The document discusses the anatomy of the pharynx. It describes how the pharynx develops from the primitive gut and is divided into 3 parts - nasopharynx, oropharynx, and laryngopharynx. It details the layers of the pharyngeal wall from mucosa to buccopharyngeal fascia. It also discusses the blood supply, nerve supply, lymphatic drainage and applied anatomy of the pharynx.

2.  INTRODUCTION
 DEVELOPMENTOFPHARYNX
 STRUCTURE OFPHARYNX
 ANATOMICALEXTENSIONOFNASOPHARYNX
 BLOODSUPPLY
 NERVESUPPLY
 LYMPHATICDRAINAGE
 APPLIEDANATOMY

3. • PHARYNX
• Pharynx is a wide musculomembranous tube situated behind
the nasal cavities, the mouth and the larynx.
• Shape :inverted cone
•DIMENSIONS OF PHARYNX
Length
• 12-14 cm in length extending from the cranial base to the level of
sixth cervical vertebra / lower border of the cricoid cartilage.
Width
• Greatest superiorly measuring 3.5 cm.
• At its junction with the oesophagus it is reduced to about 1.5
cm this being the narrowest part of the alimentary canal.

5. The primitive gut extends from
the buccopharyngeal
membrane cranially to the
cloacal membrane caudally.
Divided into 4 parts-
1-The pharynx
2-The foregut
3-The midgut
4-the hindgut
The pharynx extends from
the buccopharyngeal
membrane to the
tracheobronchial
diverticulum.

6. • Divided into
1 upper part nasopharynx
2 middle part the oropharynx
3 the lower part the
laryngopharynx

7. • The wall of pharynx is
composed of four layers
from within outwards:
1 MUCOSA
2 PHARYNGOBASILAR
FASCIA
3 MUSCULAR COAT
4 BUCCOPHARYNGEAL
FASCIA

9. 1.MUCOSA
 Continuous with that of ET , nasal cavities ,
mouth , larynx and esophagus.

10. 1-Nasopharyngeal epithelium is-
•CILIATED PSEUDO STRATIFIED
COLUMNAR EPITHELIUM
containing
• GOBLET CELLS AND
RECEIVING SUBMUCOUS
GLANDS.
2- The oro and laryngo pharynx it is-
• NON-KERATINIZED STRATIFIED
SQUAMOUS EPITHELIUM.
3- A narrow transitional zone is present
of CUBOIDAL EPITHELIUM, the cilia
being imperfect or absent.

11. 1The mucus helps maintain
epithelial moisture and traps
particulate material and pathogens
moving through the airway.
2The oropharynx, are also subject
to the abrasive swallowing of food.
To prevent the destruction of the
respiratory epithelium in these
areas, it changes to stratified
squamous epithelium, which is
better suited to the constant
sloughing and abrasion.
3The squamous layer of the
oropharynx is continuous
with the esophagus.

12. 2-PHARYNGO-BASILAR
FASCIA-
• The intermediate fibrous layer
which is thick above where the
muscular fibres are absent.
• Firmly connected to
A- Basilar occipital and
petrous temporal bones
medial to carotid canal.
B –Curving under the auditory
tube and forward to the
posterior border of the medial
pterygoid plate and
pterygomandibular raphae.
C- As it descends its
thickness diminishes.
D- Posteriorly attached to
pharyngeal tubercle and
descends as Medial Pharyngeal
raphae of constrictors .

13. 3-MUSCULAR COAT
 External circular layer
 Superior , middle , inferior constrictor
muscles.
 Internal longitudinal layer
 Stylopharyngeus ,salpingopharyngeus ,
palatopharyngeus ,

15. salpingopharyngeus
palatopharyngeus
stylopharyngeus

16. Covers the outer surface
of constrictors of
pharynx.
Extends forward across the
pterygomandibular raphae to
cover th Buccinator.
Above upper border of superior
constrictor , it bends with
pharyngeal apponeurosis.

17.  WALDEYER’S RING
 Scattered through out the pharynx in its
subepithelial layer is the lymphoid tissue which is
aggregated at places to form masses collectively
called waldeyers ring.
 Massses are
1 . Nasopharyngeal tonsil/adenoid
2 .Palatine tonsils/simply tonsils
3 .Lingual tonsil
4 .Tubal tonsil(in fossa of rosenmuller)
5 .Lateral pharyngeal bands
6 .Nodules (in posterior pharyngeal wall)

19.  PHARYNGEAL SPACES
 There are 2 potential spaces in relation to
pharynx where abscess can develop.
1.retropharyngeal space :situated behind
pharynx and extending from base of skull to
bifurcation of trachea
2.parapharyngeal space :situated on side of
pharynx.
It contain carotid vessels , jugular vein , last 4
cranial nerve and cervical sympathetic chain.

21. •Parts of Pharynx
• Cavity of pharynx is
divided into 3 parts
a. The nasal part,
NASOPHARYNX
b. The oral part,
OROPHARYNX
c. The laryngeal part
,LARYNGOPHARYNX

23.  Behind the nasal cavity.
 Extends from SKULL BASE superiorly to theSOFT PALATE
inferiorly.
 Communicates with nasal cavity with two posterior nasal
apertures which are 25mm vertically and 12.5mm
transversely and are separated by posterior edge of nasal
septum.
 Nasal and oral part communicate through the PHARYNGEAL
ISTHMUS,which is closed during swallowing by elevation of
palate and contraction of PALATOPHARYNGEAL
SPHINCHTER.
 LATERAL WALL presents pharyngeal opening of the
AUDITORY TUBE,
• 10-12.5mm behind and and a little below the posterior end
of the inferior nasal concha.

25. Roof
Floor
Anterior
wall
Posterior
wall
Lateral wall

26.  Supported mainly
by basilar
occipital bone
posteriorly.
 Posterior part of the
body of the
sphenoid
anteriorly.
 Pharyngeal tonsil, a
lymphoid mass which
lies in the mucosa of
the upper part of this
surface and it is best
developed in
childhood.

27.  Roof and posterior part of nasopharynx are
continuous due to sloping nature of inferior
body of sphenoid bone and basilar part of
occipital bone , and is continues down to the
level of junction of hard and soft palate

28.  Visible during the later fetal months.
 Increases in size up to 6 or 7
years and then usually begins to
atrophy.
 In a child of 18 months it is a
forward directed pyramidal
prominence, with its apex near the
nasal septum and its base at the
junction of nasopharyngeal roof
and posterior wall.
 It consist of folds radiating antero-
laterally from a median recess,the
PHARYNGEAL BURSA, which
ascends backward into its substance.
 It represents attachment of
notochord to the pharyngeal
endoderm during embryonic life.
 The mucosal folds are mainly
diffuse lymphoid tissue,but also
contain deep mucous glands.

30. In young children lymphoid hypertrophy in nose and
nasopharynx(ADENOIDS),with or without enlargement of the
palatine tonsil, may obstruct nasal respiration.
The mouth has to be kept open to breathe.(MOUTH
BREATHING).
The hard palate and alveolar arch are then habitually out of
contact with the lingual dorsum.
Develop an abnormally high arch and forward projection.
The hard palate becomes transversely narrow and projecting
alveolar process afford little room for the permanent teeth which
leads to crowding and overhang the lower teeth.

31. Maxillary surfaces
appears pinched
together,with narrowing
of nasal cavities and
maxillary air sinuses.
Upper lip is drawn up
exposing the projecting
upper incisors.
The face is lengthened
by dropping of the lower
jaw leading to .
CAHRACTERISTIC
FACIAL EXPRESSION
(ADENOID FACIES)

33. Tubal Tonsil
 It is collection of subepithelial lymphoid
tissue situated at the tubal elevation.
It is continuous with adenoid tissue and
forms a part of the Waldeyer’s ring.
When enlarged due to infection, it causes
eustachian tube occlusion.

34.  An abscess can form in
the bursa –
THORNWALDT’S
DISEASE.
 ATHORNWALDT’SCYST
develops if the
embryonic remanants
gets obstructed.

35.  RATHKE’S POUCH
 It is represented
clinically by a dimple
above the adenoid .
 It is reminiscent of
buccal mucosal
invagination to form
anterior lobe of
pituitary.
 Craniopharyngioma
may arise from it’

36.  Formed by soft palate
anteriorly.
 Deficient posteriorly called
as nasopharyngeal
isthmus via which it
communicates with the
oropharynx.
 PHARYNGEAL
ISTHMUS remains
closed during swallowing
by the elevation of palate
and contraction of the
PALATOPHARYNGEAL
SPHINCTER.

37.  PASSAVANT’S
RIDGE
 Mucosal ridge raised by
the fibers of
palatopharyngeus .
 It encircles posterior and
lateral walls of
nasopharyngeal isthmus.
 It opposes soft palate
during the act of
swallowing.

38. •The Superior
pharyngeal constrictor
muscle contracts
to narrow the
nasopharyngeal space.
• TENSOR VELI PALATINI
muscle tenses the soft
palate to prevent
distortion.
• The LEVATOR VELI PALATINI,
PALATOPHARYNGEUS AND
SALPINGOPHARYNGEUS
elevate it postero-superiorly.

39. • The lateral and posterior
walls around the
nasopharyngeal isthmus are
then made taut by
contraction of the
palatopharyngeal sphincter
muscle fibres( consist of
skeletal muscle fibres of
the most superior aspect of
the palatopharyngeus
muscle. These fibres forms
an incomplete circle along
the lateral and posterior
walls of the
nasopharyngeal isthmus at
the level of C1 vertebra.)
• THE LATTER ACTION
FORMS PASSAVANT’SRIDGE.
• These series of action prevent
communication b/w the
nasopharynx and the
oropharynx during swallowing.

40.  Failure to close the naso-oropharyngeal communication
results in a condition known as velo-pharyngeal
insufficiency.
 Can be caused by variety of disorders (Structural,
Genetic, Functional or Accquired.)
 Very often associated with a Cleft palate.
 Parents usually bring in infants with this complication due to
food and liquid coming through the nose during feeding
and vomiting.
 Older individuals may present with recurrent sinus and
ear infections due to ingested contents flowing back
into the nasal sinus and the ostium pharyngeum
respectively

41.  PHYSICAL THERAPY
 SPEECH THERAPY
 OPERATIVE
TECHNIQUE-.
1. Sphincter palatoplasty.
2. Posterior wall
augmentation.
3. Pharyngeal flap.
 NON-OPERATIVE
TECHNIQUES-
1. SPEECH BULB
PROSTHESIS
2. PALATAL LIFT

43.  Anteriorly it communicates with the nasal cavity,through the
two posterior nasal apertures,which are each 25mm
vertically,12.5mm transversely.
 Seperated by posterior edge of nasal septum.
 Posterior ends of nasal turbinates and meatus are seen
in this wall

45.  Bounded by
 Atlas vertebra
 Dens of C2 Vertebra
 Superior constrictor
 Buccopharyngeal
fascia
 Retropharyngeal
space
 Prevertebral fascia

47. • Superior constrictor muscle: A
quadrilateral sheet ,thinner
and paler than others.
• ORIGIN:
• 1 –attached anteriorly to the
PTERYGOID HAMULUS.
•
• 2- PTERYGOMANDIBULAR RAPHAE.
• 3- POSTERIOR END OF THE
MYLOHYOID LINE of the mandible.
• 4-SIDE OF POSTERIOR PART OF THE
TONGUE.
• INSERTION:
• 1-MEDIAN PHARYNGEAL RAPHAE
• 2-SOME FIBRES ARE
PROLONGED BY AN
APONEUROSIS TO THE
PHARYNGEAL TUBERCLE ON
THE BASILAR PART OF
OCCIPITAL BONE

48. • EXTERNALLY:
• PREVERTEBRAL FASCIA AND MUSCLES
• THE ASCENDING PHARYNGEAL ARTERY
• THE PHARYNGEAL VENOUS PLEXUS
• GLOSSOPHARYNGEAL AND LINGUAL
NERVES
• STYLOGLOSSUS AND MIDDLE
CONSTRICTOR
• MEDIAL PTERYGOID
• STYLOHYOID LIGAMENT
• STYLOPHARYNGEUS
• INTERNAL CAROTID ARTERY
• SYMPATHETIC TRUNK
• HYPOGLOSSAL NERVE
• INTERNAL JUGULAR VEIN
• STYLOID PROCESS

49.  PALOTOPHARYNGEU
S
 THE TONSILLAR
CAPSULE
 PHARYNGOBASI
LLAR FASCIA

50. • SUPERIORLY:
 IT IS SEPARATED
FROM THE CRANIAL
BASE BY A
CRESENTRIC
INTERVAL
CONTAINING LEVATOR
VELI PALITINI.
 TENSOR VELI PALITINI.
 THE AUDITORY TUBE.

51. • INFERIORLY:
 ITS BORDER IS
SEPERATED FROM
MIDDLE CONSTRICTOR BY
• 1- STYLOPHARYNGEUS
• 2- GLOSSOPHARYNGEAL
NERVE

52. • ANTERIORLY:
 SEPARATED FROM
BUCCINATOR BY
THE
PTERYGOMANDIBU
LAR RAPHAE

53. • NERVE SUPPLY:
 THE PHARYNGEAL BRANCH OF VAGUS NERVE
VIA THE
PHARYNGEAL PLEXUS .
• ACTION OF SPC:
 CONSTRICT WALL OF PHARYNX DURING
SWALLOWING.

54.  The buccopharyngeal
fascia is a fascia in the
head.
 Parallel to the carotid sheath and
along its medial aspect the
pretracheal fascia gives off a thin
lamina, the buccopharyngeal
fascia, which closely invests the
constrictor muscles of the
pharynx and is continued
forward from
the constrictor pharyngis
superior onto the buccinator.
 It is attached to the
prevertebral layer by loose
connective
tissue only, and thus an
easily distended space,
the retropharyngeal space, is
found
between them.

56.  The retropharyngeal space is
a potential space of the head
and neck, bounded by
the buccopharyngeal
fascia anteriorly and the alar
fascia posteriorly. Together
with
the lateral pharyngeal space,
these
spaces are termed
the parapharyngeal spaces.
 It contains the
retropharyngeal lymph
nodes.

57.  The prevertebral fascia is
fixed above to the base of
the skull, and below it
extends behind the
esophagus into the
posterior mediastinal cavity
of the thorax.
 It descends in front of
the longus colli
muscles.
 The prevertebral fascia
is prolonged downward
and laterally behind the
carotid vessels and in
front of
the scalene muscles.

58.  Each lateral wall presents a
pharyngeal opening of the
auditory tube 10- 12.5mm
behind and little below the
posterior end of the inferior
nasal concha.
 It is somewhat triangular in
shape,this opening is bounded
above and behind by the
TUBAL ELEVATION called
TORUS TUBARIUS raised by
cartilage of tube.
 Above and behind the tubal
elevation ,a recess called fossa
of ROSSEN MULLER which is
commenest site for origin of
nasopharyngeal carcinoma.

60.  A vertical
SALPINGOPHARYNGEAL
FOLD OF MUCOSA
descends from the tubal
elevation , covering the
SALPINGOPHARYNGEUS
MUSCLE in the wall of the
pharynx.
 A smaller
SALPINGOPALATINE
FOLD ,extends from the
anterosuperior angle of
the tubal elevation to the
soft palate.
 The LEVATOR VELI
PALITINI entering the soft
palate produces an
elevation of the mucosa
immediately below the
tubal opening.

61.  The anatomy of the fossa was first
described in 1808 by Johann
Christian Rosenmüller.
 The fossa of Rosenmüller is a
bilateral projection of the
nasopharynx just below the skull
base. It is also called the lateral
pharyngeal recess or simply the
pharyngeal recess.
 The fossa is covered by
nasopharyngeal mucosa .
 The lateral pharyngeal recess, or the
fossa of Rosenmüller, is located
behind the torus tubarius

62. • ANTERIORLY:
• 1-Eustachian
tube.
• 2-Levator
palatini
muscle.
• POSTERIOR:
• 1-Posterior wall
of
nasopharynx.

63. • LATERAL:
• 1-Parapharyngeal space.
• 2-Tensor veli palatini muscle.
• 3-Mandibular nerve
• 4-Pre styloid compartment
of Parapharyngeal space.
• INFERIORLY:
• 1-Upper edge of the superior
constrictor muscle.
• MEDIALLY:
• 1- Nasopharynx

64. •POSTERO-LATERAL OR
APEX-
• 1-CAROTID CANAL OPENING
AND PETROUS APEX
POSTERIORLY.
• 2-FORAMEN OVALE AND
SPINOSUM LATERALLY.
•SUPERIORLY:
• 1-FORAMEN LACERUM
• 2-FLOOR OF CAROTID CANAL

66. 1-NASOPHARYNGEAL CARCINOMA:
. It was determined to be the most common site of origin of
nasopharyngeal carcinoma. 50% of cases.
The fossa often too deep and narrow for clinical inspection with a
nasopharyngoscope and could constitute a blind spot in the postnasal space,
especially the floor of the fossa.
This had clinical implications in the early detection of nasopharyngeal carcinoma
Deep infiltration of NPC was most commonly to the intracranial region, usually
through the foramen lacerum and the foramen ovale.(Trotter's syndrome is a
cluster of symptoms associated with certain types of advanced
nasopharyngeal carcinoma)

67. Space between base of
skull & sup.connstictor.
Through it enters-
 Eustachian tube
 Tensor &Levator veli
palatini muscle
 Asc. Palatine
artery.
a-mucosa
b-pharyngobasilar fascia
c-muscularcoat
d-buccopharyngeal fascia

68. • In nasopharyngeal carcinoma, the tumor may extend
laterally and involve this sinus.
• It can easily breach into the PARAPHARYNGEAL SPACE.

69. • ARTERIES THAT
SUPPLY UPPER
PARTS OF THE
PHARYNX:
1 THE ASCENDING
PHARYNGEAL ARTERY
2THE ASCENDING
PALATINE AND
TONSILLAR BRANCHES
OF FACIAL ARTERY
3NUMEROUS
BRANCHES OF
MAXILLARY AND
LINGUAL
ARTERIES.(all these
vessels are
from the external
carotid artery)

70. VEINS OF THE
PHARYNX FORMS A
PLEXUS,WHICH
DRAINS SUPERIORLY
INTO THE
PTERYGOID PLEXUS
IN THE
INFRATEMPORAL
FOSSA.
INFERIORLY INTO
THE FACIAL AND
INTERNAL
JUGULAR VEIN.

71. • Lymphatic vessels from
the nasopharynx drain
into the upper deep
cervical nodes either
directly or indirectly
through
RETROPHARYNGEAL
(between nasopharynx
and vertebral column)
or PARAPHARYNGEAL
LN .
• Also drains to spinal
accessory chain of
nodes in posterior
triangle of neck.
• May also crosses mid
line to drain to
contralateral nodes

73. • Motor and most sensory innervation (except for the nasal
region) of the pharynx is mainly through branches of the
vagus [ X ] and glossopharyngeal [ IX ] nerves, which
form a plexus in the outer fascia of the pharyngeal wall.
• PHARYNGEAL PLEXUS:
The pharyngeal plexus is formed by:
■ the pharyngeal branch of the vagus nerve [ X ]
■ branches from the external laryngeal nerve from the
superior
laryngeal branch of the vagus nerve [ X ] and
■ pharyngeal branches of the glossopharyngeal nerve [ IX ]

74. • The pharyngeal branch of the vagus nerve [ X ] originates from
the upper part of its inferior ganglion above the origin of the
superior laryngeal nerve and is the major motor nerve of the
pharynx.
• All muscles of the pharynx are innervated by the vagus
nerve [ X ] mainly through the pharyngeal plexus, except
for the stylopharyngeus, which is innervated directly by
a branch of the glossopharyngeal nerve [ IX ] .

75. 1The nasopharynx is innervated by a pharyngeal branch of
the maxillary nerve [ V 2 ] that originates in the
pterygopalatine fossa and passes through the palatovaginal
canal in the sphenoid bone to reach the roof of the pharynx.

77.  1. Acts as a conduit for air, which has been
warmed and humidified in the nose, towards its
passage to larynx and trachea.
 2. Through the eustachian tube, it ventilates the
middle ear and equalizes air pressure on both
sides of tympanic membrane. This function is
important for hearing.
 3. Elevation of the soft palate against posterior
pharyngeal wall and the Passavant’s ridge helps
to cut off nasopharynx from oropharynx. This
function is important during swallowing,
vomiting, gagging and speech sage to the larynx
and trache

78. 4. Acts as a resonating chamber during voice
production. Voice disorders are seen in
nasopharyngeal obstruction and
velopharyngeal incompetence .
5. Acts as a drainage channel for the mucus
secreted by nasal and nasopharyngeal glands.