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Applied anatomy of throat


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Applied anatomy of throat

  2. 2. WALDAYER’S RING• Consists of two components• Outer ring – cervical nodes• Inner ring – adenoid, tonsil, posterior pharyngeal wall lymphatics, tubal tonsil of Gerlac, lingual tonsil• Enlargement of any one of the components of inner ring can cause oropharyngeal symptoms which include painful swallowing / difficulty in swallowing Otolaryngology online
  3. 3. COMPONENTS OF INNER WALDAYER’S RING Otolaryngology online
  4. 4. FUNCTIONS OF WALDAYER’S RING• Antigen sampling center• Antigens from inspired air are trapped by adenoid and tubal tonsil (inhaled antigen)• Ingested antigens are sampled by palatine tonsils• Surface area of adenoid is increased for efficient trapping of antigen by the presence of furrows• Presence of crypts in the palatine tonsils serves to increase its efficiency Otolaryngology online
  5. 5. ANATOMY OF PALATINE TONSIL • Largest member of waldayers ring • Present in the tonsillar fossa • Lies on either side of oropharynx Otolaryngology online
  6. 6. INTRODUCTION• Adenotonsillectomy is the commonly performed surgery• Majority of infections start from the oropharynx• Meeting point of both air & food channels• This area is well protected by the presence of lymphoid tissue (components of waldayer’s ring)• Major antigen sampling area Otolaryngology online
  7. 7. TONSILLAR FOSSA• Bounded by anterior and posterior pillars• Anterior pillar is formed by palatoglossus muscle• Posterior pillar is formed by palatopharyngeus muscle• Triangular fold of mucous membrane extends backwards from the palatoglossal fold to cover the inferior pole of tonsil (Plica triangularis)• Semilunar mucosal fold could be seen arising from the upper aspect of palatopharyngeal arch extending towards the superior pole of tonsil. This separates upper pole of tonsil from uvula Otolaryngology online
  8. 8. TONSIL• Outer aspect is lined by condensed pharyngobasilar fascia which forms the capsule• Medial surface of tonsil is lined by crypts• Medial surface of tonsil is lined by stratified squamous epithelium making it an oropharyngeal component• Glossopharyngeal nerve and stylohyoid ligament pass downwards and forwards under the superior constrictor in the lower part of tonsillar fossa Otolaryngology online
  9. 9. TONSIL – BLOOD SUPPLY• Tonsillar artery a branch of facial artery is its major arterial supply. Enters the tonsil near its lower pole• Lingual artery via its dorsal lingual branches• Ascending palatine branch of facial artery• Tonsillar branch of ascending pharyngeal artery• Venous drainage is via paratonsillar vein which drains via the pharyngeal plexus / facial vein Otolaryngology online
  10. 10. ADENOID• Collection of lymphoid tissue over basisphenoid area• It is shaped like a truncated pyramid• Its anterior edge lies in the same plane of post nasal aperture• Posterior edge merges with posterior pharyngeal wall• Lined by ciliated columnar epithelium• Surface is lined by furrows Otolaryngology online
  11. 11. ADENOID (CONTD)• It enlarges during childhood (3-4 years)• As the child grows older it regresses in size• Reduction in size attributed to comparative enlargement of nasopharynx• Its surface contains furrows, which effectively increases its surface area by another quarter.• Grossly enlarged adenoid tissue causes “Adenoid facies” Otolaryngology online
  12. 12. ADENOID FACIES• Elongated face• Pinched nostrils• Open mouth• High arched palate• Shortened upper lip• Vacant expression Otolaryngology online
  13. 13. DIFFERENCES BETWEEN ADENOID AND TONSIL Tonsil Adenoid 1. Encapsulated 1. Unencapsulated 2. Two in number 2. One 3. Has crypts 3. Has furrows 4. Present in oropharynx 4. Present in nasopharynx 5. Lined by squamous 5. Lined by ciliated epithelium columnar epithelium 6. Has no efferent 6. Has both afferent and lymphatics efferent lymphatics Otolaryngology online
  14. 14. PALATE• Literally means roof of the mouth• Separates oral and nasal cavities• Hard (Bony) palate• Soft palate• Uvula Otolaryngology online
  15. 15. TONGUE• Dynamic part of oral cavity• Muscle mass lined by oral mucosa• Two portions – Anterior 2/3 and posterior 1/3• Two portions separated by circumvallate papillae and foramen caecum• Tongue base contains lymphoid tissue (Lingual tonsil) Otolaryngology online
  16. 16. TONGUE (CONTD)• Lingual papilla are projections of lamina propria covered by epithelium• 4 types of lingual papilla have been identified• Vallate, foliate, filiform and fungiform papillae.• These papillae contains taste buds• 4 extrinsic and 4 intrinsic muscles• Muscles on either side of tongue are separated by fibrous septa Otolaryngology online
  17. 17. LINGUAL PAPILLAE• Vallate – These are flat and prominent 8-12 in number. Von Ebner’s gland secrete here• Foliate papillae are present in the lateral surface of tongue• Filiform papillae are thin and long and are present over the entire dorsum of the anterior third of tongue• Fungiform papillae are mushroom shaped and are present along the tip and lateral surfaces of tongue Otolaryngology online
  18. 18. TONGUE MUSCULATURE Muscle Type Origin Insertion Action Superior Intrinsic Lingual septum Margins of Raises tip and longitudinal and submucous tongue sides of tongue; fibrous layer shortens tongue Inferior Intrinsic Body of hyoid Apex of tongue Curls tip longitudinal and base of inferiorly; tongue shortens tongue Transverse Intrinsic Lingual septum Submucous Narrows and fibrous layer lengthens tongue Vertical Intrinsic Superior surface Inferior surface Flattens and of tongue of tongue broadens tongue Genioglossus Extrinsic Mental spine of Lateral and Depresses and mandible inferior tongue protrudes tongue Hyoglossus Extrinsic Body and Lateral and Depresses and greater horn of inferior tongue retracts tongue hyoid Styloglossus Extrinsic Styloid and Lateral and Retracts tongue stylohyoid inferior tongue ligament Palatoglossus Extrinsic Palatine Lateral tongue Elevates aponeurosis posterior tongue Otolaryngology online
  19. 19. TONGUE NERVE SUPPLY• Hypoglossal nerve is the motor nerve of tongue. Innervates all lingual muscles except palatoglossus which is supplied by pharyngeal plexus• Lingual nerve – general sensation from anterior 2/3 of tongue• Chorda tympani branch of facial nerve – taste from anterior 2/3 of tongue• Glossopharyngeal nerve – general and taste sensation from posterior third of tongue• Internal laryngeal nerve – general and taste sensation from posterior third tongue and epiglottis Otolaryngology online
  20. 20. TONGUE (CONTD) Otolaryngology online
  21. 21. Otolaryngology online