anatomy of pharynx with some clinical information

1. Anatomy of pharynx
BY
D.Almawsiley alsayed alnoure

2. objective
 By the end of this lecture the student will be able to
1. Identify anatomical location of pharynx
2. Define the different part of the pharynx
3. Describe the characteristic feature of each parts
4. Identify the arterial supply ,nerve supply and
lymphatic drainage

3. contents
 Muscles fascia
 Nasopharynx ,
 Oropharynx,
 Laryngopharynx
 Blood supply, innervation
 Walderyer’s rings
 clinical

4. H .B .DAY DR. RANDA

5. The pharynx is a musculofascial
tube,incomplete anteriorly,
 which extends from the base of the skull
to the oesophagus 12cm
acts as a common entrance to the
respiratory and alimentary tracts.
pharynx

6.  it is made up of three portions :
the nasopharynx — lying behind the nasal
fossae and above the soft palate
the oropharynx —lying behind the anterior
pillars of the fauces
the laryngopharynx —lying behind the
larynx.
Parts of the pharynx

8. NP
OP
LP
NP= Nasopharynx: from
post. border of
nasal septum to tip of Uvula.
OP= Oropharynx: from tip
of Uvula to tip
of Epiglottis.
LP= Laryngopharynx:
from tip of Epiglottis
bifurcation of
larynx/esophagus.

9. constrictor muscles
 They are three make up the outer layer of the wall
 The superior,
 middle and
 inferior pharyngeal constrictor muscles
 form a muscular sleeve that has a strong internal lining on
its fascial aspect known as the pharyngobasilar fascia.
 These muscles contract involuntarily on peristalsis and
push the food bolus down from the oral cavity and into
the esophagus which occurs during and immediately after
swallowing

11. Elevator
 The three paired muscles of the inner pharynx act as a
group in order to elevate the larynx, shorten the
pharynx and act during swallowing and speaking.
These muscles are known as
 stylopharyngeus
 palatopharyngeus
 salpingopharyngeus.

12. superior pharyngeal constrictor
 muscle originates from the pterygoid hamulus, the
pterygomandibular raphe, the retromolar trigone of
the mandible and the side of the tongue. It inserts into
the pharyngeal tubercle and the pharyngeal raphe. Its
function is to constrict the upper portion of the
pharynx.

14. middle pharyngeal constrictor
 muscle proximally attaches to the stylohyoid ligament
and the greater and lesser cornu of the hyoid bone. It
distally attaches to the pharyngeal raphe, It constricts
the middle portion of the pharynx.

16. The inferior pharyngeal constrictor
 muscle arises from the oblique line of the thyroid
cartilage of the larynx and the lateral aspect of
the cricoid cartilage of the larynx. It acts by
constricting the lower portion of the pharynx. Consist
of 2 muscles
 Oblique thyropharyngeus muscle
 Transverse cricopharyngeus muscle

18. B SC
MC
IC
Stylopharyngeus m
Esophagus
SC, MC, IC form the
external circular layer
of voluntary muscle.
Thyropharyngeus m.
Cricopharyngeus m.

19. (Upper Esophageal Sphincter)
Inferior pharyngeal constrictor:
-Thyropharyngeus part
-Cricopharyngeus part
** (site of pharyngeal diverticulum)
** (site of pharyngo-esophageal
diverticulum) killians dehiscence
]

20. palatopharyngeus muscle
 The palatopharyngeus muscle starts at the posterior
border of the hard palate on the palatine aponeurosis
and finishes on the posterior aspect of the lamina of
the thyroid cartilage of the larynx, as do the other
paired muscles. It elevates the pharynx in order to
close off the nasopharynx during swallowing.

22. salpingopharyngeu
 muscle originates from the cartilage of the auditory
tube and elevates the superior and lateral aspects of
the pharynx.

23. stylopharyngeus
 , the muscle comes from the medial aspect of the base
of the styloid process and functions by elevating the
pharynx and expanding it laterally.

24. Superior pharyngeal
constrictor
Middle pharyngeal
constrictor
Inferior pharyngeal
constrictor
Esophagus
Levator veli palatini
Soft palate
Salpingopharyngeus m.
Palatopharyngeus m.
Stylopharyngeus m.
Inner vertical layer is made of Salpingo-, Palato-,and Stylopharyngeus m.

25. Tensor veli palatini
Levator veli palatini
Pharyngotympanic tube
(Eustachian/Auditory tube)
Salpingopharyngeus m.
Superior pharyngeal
constrictor
Middle pharyngeal
constrictor
Inferior pharyngeal
constrictor
Palatopharyngeus

26. Nasal septum
Soft palate
Lingual Tonsil
Epiglottis
Salpingopharyngeal fold
Piriform recess
Pharyngeal Tonsil
Palatine Tonsil

27.  There are gaps between muscels
 which allow structures to enter and exit the pharynx.
 s.constrictor and the skull
 levator palatini muscle,
 the auditory tube
 ascending palatine artery
 . S and M
 stylopharyngeus muscle,
glossopharyngeal nerve
stylohyoid muscle
M and i , anteriorly the
internal laryngeal nerve
superior laryngeal artery and vein
below the inferior
the recurrent laryngeal nerve and the inferior laryngeal artery

28. Blood Supply to Pharynx and Tonsils
Ascending Pharyngeal aertery
•Pharyngeal Branches
•Tonsilar Branches
Facial artery .: gives off Tonsilar Branch – also found in
tonsilar bed
Dorsal Lingual artery .: gives off Tonsilar Branch -
found in tonsilar bed
** May also receive supply from Inferior Thyroid
and Ascending Cervical arteries **

29. Nerve Supply to PharynxMotor:
 Sup/Mid. Constrictor- Pharyngeal branch of Vagus via
Pharyngeal plexus.
 Inf. Constrictor- Vagus, Ext. Laryngeal, and Inf. Laryngeal.
 Salpingopharyngeus- Vagus
 Palatopharyngeus- Vagus
 Stylopharyngeus- Glossopharyngeal
Sensory to Mucosa:
 Nasopharynx - Glossopharyngeal via Pharyngeal plexus
Exception: Ant/Sup Nasopharynx mucosa
supplied by V2.
 Oropharynx/Upper Laryngopharynx – Glossopharyngeal via
Pharyngeal plexus.
 Lower Laryngopharynx – Vagus via Pharyngeal plexus.
 Piriform Recess (Fossa) – Internal Laryngeal, Inferior
Laryngeal

30. Walderyer’s ring
 Naso.ph
 Tubular.t
 Platine.t
 Lingual .t

31. Clinic

32. Adenoid Hypertrophy Occupies large area of nasopharynx age <6
 Atrophies and by age 15 little remains
 Recurrent URTI or allergies can lead to hypertrophy
 Clinical
 Nasal Obstruction; Mouth breathing / Adenoid Facies,
chest infections, pharyngeal infections, sinusitis, snoring
 Eustachian Tube; Recurrent Otitis Media, CSOM
 Choanal Obstruction; OSA, chronic sinusitis

33. Adenoidectomy
 Criteria for surgery
 Chronic upper airway obstruction with OSA +/- cor
pulmonale
 Chronic serous/suppurative otitis media
 Recurrent acute otitis media
 Suspicion of nasopharyngeal malignancy
 Chronic sinusitis
 Complications
 Early Haemorrhage
 Otitis media
 Regrowth of residual adenoid tissue

35. Tonsillitis Commonest area of infection of head and neck
 Clinical; Sore throat and Odynophagia, Otalgia,
headache, malaise, Fever, hyperaemic tonsils,
cervical lymphadenopathy
DDx;
 Viral
 Group A Streptococcus (20-30%)
 EBV; Palatal petechia
 Diptheria; Unimmunised, grey membrane
 Tx; Rest, paracetamol +/- ABx

36. Tonsillitis
 Complications;
 Acute Otitis Media (most common)
 Peritonsillar abscess (Quinsy)
 GAS
 Post Strep GN
 Rhuematic Fever
 Scarlet Fever; Strawberry tongue and scarlitiform rash
 Recurrent Tonsillitis
 Tonsillar Hypertrophy

37. Tonsillectomy Indications for surgery
 Absolute
 Airway obstruction
 Suspicion of malignancy
 Relative
 Sleep apnoea, mouth breathing, difficulty swallowing
 Recurrent tonsillitis >5 episodes
 Any complications
 Complications
 Reactionary haemorrhage
 Secondary haemorrhage
 5-10 days post op
 Due to fibrinolysis aggravated by infection

38. Pharyngitis
 Acute
 >70% Viral Cause, GAS
 Supportive Treatment
 Chronic
 Persistent mild soreness and dryness
 Predisoposing factors include; smoking, ETOH, mouth
breathing, chronic sinusitis, Industrial fumes, antiseptic
throat lozengers
 Enlarged lymphoid tissue can be removed

39. Nasopharyngeal Carcinoma
 Rare in Europe
 Common in Asian countries
 20% of all malignancies in Hong Kong
 Pathology
 Squamous cell/undifferentiated
 Aietology
 Unknown, however EBV plays a role
 Others; ingestion of preserved foods

40. Nasopharyngeal Carcinoma
 Clinical;
 Most commonly as lump in the neck
 Local; Nasal obstruction, blood stained discharge
 Neurological; Invasion of skull base causing cranial
nerve palsies (V, VI, IX, X, XII)
 Otological; Serous otitis media
 Metastasis to bone, lung, liver

41. Nasopharyngeal Carcinoma
 Ix;
 Tissue sampling, CT/MRI, Staging
 Management
 Radiotherapy with concominant chemotherapy
 Poorly amendable to surgery due to anatomical location
 DDx
 Lymphoma, cystic adenocarcinoma, Infection

43. summery

44. Anatomy of Pharynx
 Fibromuscular Tube
 Base of Skull to C6 (12cm)
 Divided into three parts
 Nasopharynx
 Oropharynx
 Laryngopharynx
 4 Layers
 Mucosal, submucosal (Fibrous), Muscular, Fascial layer
(buccal pharyngeal)

45. Nasopharynx Base of skull to the soft
palate
 Key components
 Pharyngeal Tonsil
(Adenoids)
 Pharyngeal Recess (ICA)
 Opening of Auditory tube

46. Oropharynx Soft Palate to the
epiglottis
 Key Components
 Palatopharyngeal and
Palatoglossal arches
 Palantine Tonsil – project
from tonsillar fossa
 Lingual Tonsil
 Valleculae – lie between
epiglottis and posterior
border of the tongue

47. Laryngopharynx Epiglottis to the level of
cricoid cartilage
 Key features
 Opening to the larynx
 Piriform recess
(endoscope)

48. Anatomy of Pharynx
 Blood supply
 Branches of many arteries (ascending pharyngeal,
greater palantine, lingual, tonsilar)
 Nerve Supply
 Afferent; maxillary nerve, glossopharyngeal, internal
and recurrent laryngeal nerves
 Motor; Pharyngeal Plexus (Vagus, glossopharyngeal,
Cervical Sympathetic)

49. references
 Sadler anatomy
 Moore
 Kenhub web site
 Some of slids