Anatomy of the Pharynx PDF

SAINT LOUIS UNIVERSITY P.16 ANATOMY OF THE PHARYNX Dr. Baga | September 09.2023...

SAINT LOUIS UNIVERSITY P.16 ANATOMY OF THE PHARYNX Dr. Baga | September 09.2023 SOM 2027 A. DIVISIONS OF THE PHARYNX OUTLINE - The pharynx is divided into nasopharynx, oropharynx, I. Anatomy of the Pharynx...................................................... 1 and hypopharynx. A. Divisions of the Pharynx.............................................. 1 - Widest area: level of hyoid bone - Narrowest area: lowest border of the hypopharynx, B. Pharyngeal Anatomy……………………………………4 which is continuous with the esophagus II. Checkpoint.......................................................................... 8 (cricopharyngeal junction) III. Clinical Correlations............................................................ 8 I. ANATOMY OF THE PHARYNX - It is a muscular tube lying behind the nose. The oral cavity and the larynx extend from the base of the skull to the level of the six cervical vertebrae, where it is continuous with the esophagus. - The deficient anterior wall of the nasopharynx opens to the nasal cavity. - The deficient anterior border of the hypopharynx which leads into the laryngeal inlet. Figure 3: Divisions of the Pharynx A. Nasopharynx - Superiorly: bordered by the skull base and the floor of the sphenoid sinus. - Inferiorly: bordered by a horizontal line from the tip of your uvula.vilue/soft palate fract From - Posteriorly: coincides to the curve of the first Figure 1. Anatomy of the Pharynx - cont of Digestive · , - Funnel-suspec prangx vertebra, the prevertebral muscles and fascia. - Fibromuscular - Laterally: bordered by the torus (means thumb) tubarius which is a cushion of the auditory canal - Tube 15 cm long - Approx - or the pharyngeal end of the cartilaginous. - Common route For - - portion of the- eustachian tube. air a food - Behind this torus tubarius is the pharyngeal recess, -DC - skull based also known as the fossa of Rosen-muller. I - - opening - The anterior border of the nasopharynx is -Ant diffecienti. deficient as mentioned and it coincides with your nasal cavity choanae, which is the posterior opening of the = nasal cavity. - - The pharyngeal recess is a depression in the pharyngeal wall behind the tubal elevation. Antho OpeningNustibnostril a Anton us landwerk site for & : common reso phongeal careiot ma Figure 2. Deficient Anterior Wall choanal atrasia opening is close - BETE, ESNARA, URBANOZO, MARCIAL ↳ tanimik-ble Page 1 of 9 Dimakahinga Fran-o pink not passed L for NET ; bore/membrane grows - pass atrasion choanae  SAINT LOUIS UNIVERSITY P.16 ANATOMY OF THE PHARYNX Dr. Baga | September 09.2023 SOM 2027 Figure 4: Anatomy of the Nasopharynx B. Oropharynx - - Superiorly: bounded by the interior border of the nasopharynx, it’s a horizontal line from the velum. ~ - - Inferiorly: upper margin of epiglottis Posteriorly: 2nd and 3rd cervical vertebra - Laterally: where you’ll find the Tonsillar maxillary pillars and palatine tonsils - - Anteriorly: opens to your oropharynx, or it may be bordered by the posterior border of the tongue or the base of the tongue and your Figure 6: Medial Sagittal View of the Pharynx lingual tonsils. lingual fontils Oral caxi by Figure 7: Palatine Tonsil Figure 5: Anatomy of the Oropharynx The following statements are true of the tonsils except? C. Palatine Tonsils A. The palatine tonsil is the biggest tonsil in the waldeyers - Masses of lymphoid tissue located in the ring palatine fossa in the lateral wall of your B. The palatine tonsils will reach its maximum size at puberty oropharynx. then will start to diminish in size - The lateral surface is covered by a fibrous C. Tonsillar stones can may develop in its medial surface capsule. - D. Palatine tonsils are encapsulated - E. All are true important T F biggest :.. - to orophages Rationale: border : projects A. The lymphatic tissues located in the oropharynx are Medial mucous membrane us composed of a circumferential tonsillar ring, known as by aupts covered resion & tonsillar the Waldeyer's ring which consists of the palatine dep tonsils (faucial tonsils), adenoid (nasopharyngeal multiple tonsil), lingual tonsil, and tubal tonsils (tonsil of the eustachian tube). B. As part of the immune system, tonsils are like lymph nodes. They help filter out germs that enter through the nose or mouth to protect the body from infection. So once a person’s immunity is established, the Tonsililtiatis- palatine tonsils will be of no use and it will start to diminish in size. However, in people who have sleep BETE, ESNARA, URBANOZO, MARCIAL Page 2 of 9  SAINT LOUIS UNIVERSITY P.16 ANATOMY OF THE PHARYNX ~ Dr. Baga | September 09.2023 SOM 2027 apnea, they have repeated tonsil infections that’s - Posteriorly: bounded by the prevertebral why their tonsils are removed. muscles and fascia and coincides with the 3rd C. Although the presence of tonsillar stone is not an to 6th cervical vertebrae absolute indication of tonsillectomy. - Laterally: bordered by the thyroid cartilage D. The lateral surface is covered by a fibrous capsule and the thyrohyoid membrane (between - these, is a space called piriform fossa) o PALATINE TONSILS: RELATIONS § Anteriorly: bordered by a palate-glossal fold in which it is a palatoglossus muscle covered by a mucus membrane. § Posteriorly: covered by a palatopharyngeal fold which is the palatopharyngeus muscle, covered by a mucus membrane. § Superiorly: it is related to your soft palate. § Inferiorly: the posterior third of the tongue and medially into the cavity of the oropharynx. § Laterally: the capsule separates it from the structures forming the tonsillar bed, which is composed of loose areolar connective tissue, the O external palatine vein, tonsilar branch of the facial artery - accompanied by the branches of glossa pharyngeal nerve, the superior constrictor muscle of the pharynx, and the stylo-glossus muscle. § More laterally: to this tonsillar bed, will be your Figure 9: Anatomy of the Hypopharynx facial artery and your internal carotid artery. § Main blood supply: facial artery piriform Fossan § Lingual artery, maxillary artery and ascending - Small depression situated on either side of pharyngeal artery may also contribute to the laryngeal inlet and leads obliquely backward blood supply and downward from the region on the back of § Venous drainage: superior constrictor muscle the tongue to the - esophagus. This is a common joins the external palatine, and the pharyngeal site of lodging of foreign bodies. - plexus of the vein lymphatics join the upper deep - Medially: bounded by aryepiglottic fold cervical lymph nodes or the jugulodigastric chain - Laterally: lamina of the thyroid cartilage and of nodes. thyrohyoid membrane ↓ - F size D.. Branches of internal and recurrent laryngeal - nerve lie deep in the mucus membrane of piriform fossa and are vulnerable to injury during removal of foreign bodies. ↳ latement of bores of isda 13 "TINIK ~ Figure 8: Blood Supply of Palatine Tonsils ~ LasirN I OFT C.. Figure 10: Piriform Fossa D. Hypopharynx ~ - Most interior part; lies behind the- laryngeal inlet and-posterior surface of the larynx. - Superiorly: bound by the interior border of the E - oropharynx which is also I the horizontal line of epiglottis - : upper borae tip of epiglotts BETE, ESNARA, URBANOZO, MARCIAL in fair : ailoid cartilage Page 3 of 9  SAINT LOUIS UNIVERSITY P.16 ANATOMY OF THE PHARYNX Dr. Baga | September 09.2023 SOM 2027 § Pharyngeal Wall - Figure 11: Pharyngeal Wall pranggal wall - - It is a musculo-membranous wall, composed of: - Mucosa & submucosa - Pharyngobasilar fascia Muscles: circular & longitudinal ~ Buccopharyngeal fascia Figure 13: Mid-sagittal section of Head and Neck - The buccopharyngeal fascia is separated from the prevertebral fascia by the retropharyngeal B. PHARYNGEAL ANATOMY - space. o Three overlapping constrictors (superior, middle, and inferior ~ constrictors) - § Retropharyngeal Space - Movement of pharynx during swallowing – - Extend around the pharynx and are inserted posteriorly into a fibrous raphe that extends from the pharyngeal - Is a space which is a potential space lining the tubercle in the occipital bone to the esophagus, -- pharynx and the prevertebral fascia In between buccopharyngeal fascia and ~ common insertion of three constrictors muscles – The gap between the superior border of the superior prevertebral fascia contains loose areolar constrictor and the occipital bone is filled with thickened connective tissue = - pharyngobasilar fascia. -- ~ - - Laterally: closed by the- O Superiorly: it is closed by the skull base carotid sheath o Constrictor Muscles - Inferiorly: it opens the superior mediastinum - 1. Superior Constrictor - - **Infections coming from tonsils can move to 2. Middle Constrictor the retropharyngeal space and then move to 3. Inferior Constrictor the mediastinum. Even a every simple tonsilitis can be detrimental once it reaches that stage. Functions: the constrictor muscles propel the bolus of food into the esophagus - - C movement Retropharynged space-swallowing movement O Figure 12: Cross sectional diagram showing the relationship of the buccopharyngeal fascia (green), prevertebral fascia (orange), and retropharyngeal space 2 0, 5 , day swallory BETE, ESNARA, URBANOZO, MARCIAL Page 4 of 9  SAINT LOUIS UNIVERSITY P.16 ANATOMY OF THE PHARYNX Dr. Baga | September 09.2023 SOM 2027 § Middle Constrictor -- Origin: lower part of stylohyoid ligament, greater & lesser cornu of hyoid bone - ~ - = Insertion: pharyngeal raphe Figure 16: Middle Constrictor Muscles -partiary § Inferior Constrictor § Figure 14: Constrictor Muscles Superior Constrictor a- - - Origin: lamina of thyroid cartilage, cricoid cartilage Insertion: pharyngeal raphe - Origin: medial pterygoid plate (originate from - - - Functions: the constrictor muscles propel the bolus of food down into the esophagus sphenoid cone), pterygoid hamulus, pterygomandibular ligament, mylohyoid line thickened P - crico pharyngely - Of - Insertion: pharyngeal tubercle, pharyngeal o ~ Longitudinal Muscles 1. Stylopharyngeus lover part constrictiv ~ raphe 2. Salpingopharyngeus intero- ↳ sphincte air 3. Palatopharyngeus presents to § Function: Elevate the larynx & pharynx during swallowing entry esophagus - - - narrowest G & part ok Figure 17: Longitudinal Muscles Gl part § Stylopharyngeus -- Origin: styloid process old - - Insertion: posterior border of thyroid cartilage a year 5pesos ; passed § Salpingopharyngeus Figure 15: Superior Constrictor Muscles citibe" if not in X-ray ~ - - Origin: auditory tube Insertion: blends with palatoglossus BETE, ESNARA, URBANOZO, MARCIAL Page 5 of 9  SAINT LOUIS UNIVERSITY P.16 ANATOMY OF THE PHARYNX Dr. Baga | September 09.2023 SOM 2027 ~ § Palatopharyngeus - Origin: palatine aponeurosis - Insertion: posterior border of thyroid cartilage o Pharyngeal Anatomy: Innervation § Sensory Nerve Supply: - ▪ Nasopharynx: Maxillary nerve - ▪ Oropharynx: Glossopharyngeal nerve - ▪ Laryngopharynx: Internal laryngeal branch of the vagus nerve § Motor Nerve Supply: - ▪ All the muscles of pharynx, except the stylopharyngeus, supplied by the CN X (motor component of pharyngeal plexus) - ▪ The stylopharyngeus is supplied by the glossopharyngeal nerve - o Pharyngeal Anatomy: Blood Supply Figure19: Lymphatic Drainage § Waldeyers Ring - It is a lymphoid tissue ring located in the pharynx that function as a barrier to infection, especially in the few years of life - Composition: Adenoids found in the nasopharynx Tubal tonsils (Tonsils of Gerlach) of found in the nasopharynx Figure 18: Blood supply of the Pharynx Palatine tonsils Lingual Tonsils Which among the following is not a direct branch of the external carotid artery? A. Ascending Pharyngeal ~ B. Ascending Palatine C. Facial D. Lingual E. Maxillary § ~Lymphatic Drainage - Venous drainage into the pharyngeal venous plexus which drains into the internal jugular vein - Lymphatic drainage the nasopharynx drains Figure 20: Waldayer’s Ring into the retropharyngeal nodes and into pharyngeal or deep jugular chain - Oropharynx drain in the retropharyngeal nodes arain into retromandibula I Nosopharynx and the superior deep cervical and jugular nodes Orophary ny reme Muscles of : torque : Hypoglossal Hypopharynx Innensation BETE, ESNARA, URBANOZO, MARCIAL Page 6 of 9  SAINT LOUIS UNIVERSITY P.16 ANATOMY OF THE PHARYNX Dr. Baga | September 09.2023 SOM 2027 Clinical Correlations - Can cause obstruction. Usually the voice is already nasal. - Coin in vertical position: foreign body is at the esophagus - Coin in vertical position: foreign body is at the airway (trachea) o Three longitudinal muscles: Function: Elevate the larynx and pharynx during swallowing Stylopharyngeus Origin: styloid process Insertion: posterior border of thyroid cartilage Salpingopharyngeus Origin: auditory tube Insertion: blends with palatoglossus Palatopharyngeus Origin: palatine aponeurosis Insertion: posterior border of thyroid cartilage - Exudative stage- if left untreated, can develop peritonsillar abscess. o Treatment: Drain (incise the middle of the uvula) Figure 1. Constrictor Muscles Ø INNERVATION OF THE PHARYNX o Sensory Nerve Supply Nasopharynx: Maxillary nerve Oropharynx: Glossopharyngeal nerve Laryngopharynx: Internal laryngeal branch of the vagus nerve o Motor Nerve Supply all the muscles of the pharynx, except stylopharyngeus, supplied by the pharyngeal plexus the stylopharyngeus is supplied by the - If still left untreated, can lead to retropharyngeal glossopharyngeal nerve abscess. BETE, ESNARA, URBANOZO, MARCIAL Page 7 of 9  SAINT LOUIS UNIVERSITY P.16 ANATOMY OF THE PHARYNX Dr. Baga | September 09.2023 SOM 2027 Ø BLOOD SUPPLY OF THE PHARYNX o Is mainly done by branches of the external carotid artery Lingual artery Facial artery Ascending pharyngeal artery Figure 3. Tonsils of mouth breathers Figure 2. Blood Supply of the Pharynx Which among the following is not a direct branch of the external carotid artery? A. Ascending Pharyngeal B. Ascending Palatine Figure 4. Peritonsillar abscess C. Facial D. Maxillary Ø Lymphatic Drainage Venous drainage into the pharyngeal venous plexus which drains into the internal jugular vein Lymphatic drainage the nasopharynx drains into the retropharyngeal nodes and into pharyngeal or deep jugular chain Oropharynx drain in the retropharyngeal nodes and the superior deep cervical and jugular nodes Waldeyer’s Ring- it is a lymphoid tissue ring located in the pharynx that function as a barrier to infection, especially in the few years Figure 5. Coins on Chest Xray. Trachea vs Esophagus of life o Composition: Coins in the sagittal plane on X-ray are more likely to be Adenoids found in the nasopharynx in the trachea than in the esophagus. Tubal tonsils (Tonsils of Gerlach) of found in the nasopharynx II. CHECKPOINT! Palatine tonsils Lingual Tonsils II. CHECKPOINT! space Clinical Correlations Retropharyngeal 1. Is a space which is a potential space lining the pharynx and the prevertebral fascia The tonsils in the nasopharynx or the adenoids can Tonsils/ 2. It is a lymphoid tissue ring located in the pharynx that become so enlarged that it can block the passage of unages ug function as a barrier to infection, especially in the few air this may present to patients as mouth breathers years of life (voice is nasally). Exudative tonsillopharyngitis if left untreated or in Middle 3. Which constrictors originates from the lower part of constrictio stylohyoid, greater and lesser cornu of hyoid bone? patients with comorbidities, can lead to peritonsillar abscess 4. It is the posterior border of the pharynx Treatment of this condition is drainage of pus from the 5. Which longitudinal muscles inserts at the posterior peritonsillar space stylo pragagey border of thyroid cartilage? If this condition is still not treated, infections will go to the retropharyngeal space ↳ parato play get BETE, ESNARA, URBANOZO, MARCIAL Page 8 of 9  SAINT LOUIS UNIVERSITY P.16 ANATOMY OF THE PHARYNX Dr. Baga | September 09.2023 SOM 2027 Palatopharyngeus 5. Pharyngeal Wall 4. Middle constrictor 3. Waldeyers Ring 2. Retropharyngeal space 1. III. REFERENCES Netter, F. H. (2022). Netter Atlas Of Human Anatomy: Classic regional approach (hardcover). Elsevier - Health Science. III. REFERENCES BETE, ESNARA, URBANOZO, MARCIAL Page 9 of 9