Surgical anatomy and physiology of pharynx(中山医)

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  • The posterior aperture (choanae)vof the nasal cavities open into the nasopharynx; The posterior opening of the oral cavity (oropharyngeal isthmus) opens into the oropharynx; The superior aperture of the larynx (laryngeal inlet) opens into the laryngopharynx.
  • According to the anterior relationship the pharynx is sundivided into three regions
  • Enlarge of this tonsil,known as adnoids, can occlude the nasppharynx so that breathing is only possible through the oral cavity.
  • * When holding liquid or solids in the oral cavity,the oropharyngeal isthmus is closed by depression of the soft palate, elevation of the back of the tongue, and movement toward the midline of the palatoglossal and palatopharyngeal fols. This allows person to breath while chewing or manipulating material in the oral cavity. On swallowing, the oropharyngeal isthmus is opened, the palate is elevated, the pharyngeal cavity is closed, and the food or liquid is dericed into the esophagus. A person can not breath and swallow at the same time because the airway is closed at two sites , the paryngeal isthmus and the larynx. ** The palatin tonsils are visible through the oral cavity just posterior to the palatoglossal folds.
  • * The pyriform fossea form channels that direct solids and liquids from oral cavity around the raised laryngeal inlet and into the esophagus.
  • show pyriform fossae and posterior view of pharyngeal wall opend
  • *The pharyngeal wall is formed by skeletal muscles and by fascia ** The muscles of the pharynx are organized into two groups based on the orientation of muscle fibers. 1. constrictor muscles have thefibers oriented in a circular direction relative to the pharyngeal wall. 2. longitudinal muscles have fibers orientedvertically. 3. levator palati, tensor palati,palato-glossus,etc control the soft palate
  • * Contracting in succession squeeze the food downwards to the esophageal entrance.
  • * which sandwich the pharyngeal muscles between them. ** The fascia reinforces the pharyngeal wall where muscle is deficient. This is particularly evident above the level of the superior constrictor where the pharyngeal wall is formed almost entirely of fascia.
  • * Collection of lymphoid tissue in the mucosa of the pharynx surrounding the openings of the nasal and oral cavity are part of the body’s defence system. The largest of these collections form the distict masses (tonsils).
  • * Motor and most sensory innervation of the pharynx is mainly through branches of the vagus nerve[ Ⅹ ] and glossopharyngeal nerve[ Ⅸ ],which form a plexus in the outer fascia of the pharyngeal wall.
  • Surgical anatomy and physiology of pharynx(中山医)

    1. 1. Surgical anatomy and physiology of pharynx Otorhinolaryngology Department of the First Affiliated Hospital of Sun Yat-Sen University Otorhinolaryngology Institute of Sun Yat-Sen University Rui Xu
    2. 3. Pharyngeal surgical anatomy <ul><li>◆ is a musculofascial half-cylinder that links the oral and nasal cavities in the head to the larynx and esophagus in the neck. </li></ul><ul><li>◆ the pharyngeal cavity is a common pathway for ‘air ’and ‘food’. (common passages of respiratory systems and digestive systems) </li></ul>
    3. 4. Pharyngeal surgical anatomy <ul><li>Relationship: </li></ul><ul><li>◆ It is attached above to the base of skull and continuous below, approximately at the level of the sixth cervical vertebra, with the top of esophagus. Anteriorly attached to the margin of nasal cavities, oral cavities , and larynx. Posterior wall is adjacent to the prevertebral fascia, and bilateral is close to the cervical blood vessels and nerves. </li></ul>
    4. 5. Pharyngeal surgical anatomy <ul><li>♣ nasopharynx </li></ul><ul><li>♣ oropharynx </li></ul><ul><li>♣ laryngopharynx (hypopharynx) </li></ul>
    5. 7. Nasopharynx ◆ Position: behind the posterior apertures of the nasal cavities and above the level of the soft palate. ◆ Characteristics: the cavity of the nasopharynx is continuous below with the cavity of the oropharynx at the pharyngeal isthmus.
    6. 8. Nasopharynx <ul><li>Relationships of the nasopharynx are as follows: </li></ul><ul><li>roof---part of sphenoid bone and occipital bone, adenoids situated at the junction of roof and posterior wall of nasopharynx. </li></ul><ul><li>posterior --- first and second cervical vertebra </li></ul><ul><li>anterior --- posterior naris. </li></ul><ul><li>lateral---opening of Eustachian (pharyngotympanic) tube, pharyngeal recesses, the fossae of rosenmuller. </li></ul><ul><li>Inferior---oral cavity. </li></ul>
    7. 10. Nasopharynx <ul><li>There is a large collection of lympoid tissue (the pharyngeal tonsil) in the mucosa covering the roof of nasopharynx. </li></ul>
    8. 13. Oropharynx <ul><li>● Position: posterior to the oral cavity, inferior to the level of the soft palate, and superior to the upper margin of the epiglottis. </li></ul><ul><li>● Posterior---second and third cervical vertebra </li></ul><ul><li>● Anterior--- isthmus oropharyngeus. </li></ul>
    9. 15. Oropharynx <ul><li>● I sthmus oropharyngeus : uvula, free edge of soft palatine,palatoglossal arch, palatopharyngeal arch and dorsum of tongue * . </li></ul><ul><li>● P alatine tonsils : on the lateral wall of the oro- </li></ul><ul><li>-pharynx, and b etween the palatoglossal and palatopharyngeal arches ** . </li></ul>
    10. 17. Hypopharynx (Laryngopharynx) <ul><li>☆ Position: extends from the supior margin of the epiglottis to the top of the esophagus at the level of cervical vertebral Ⅵ </li></ul>
    11. 19. Hypopharynx (Laryngopharynx) <ul><li>☆ Relationships of the hypo pharynx are as follows: </li></ul><ul><li>s uperior---upper border of the epiglottis </li></ul><ul><li>inferior--- lower border of cricoid cartilage contiunes into </li></ul><ul><li>oesophagus. </li></ul><ul><li>anterior ---by the laryngeal inlet </li></ul><ul><li>p osterior---the third to sixth cervical vertebra 。 </li></ul>
    12. 20. Hypopharynx (Laryngopharynx) <ul><li>☆ valleculae: a pair of mucosal pouches, anteriorly to the cavity of laryngopharynx, one on each side, and between the base of tongue and epiglottis. </li></ul><ul><li>☆ piriform fossae: another pair of mucosal recess, between the central part of the larynx and more lateral lamina of the thyroid cartilage * . </li></ul>
    13. 24. Pharyngeal wall* <ul><li>★ mucosa : pseudostratified ciliated columnar epithelia, stratified squamous epithelia. </li></ul><ul><li>★ fibrous layer: anterior by skull base , pharyngeal suture formed at the midline of posterior wall. </li></ul><ul><li>★ muscular layer : constrictor pharyngis,longitudinal , levator palati, tensor palati,palato-glossus,etc.** </li></ul><ul><li>★ External membrane layer : fascia membrane. </li></ul>
    14. 25. Pharyngeal wall muscle posterior attachment anterior attachment Innervation Function superior constrictor pharyngeal raphe pterygomandibular raphe and adjent bone on the mandibular and pterygoid hamulus Vagus nerve [Ⅹ] Constriction of pharynx ★ Constrictor muscles*: middle constrictor pharyngeal raphe Upper margin of greaterbhorn of hyoid bone and adjent margins of lesser horn and stylohyoid ligament Vagus nerve [Ⅹ] Constriction of pharynx inferior constrictor pharyngeal raphe Cricoid cartilage,oblique line of thyroid crtilage, and a ligament that spans between these attachments and crosses the crocothyroid muscle Vagus nerve [Ⅹ] Constriction of pharynx
    15. 27. Pharyngeal wall ★ Longitudinal muscles: Muscle origin Insertion Innervation Function stylopharyngeus middle side of base of styloid process pharyngeal wall glossopharyngeal nerve [Ⅸ] Elevation of the pharynx Salpingppharyngeus inferior aspect of pharyn- geal end of pharyngo- tympanic tube pharyngeal wall vegus nerve [Ⅹ] Elevation of pharynx palatopharyngeus upper surface of palatine aponeurosis pharyngeal wall vegus nerve [Ⅹ] Elevation of phary- nx, and closure of the oropharyngeal isthmus
    16. 29. Fascia <ul><li>The pharyngeal fascia is seperated into two layers*: </li></ul><ul><li>♣ buccopharyngeal fascia: a thin layer, coats the outside of the muscular part of the wall. </li></ul><ul><li>♣ pharyngobasilar fascia: a much thicker layer, lines the inner surface </li></ul>
    17. 30. Fascial spaces <ul><li>♦ Retropharyngeal space : </li></ul><ul><li>※ Between the buccopharyngeal fascia and prevertebral fascia, which extends from skull base to the upper part of posterior mediastinum (T 1 ,T 2 ) . </li></ul><ul><li>※ anteriorly by the posterior pharyngeal wall and buccopharyngeal fascia; posteriorly by the cervical vertebra , their muscles an d fascia. One on each side, and seperated from parapharyngeal space. It contains retropharyngeal lymph nodes and connective tissue. </li></ul>
    18. 32. <ul><li>♦ parapharyngeal space : </li></ul><ul><li>From the skull base above to the glossal bone below. </li></ul><ul><li>It’s occupied by the carotid vessels, internal jugular vein, deep cervical lymph nodes, the last four cranial nerves and cervical sympathetic trunk. </li></ul>Fascial spaces
    19. 34. Pharyngeal lymphoid tissue* : <ul><li>● Accumulated to form mass---tonsils </li></ul><ul><li>● Scatterd---follicle or lymph chord </li></ul><ul><li>● Pharyngeal internal lymphoid ring </li></ul><ul><li>● Pharyngeal external lymphoid ring </li></ul>
    20. 35. Pharyngeal lymphoid tissue <ul><li>Tonsil occur mainly in three areas: </li></ul><ul><li>▪ the pharyngeal tonsils, known as adenoids when enlarged, is in the midline on the roof of the nasapharynx. </li></ul><ul><li>▪ the palatine tonsils are on each side of the oropharynx between the palatoglossal and palatopharyngeal arches </li></ul><ul><li>▪ the lingual tonsil refer collectively to numerous lymphoid nodules on the posterior one-third of the tongue. </li></ul>
    21. 38. Palatine tonsils <ul><li>♠ tortuous crypts </li></ul><ul><li>♠ Capsule: lateral two-third of each tonsil, a well defined structure composed of fibrous tissue, elastic tissue and muscle fibres. </li></ul><ul><li>♠ Blood supply : A. palatina descendens, A. palatina ascendens, A. pharyngea ascendens, A. facialis and A. dorsales linguae </li></ul>
    22. 41. Vessels supply of pharynx <ul><li>♣ Arteries </li></ul><ul><li>◆ upper parts of pharynx: the ascending pharyn- </li></ul><ul><li>geal a.,the ascending palatine and tonsillar branches of the facial a.,numerous branches of the maxillary and the lingual a. </li></ul><ul><li>◆ lower parts of pharynx: pharyngeal branches from the inferior thyroid a. </li></ul>
    23. 44. Vessels supply of pharynx <ul><li>♣ Veins </li></ul><ul><li>◆ veins of the pharynx form a plexus, which drains into: </li></ul><ul><li>superiorly : pterygoid plexus in the infratemporal </li></ul><ul><li>fossa. </li></ul><ul><li>inferiorly : the facial and internal jugular veins </li></ul>
    24. 46. Innervation of the pharynx <ul><li>♣ pharyngeal plexus*: pharyngeal branch of the vagus nerve[Ⅹ], superior laryngeal branch of the vagus nerve[Ⅹ], and pharyngeal branch of the glossopharyngeal nerve [Ⅸ] </li></ul><ul><li>♣ trigeminal nerve (tensor veli palatini,etc.) </li></ul>
    25. 47. Lymphatic vessels from the pharynx <ul><li>♣ deep cervical nodes and include retropharyngeal, paratracheal , and infrahyoid nodes. </li></ul><ul><li>♣ the palatin tonsils drain through jugulodigastric nodes </li></ul>
    26. 50. Physiology of pharynx <ul><li>1 . Respiration </li></ul><ul><li>2 . Swallowing </li></ul><ul><li>3 . Language formation </li></ul><ul><li>4 . Protective function </li></ul><ul><li>5 . Modulate barometric pressure </li></ul><ul><li>6 . Tonsil immunologic function (IgA, IgG and small amount of IgD. These are secreted into pharynx and increased when inflammation) </li></ul>
    27. 51. Symptomatology of Pharynx <ul><li>● pharyngeal pain </li></ul><ul><li>● pharyngeal abnormal sensation </li></ul><ul><li>● dysphagia </li></ul><ul><li>● heterophony </li></ul><ul><li>● drink back flowing </li></ul>

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