NOSE PHARYNX

1. Upper
respiratory tract
nose &pharynx
DR MOSTAFA KANDIL
MBCHB MS MD PHD
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2. External Nose
Internal Nose
Musculature of Nose
Vascular Supply.
Nerve supply.
Lymphatic Drainage
Paranasal Sinuses
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3. External nose
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4.  External Nose
It is pyramidal in shape with its root up and the base directed downwards
Nares – external opening of nose Choanae - open into the nasopharynx
1. Bony Part: Posterior 1/3rd is bony
1. Nasal Bone
2. Frontal Process of Maxilla
3. Nasal Part of Frontal Bone
2. Cartilaginous Part: Anterior 2/3rd is cartilaginous
1. Upper Lateral Cartilage
2. Lower Lateral Cartilage/Alar Cartilage
3. Septal Cartilage
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5. Nasal Skin
•The skin over the
nasal bones and
upper lateral
cartilages is thin and
freely mobile while
that covering the alar
cartilages is thick and
adherent, and
contains many
sebaceous glands.
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6.  Internal Nose
Nasal Cavity
• Extends from Nostrils externally
to Choanae internally
• Nasal Septum divides Nasal
Cavity into two compartments
Nasal Septum
1. Septal Cartilage
2. Perpendicular Plate of
Ethmoid Bone
3. Vomer
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7. Zeeshan Ali
M-1036
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8.  Boundaries of
Nasal Cavity
• Floor
1. Palatine Process of
Maxilla
2. Horizontal Process of
Palatine Bone
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9. Roof
1. Nasal Bone
2. Frontal Bone
3. Cribriform Plate of Ethmoid Bone
4. Sloping body of Sphenoid Bone
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10. Medial Wall
1. Septal Cartilage
2. Perpendicular Plate
of Ethmoid Bone
3. Vomer
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11. Lateral Wall
• 3 Projections
• Superior, Middle and Inferior
Conchae/Vestibule
• Space below each Concha is called Meatus
• Spenoethmoidal Recess – Above superior
concha > Sphenoid Air Sinus Superior Meatus
– Below superior concha > Posterior ethmoid
sinuses Middle Meatus – Below middle
concha
I. Bulla Ethmoidalis > formed by Middle
ethmoidal air sinuses
II.Hiatus semilunaris – Lies below bulla >
Maxillary Sinus
• Infundibulum – continuous with frontal sinus
• Inferior Meatus – Below inferior concha >
Nasolacrimal Duct
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12. Regions of Nasal Cavities
•Each nasal cavity consists of three general regions
•Nasal vestibule
– small dilated space just internal to the naris that is
lined by skin and contains hair follicles
•Respiratory region
–Largest part of the nasal cavity
–Rich neurovascular supply
–Lined by respiratory epithelium composed mainly of
ciliated and mucous cells
•Olfactory region
–small, is at the apex of each nasal cavity
–Lined by olfactory epithelium which contains the
olfactory receptors
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13. Nerve Supply of Nose
• Three cranial nerves
– Olfaction - the olfactory nerve [I]
– General sensation - the trigeminal
nerve [V],
• Anterior - ophthalmic nerve [V 1 ]
• Posterior - maxillary nerve [V 2 ]
– Glands - parasympathetic fibers in
the facial nerve [VII] (greater
petrosal nerve),
• Sympathetic fibers
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15. • (c) Autonomic nerves
• Parasympathetic nerve fibres supply the nasal glands and control nasal
secretion. They come from greater superficial petrosal nerve, travel in the
nerve of pterygoid canal (vidian nerve) and reach the sphenopalatine
ganglion where they relay before reaching the nasal cavity. They also
supply the blood vessels of nose and cause vasodilation.
• Sympathetic nerve fibres come from upper two thoracic segments of
spinal cord, pass through superior cervical ganglion, travel in deep petrosal
nerve and join the parasympathetic fibres of greater petrosal nerve to form
the nerve of pterygoid canal (vidian nerve). They reach the nasal cavity
without relay in the sphenopalatine ganglion. Their stimulation causes
vasoconstriction.
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17. Lymphatic Drainage
•Lymphatics from the external nose
and anterior part of nasal cavity
drain into submandibular lymph
nodes
•The rest of nasal cavity drain into
upper jugular nodes either directly
or through the retropharyngeal
nodes.
•Lymphatics of the upper part of
nasal cavity communicate with
subarachnoid space along the
olfactory nerves.
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18. Paranasal sinuses
• four paired paranasal sinuses
• The paranasal air sinuses are lined with
respiratory epithelium
1- Maxillary sinuses, the largest of the
paranasal sinuses, are under the eyes, in the
maxillary bones (open in the back of the
semilunar hiatus of the nose).
2- Frontal sinuses, superior to the eyes, in the
frontal bone, which forms the hard part of
the forehead.
3- Ethmoidal sinuses, which are formed from
several discrete air cells within the ethmoid
bone between the nose and the eyes.
4- Sphenoidal sinuses, in the sphenoid bone.25/06/1441 NOSE PHARYNX DR KANDIL 18

19. Functions of paranasal sinuses
• The presence of these
sinuses lightens the
skull
• They add resonance
to speech
• They humidify the air
entering to respiratory
system.
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Arteries that supply the nasal cavity include vessels that
originate from both the internal and external carotid
arteries :
• vessels that originate from branches of the external
carotid artery include the sphenopalatine, greater
palatine, superior labial, and lateral nasal arteries;
• vessels that originate from branches of the internal
carotid artery are the anterior and posterior ethmoidal
arteries.
Arterial supply of the nasal cavities.
A. Lateral wall of the right nasal
cavity. B. Septum
(medial wall of right nasal cavity).
Arterial supply of the nasal cavities
Nosebleed
A nosebleed, or epistaxis, is
a common occurrence and
often involves the richly
vascularized region of the
vestibule and the
anteroinferior aspect of the
nasal septum (Kiesselbach’s
area). Commonly,
nosebleeds occur because
of trauma involving the
septal branch of
the superior labial artery
from the facial artery.
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Paranasal sinuses. A. Anterior view. B. Posteroanterior skull radiograph. C. Paramedian view of right
nasal cavity. D. Lateral skull radiograph.
Paranasal sinuses (Cont’d)
• The frontal sinuses are innervated by branches of the supra-orbital nerve from the ophthalmic nerve
[V1]. Their blood supply is from branches of the anterior ethmoidal arteries.
• The ethmoidal cells, which are divided into anterior, middle, and posterior ethmoidal cells, are
innervated by: the anterior and posterior ethmoidal branches of the nasociliary nerve from the
ophthalmic nerve [V1]; and the maxillary nerve [V2] via orbital branches from the pterygopalatine
ganglion. The ethmoidal cells receive their blood supply through branches of the anterior and posterior
ethmoidal arteries.
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• The maxillary sinuses are innervated by infra-orbital and alveolar branches of
the maxillary nerve [V2], and receive their blood through branches from the infra-
orbital and superior alveolar branches of the maxillary arteries.
• The sphenoidal sinuses are innervated by the posterior ethmoidal branch of
the ophthalmic nerve [V1]; and the maxillary nerve [V2] via orbital branches
from the pterygopalatine ganglion. The sphenoidal sinuses are supplied by
branches of the pharyngeal arteries from the maxillary arteries.
Paranasal sinuses (Cont’d)
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Drainage of the paranasal sinuses:-
• Sphenoethmoidal recess:
Sphenoidal air sinus
• Superior meatus:
Posterior ethmoidal air sinus
• Middle meatus :
Bulla ethmoidalis:
Middle ethmoidal air sinus
Hiatus semilunaris:
Frontal air sinus
Maxillary air sinus
Anterior ethmoidal
• Inferior meatus:
Nasolacrimal duct
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24. Pharynx
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25. • Is a wide muscular tube
• 12 cm in length
• Located posterior to the nasal and oral
cavities
• Extends inferiorly, posterior to the larynx
• Extends from the cranial base to the inferior
border of the cricoid cartilage (anteriorly)
and inferior border of C6 (posteriorly)
[Extends from the base of the skull to the
level of the C6 vertebra] where it is
continuous with the oesophagus
• Widest opposite the hyoid bone and
narrowest at the junction where it joins the
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26. Pharyngeal wall
The wall of the Pharynx consists of five
layers:
1.Mucous membrane
2.Submucosa
3.Pharyngobasilar fascia
4.Pharyngeal muscles (3 constrictors)
a- Stylopharyngeus
b- Salpingopharyngeus
C- Palatopharyngeus
5.Buccopharyngeal fascia
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28. • Respiratory function
• Roof and Posterior wall:
Continuous surface that lies
inferior to the body of the
sphenoid bone and the
basilar part of the occipital
bone
• Pharyngeal tonsils:
Found in the mucous membrane
of the roof and the posterior
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30. • Digestive function
• Helps in the process of
deglutition
• Borders
Superiorly: Soft Palate
Inferiorly: Base of the Tongue
Laterally: Palatoglossal and
Palatopharyngeal arches and
palatine tonsils
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31. • Palatine tonsils
– Collections of lymphoid tissue on
either side of the Oropharynx
between the arches
• Tonsillar bed
– Superior constrictor of the
pharynx and the pharyngobasilar
fascia form the tonsillar bed
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32. ARTERIAL SUPPLY OF THE
TONSIL
1- Tonsillar A. From facial A.
2- Lingual A.
3- Ascending palatine A.
4- Maxillary artery.
Acute follicular tonsillitis
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33. • Extends from the superior
border of the epiglottis and
the pharyngoepiglottic folds to
the inferior border of the
cricoid cartilage
Borders
• Posteriorly: related to the
bodies of the C4- C6
vertebrae.
• Posterior and lateral walls:
Middle and Inferior constrictor
muscles
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34. • Palatopharyngeus and
Stylopharyngeus muscles form the
walls
• Piriform recess: Small
depression of the
laryngopharyngeal cavity on either
side of the laryngeal inlet
separated from the laryngeal inlet
by the aryepiglottic fold
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35. 2 layers of voluntary
muscle:
• External circular layer
• Internal Longitudinal layer
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36. External circular layer
• Constrictor muscles
Primarily responsible
for constricting the
pharynx during
swallowing
Both types are
innervated by
the vagus nerve,
except for
the stylopharyngeus,
which is innervated by
the glossopharyngeal
nerve.
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37. • Internal Longitudinal layer
• Elevate/shorten and widen the
pharynx during swallowing and
speaking
• Palatopharyngeus
• Stylopharyngeus
• Salpingopharyngeus
Palatopharyngeus and
salpingopharyngeus are innervated by
the pharyngeal branch of CNX and
the pharyngeal plexus
• Stylopharyngeus is innervated by CN
IX
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38. A- Sensory: Each of the three sections of the pharynx have
a different innervation:
1- The nasopharynx is innervated by the maxillary nerve
(CN V2).
2- The oropharynx by the glossopharyngeal nerve (CN IX).
3- The laryngopharynx by the vagus nerve (CN X).
B- Motor: All the muscles of the pharynx are innervated by
the vagus nerve (CN X), except for the stylopharyngeus,
which is innervated by the glossopharyngeal nerve (CN IX).
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39. Blood Supply of
the pharynx:
1- Arterial supply is
via branches of
the external
carotid artery:
• Ascending pharyngeal artery
• Ascending palatine artery
• Tonsillar branches of the
facial artery
• Branches of the maxillary
and lingual arteries
• Pharyngeal branches of the
inferior thyroid artery
2- Venous drainage is achieved by
the pharyngeal venous plexus, which
drains into the internal jugular vein.
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41. Nasopharyngeal tonsil
• Adenoids is the
hypertrophied mass of
lymphoid tissue situated at
the junction of roof & post.
wall of nasopharynx.
• The mass of lymphoid
tissue is termed as
Adenoids only when it is
hypertrophied.
• It usually undergoes
atrophy by puberty (13- 14
yrs)
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42. Waldeyer’sRing
• Waldeyer's
tonsillar ring
includes
1. Adenoid tonsil
2. Two tubal
tonsils
3. Two palatine
tonsils
4. Lingual tonsil.
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43. Thank
you
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