PHARYNX

Prof .Saeed MakaremProf .Saeed Makarem

DEFINATIONDEFINATION

It is a muscular tube It is a muscular tube that that extendsextends from from the base of the skull the base of the skull to the to the 66thth cervical cervical vertebravertebra..It is It is continuous continuous belowbelow with the with the esophagusesophagus..It is It is funnelfunnel shaped with shaped with an upper expanded an upper expanded end and a narrowend and a narrow lower endlower end Prof. Saeed MakaremProf. Saeed Makarem

SUBDIVISIONSSUBDIVISIONS It lies behind the nose, It lies behind the nose, mouth and larynxmouth and larynx..It communicates withIt communicates with each of themeach of them..

It is divided into 3 partsIt is divided into 3 parts::

NasoNasopharynxpharynx..OroOropharynxpharynx..LaryngoLaryngopharynxpharynx..

So, So, Its anterior wall is deficient Its anterior wall is deficient where it is related to nose, where it is related to nose, mouth & larynxmouth & larynx..

Prof. Saeed MakaremProf. Saeed Makarem

RELATIONSRELATIONS PosteriorlyPosteriorly::It lies infront of the It lies infront of the prevertebral muscles and prevertebral muscles and fasciafascia..LaterallyLaterally : :

It is related from above It is related from above downward todownward to::

11--Auditory tubeAuditory tube..22--Styloid process and its Styloid process and its

musclesmuscles..33--Carotid sheath and its Carotid sheath and its

contentscontents..44--Thyroid glandThyroid gland


STRUCTURE OF STRUCTURE OF THE WALLTHE WALL

From inwards outwardsFrom inwards outwards11--Mucous membraneMucous membrane::

It is continuous with that of theIt is continuous with that of the Nose,

Oral cavity , Auditory tube ,

Larynx ,esophagus.22 - -Pharyngobasilar fasciaPharyngobasilar fascia..

33 - -MusclesMuscles..44 - -Buccopharyngeal fasciaBuccopharyngeal fascia

The 2 layers of FasciaThe 2 layers of Fascia::It is thickened internally to It is thickened internally to form the form the PharyngobasilarPharyngobasilar fascia and externally to fascia and externally to form form BuccopharyngealBuccopharyngeal

MUSCLES OF PHARYNXMUSCLES OF PHARYNX

Prof.Saeed MakaremProf.Saeed Makarem

NAMEORIGININSERTIONACTIONNERVE

Superior constrictorMedial pterygoid plate, pterygoid hamulus, pterygoamndibular raphe, mylohyoid line

Pharyngeal tubercle, pharyngeal raphe

Constricts the pharynx

Vagus nerve through the pharyngeal plexus

Middle constrictorGreater & lesser horns of hyoid bone & Stylohyoid ligament

pharyngeal rapheConstricts the pharynx


Inferior constrictorArch of cricoid cartilage & oblique line of thyroid cartilage

pharyngeal rapheConstricts the pharynx


LongitudinalSalpingeopharyngeusCartilage of auditory tubeLateral wall of

pharynxElevate the pharynx in swallowing


PalatopharyngeusPosterior border of the hard palate & palatine aponeurosis

Thyroid cartilage, lateral wall of pharynx

Elevate the pharynx in swallowing


StylopharyngeusStyloid processThyroid cartilageElevate the pharynx in swallowing

Glossopharyngeal nerve

MUSCLESMUSCLES

ConstrictorsConstrictors::11 - -SuperiorSuperior..

22 - -MiddleMiddle33 - -InferiorInferior..


The three The three constrictors constrictors muscles overlap muscles overlap each others like each others like segment of an segment of an antennaantenna..Each one fans out Each one fans out from its anterior from its anterior attachment and attachment and passes passes posteriorly posteriorly around the around the pharynx pharynx horizontallyhorizontally..


CONSTRICTORSCONSTRICTORSEach muscle joins its Each muscle joins its fellow of the opposite fellow of the opposite side in a fibrous midlineside in a fibrous midline PharyngealPharyngeal rapheraphe..The raphe extends from The raphe extends from the pharyngeal the pharyngeal tubercle of the occipital tubercle of the occipital bone to the esophagusbone to the esophagus..The The constrictorsconstrictors propel propel the bolus of food down the bolus of food down into the esophagusinto the esophagus..


CONSTRICTORSCONSTRICTORSThe lowest fibers of the The lowest fibers of the inferior constrictor inferior constrictor forms the forms the Cricopharyngeus Cricopharyngeus musclemuscle..It has a sphincteric action It has a sphincteric action on the lower end of on the lower end of the pharynx and the pharynx and prevents the entry of prevents the entry of the air into the the air into the esophagus in between esophagus in between swallowingswallowing . .


LONGITUDINAL LONGITUDINAL MUSCLESMUSCLES

11--StyloStylopharyngeuspharyngeus..22--SalpingeopharyngeusSalpingeopharyngeus..

33--PalatoPalatopharyngeuspharyngeus..They are attached to the They are attached to the styloid processstyloid process. . Auditory tubeAuditory tube . .Soft palateSoft palate..They elevate the larynx and They elevate the larynx and pharynx and pulls the pharynx and pulls the palatopharyngeal arch palatopharyngeal arch medially during medially during swallowingswallowing


MOTOR MOTOR INNERVATIONINNERVATION

AllAll muscles of the muscles of the pharyngeal are pharyngeal are supplied by the supplied by the pharyngeal pharyngeal plexusplexus

ExceptExcept the the StylopharyngeusStylopharyngeus which is supplied by which is supplied by the the glossopharyngealglossopharyngeal nervenerve..


SENSORY INNERVATIONSENSORY INNERVATION

Nasopharynx: 55--Maxillary nerveMaxillary nerve..

OropharynxOropharynx::

99--GlossopharyngealGlossopharyngeal

LaryngopharynxLaryngopharynx:: 1010--Vagus nerveVagus nerve


NASOPHARYNXNASOPHARYNX It has a respiratory It has a respiratory functionfunction . .

It extends from skull It extends from skull base to the soft base to the soft palatepalate..BoundariesBoundaries::RoofRoof : :

Basilar part of occipital Basilar part of occipital bonebone . .Body of sphenoidBody of sphenoid..A collection of lymphoid A collection of lymphoid tissue lies in the tissue lies in the submucosa at the submucosa at the junction of roof & junction of roof & posterior wallposterior wall..

it is calledit is calledpharyngeal tonsilpharyngeal tonsil


NASOPHARYNXNASOPHARYNXFloorFloor: :

Sloping upper surfaceSloping upper surface of of the soft palatethe soft palate..Posterior wallPosterior wall::Anterior arch of atlasAnterior arch of atlas..

Pharyngeal isthmusPharyngeal isthmus ::It is a gap in the floor It is a gap in the floor between the free end of between the free end of the soft palate and the the soft palate and the posterior wall of the posterior wall of the pharynxpharynx..


NNASOPHARYNXASOPHARYNX

LATERAL WALLLATERAL WALL:: it hasit has::

11 . .Pharyngeal opening Pharyngeal opening of of the auditory tubethe auditory tube..

22..Tubal elevationTubal elevation : :The elevated posterior The elevated posterior margin of the tubemargin of the tube..

33--Pharyngeal recessPharyngeal recess::It is a slit like depression It is a slit like depression behind the tubal behind the tubal elevationelevation..


NASOPHARYNXNASOPHARYNX

44..Salpingo-Salpingo-pharyngealpharyngeal fold of fold of mucous membrane mucous membrane produced by the produced by the salpingopharyngeal salpingopharyngeal musclemuscle..

55..Tubal tonsilTubal tonsilIt is a collection of It is a collection of lymphoid tissue lymphoid tissue behind the opening of behind the opening of the auditory tubethe auditory tube..


ADENOIDADENOID Repeated infection of the Repeated infection of the pharyngeal tonsils leads pharyngeal tonsils leads to its hypertrophyto its hypertrophy

Now it is calledNow it is called adenoidsadenoids..

It causes obstruction of the It causes obstruction of the posterior naresposterior nares . .

The patient breathes The patient breathes through his mouth and through his mouth and snoressnores..

It can cause deafness and It can cause deafness and recurrent otitis media recurrent otitis media due to its close relation due to its close relation to the auditory tubeto the auditory tube . .

Prof . Saeed MakaremProf . Saeed Makarem

OROPHARYNXOROPHARYNX

It has a digestive functionIt has a digestive function..It lies behind the mouth It lies behind the mouth cavity and extends from cavity and extends from the soft palate to the the soft palate to the upper border of the upper border of the epiglottisepiglottis..

RoofRoof : : It is the under surface of It is the under surface of the soft palate and the the soft palate and the

pharyngeal isthmuspharyngeal isthmus..


OROPHARYNXOROPHARYNX

FloorFloor: : It is the posterior one third It is the posterior one third of the tongue and the of the tongue and the interval between the interval between the tongue and the anterior tongue and the anterior surface of the epiglottissurface of the epiglottis..

Lingual tonsilLingual tonsil ::A collection of lymphoid A collection of lymphoid tissue on the posterior tissue on the posterior third of the third of the tonguetongue..


OROPHARYNXOROPHARYNX The tongue is connected The tongue is connected to the epiglottis by one to the epiglottis by one medianmedian and two and two lateral lateral glossoepiglotticglossoepiglottic foldsfolds..VALLECULAVALLECULA: :

It is a depression on each It is a depression on each side of the of the side of the of the median glossoepiglottic median glossoepiglottic

foldfold..


OROPHARYNXOROPHARYNX Anterior wallAnterior wall: : It opens into the mouth It opens into the mouth cavity through the cavity through the oropharyngeal isthmusoropharyngeal isthmus..

Posterior wallPosterior wall: : Body of 2Body of 2ndnd cervical cervical vertebra and the upper vertebra and the upper part of the body of the part of the body of the 33rdrd vertebra vertebra..


OROPHARYNXOROPHARYNX Lateral wallLateral wall: : Palatoglossal archPalatoglossal archIt is a mucous fold It is a mucous fold overlying the overlying the palatoglossal musclepalatoglossal muscle..PalatopharyngealPalatopharyngeal archarchIt is a mucous fold behind It is a mucous fold behind thethe palatoglossal archpalatoglossal arch..

The interval between the The interval between the two palatopharyngeal two palatopharyngeal arches is thearches is the

Oropharyngeal Oropharyngeal isthmusisthmusProf .Saeed MakaremProf .Saeed Makarem

PALATINE TONSILPALATINE TONSILIt occupies theIt occupies the ((Tonsillar Tonsillar BedBed))..

Which is the Which is the interval interval between the between the

palatoglossalpalatoglossal & & palatopharyngealpalatopharyngeal


PALATINE TONSILPALATINE TONSILStructureStructure: :

It is an oval body of It is an oval body of lymphoid tissuelymphoid tissue . .

It has an upper and It has an upper and lower poleslower poles..Its deep surface is Its deep surface is attached to a fibrous attached to a fibrous capsulecapsule . .


PALATINE TONSILPALATINE TONSILRELATIONSRELATIONS ::LateralLateral : :

superior constrictor muscle and superior constrictor muscle and fasciafascia . .

The external palatine vein The external palatine vein lies lies within this fasciawithin this fascia..The The facial artery facial artery is more lateralis more lateral..

MedialMedial : : Oropharyngeal isthmusOropharyngeal isthmus..


PALATINE TONSILPALATINE TONSILSuperiorSuperior:: Soft palateSoft palate . .

Here the tonsil is Here the tonsil is continuous with the continuous with the lymphoid tissue on lymphoid tissue on

its undersurfaceits undersurface. . InferiorInferior ::

Posterior third of Posterior third of tonguetongue..It is continuous with It is continuous with the lingual tonsilthe lingual tonsil..


PALATINE TONSILPALATINE TONSIL Arterial SupplyArterial Supply: :

Tonsillar branch of Tonsillar branch of facial arteryfacial artery..Tonsillar branch of Tonsillar branch of ascending ascending palatinepalatine..

The arteries enter its deep The arteries enter its deep surfacesurface..Venous DrainageVenous Drainage::

The veins pierces the superior The veins pierces the superior constrictor and join the constrictor and join the external palatine, the external palatine, the pharyngeal and or the facial pharyngeal and or the facial veins veinveins vein . .

..

PALATINE PALATINE TONSILTONSIL

Lymph DrainageLymph Drainage : :JugulodigastricJugulodigastric nodesnodes

((which lies below and which lies below and behind the angle of behind the angle of the mandiblethe mandible.).)


TONSILITISTONSILITIS The tonsils have their The tonsils have their maximum size in maximum size in childhoodchildhood..They are a common site They are a common site of infectionof infection..This is manifested by sore This is manifested by sore throat ,pyrexia and throat ,pyrexia and tender enlarged tender enlarged jugulodigastricjugulodigastric lymph lymph nodesnodes..

After tonsillectomy ,the After tonsillectomy ,the external palatine vein external palatine vein may be the source of may be the source of postoperative bleedingpostoperative bleeding..


PERITONSILAR ABSCESSPERITONSILAR ABSCESS QUINSYQUINSYIt is causedIt is caused by the by the spread of infection spread of infection from the palatine from the palatine tonsil to the loose tonsil to the loose connective tissue connective tissue outside the capsuleoutside the capsule..


LARYNGOPHARYNXLARYNGOPHARYNXIt extends from the It extends from the upper border of the upper border of the epiglottis to the epiglottis to the lower border of the lower border of the cricoid cartilage (C6)cricoid cartilage (C6)..Anterior wallAnterior wall::Inlet of the larynxInlet of the larynx..Posterior wallPosterior wall::

Bodies of 3Bodies of 3rdrd , 4 , 4thth ,5 ,5thth and 6and 6thth cervical cervical vertebraevertebrae..


LARYNGOPHARYNXLARYNGOPHARYNX

Lateral wallLateral wall::Thyroid cartilage. Thyroid cartilage. Thyrohyoid Thyrohyoid membranemembrane..


PIRIFORM FOSSAPIRIFORM FOSSAIt is a small It is a small depression on depression on either side of the either side of the laryngeal inletlaryngeal inlet..It is separated It is separated from the from the laryngeal inlet laryngeal inlet by the by the AryepiglotticAryepiglottic foldfold..


PIRIFORM FOSSAPIRIFORM FOSSAIt is bounded It is bounded LaterallyLaterally by the thyroid cartilage by the thyroid cartilage and thyrohyoid and thyrohyoid membranemembrane..

Branches of the Branches of the internal internal laryngeal and laryngeal and recurrentrecurrent Laryngeal Laryngeal nerves lie deep to its nerves lie deep to its mucous membranemucous membrane . .


PIRIFORM PIRIFORM FOSSAFOSSA

They are liable to be They are liable to be injured when a foreign injured when a foreign body ( bony fish) is body ( bony fish) is lodged in the fossalodged in the fossa..A foreign body in the A foreign body in the fossa causes the fossa causes the patient to gag violently, patient to gag violently, and needs a physician’s and needs a physician’s assistanceassistance


PHARYNX

Documents

saeed makaremprof

saeed makaremdefinationit

saeed makaremsubdivisionsit

saeed makarem structure

pharynxvagus nerve

swallowingvagus nerve

constrictors muscles

pharyngobasilar fascia