular facets, for articulation w/the atlas above.
c. Dens (odontoid process) represents body of atlas and projects superiorly to articulate with the ant. arch of the atlas. Dens also has a facet on
its posterior aspect for the transverse lig. of the atlas.
d. Spinous process of axis is large and bifid.
Interarticular part
Lat. Proc.
Ant. arch
Ant. tubercle
Inf. articular pr.
Spinous pr.
Atlas-Inferior View
AXIS (C2): POSTEROSUPERIOR VIEW