Pharynx - NotesMed
Transcript of Pharynx - NotesMed
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Pharynx
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• Funnel-shaped fibromusculartube lined by mucous membrane
• Extent- base of the skull to C6
vertebra
• Location :
Behind
– The Nose- Nasopharynx
– The Mouth -oropharynx
– The Larynx-laryngopharynx
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Boundaries
• Roof :- body of sphenoid and basilar part of the occipital bone.
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Contd..• Inferiorly:
– continuous with oesophagus
opposite the sixth cervical
vertebra.
• Posteriorly:
– supported by upper six
cervical vertebra, prevertebral
muscles and fascia.
• Anteriorly:
– communicate with oral cavity,
nasal cavity and larynx.
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On each side :
Attached to:-
– Medial pterygoid plate.
– Pterygomandibular
raphe mandible.
– Tongue.
– Hyoid bone.
– Thyroid and cricoid
cartilage.
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A. Related to:-
styloid process, common
carotid artery, external
and internal carotid
arteries.
B. Communicate with:-
middle ear cavity with
auditory tube
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Sub divisions
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Nasopharynx
• Behind the nasal cavity.
• Extends: from base of
skull superiorly to the soft
palate inferiorly.
• Anteriorly: communicates
with nasal cavity.
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• Roof and posterior wall form a continuous surface andpresents:
• Pharyngeal or nasopharyngeal tonsil:
• Enlarged tonsil is known as adenoid
• Pharyngeal bursa
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• Lateral wall :
– Pharyngealopening ofauditory tubeabout 1.25 cmbehind andslightly below thelevel of inferiornasal concha.
– Tubal elevation-
• guards the upperand posteriormargin of theauditory tube
• Overlies the tubaltonsil
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• Two mucous folds passes downward i.e.
• Salpingopharngeal fold
• Salpingopalatine fold (formed by the L. veli palatinimuscle)
• Pharyngeal recess (fossa of Rosenmuller): mucouscovered deep depression behind the tubal elevation
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Contd.• Floor : communicate with oropharynx through pharyngeal isthmus.
• Boundaries
– Anterior: posterior surface of free margin of soft palate.
– Posterior: Mucous elevation formed by palatopharyngealsphincter (passavant’s ridge).
– On each side: palatopharyngeal arch.
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Features of Nasopharynx
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Oropharynx• Behind the oral cavity
(in front of 2nd&3rd
Cervical vertebra).
• From the soft palatesuperiorly to tip ofepiglottis inferiorly.
• Below: itcommunicate withlaryngo-pharynx.
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Contd..
• Anteriorly communicates with oral cavity through oropharyngeal isthmus
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Tonsillar fossa• Lateral wall presents
tonsillar fossa which lodges palatine tonsil
• Boundaries:
• Anteriorly-palatoglossal arch
• Posteriorly-palatopharyngeal arch
• Apex -soft palte where both arches meet
• Base dorsal surface of tongue
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Waldeyer’s ring
• The lymphoid tissue in thepharyngeal aponeurosisaggregates in some areasforming tonsils:
Pharyngeal tonsil (1).
Tubal tonsil (2).
Palatine tonsil (2).
Lingual tonsil (1).
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Laryngopharynx
• Lower part of the pharynx
situated behind the larynx.
• Extent: from the upper
border of epiglottis to the
lower border of cricoid
cartilage.
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• Communications:
Anteriorly with the
laryngeal cavity through
laryngeal inlet
Inferiorly with oesophagus.
– On each side presents the
piriform fossa.
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Boundaries
• Anterior wall:
– inlet of larynx, and posterior surface of cricoid and arytenoidcartilage.
• Posterior wall:
– mainly by fourth and sixth cervical vertebra.
• Lateral wall:
– piriform fossa.
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Piriform fossa
• Importance:
lateral food channel.
Catch point for foreign body.
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Piriform fossa
Boundaries :
• Medial:– Aryepiglottic fold and quadrangular membrane of larynx.
• Lateral:– Mucous membrane covering of lamina of thyroid cartilage
and thyrohyoid membrane.
– Internal laryngeal nerve and superior laryngeal vessels pierce the thyrohyoid membrane.
• Above:– lateral glossoepiglottic fold (separates from epiglottic
vallecula).
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Structure of pharynx• From within outwards
a) Mucosa
Nasopharynx:
Pseudostratified ciliated
columnar epithelium
Oro- and laryngo-
pharynx: stratified
squamous
nonkeratinized
epithelium
b) Pharyngo-basilar fascia:
fibrous sheet internal to
the pharyngeal muscles
c) Muscular coat
d) Buccopharngeal fascia
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Muscles• Pharynx consists of striated
muscles which are arranged in
outer circular and inner
longitudinal layers.
Circular layer comprises
• Superior constrictor
• Middle constrictor and
• Inferior constrictor
• These muscles joinedtogether posteriorly by thepharyngeal raphe.
• Anteriorly attach to bonesand ligaments related to thelateral margins of the nasaland oral cavities and thelarynx.
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Superior constrictor
• Anteriorly attached to the medial pterygoid plate, pterygoid hamulus,pterygomandbular raphe, mylohyoid line of the mandible and side ofthe tongue.
• Posteriorly to the pharyngeal tubercle and pharyngeal raphe.
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Middle constrictor
• Anteriorly attached to the loweraspect of the stylohyoidligament, the lesser horn of thehyoid bone, and the entireupper surface of the greaterhorn of the hyoid bone.
• Posteriorly attach to thepharyngeal raphe.
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Inferior constrictor
• Consist of two parts i.e
– Thyropharyngeusarise from the obliqueline and inferior hornof the thyroidcartilage.
– Cricopharyngeus arisefrom the anterior archof cricoid cartilage.
• posteriorly attach to thepharyngeal raphe
• Dehiscence of Killian
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Constrictor muscle
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Killians Dehiscence• The junction between the
thyropharyngeus and crico-
pharyngeus is the weakest
part of the pharynx and is
known as killians
dehiscence.
• The area above the
dehiscence is re-inforced by
all the three constrictor
muscles, but below the
dehiscence is formed only by
the crico-pharyngeus part of
inferior constrictor.
• This weak point develops asDiverticulum of pharynx.
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Contd..
• Longitudinal layer
comprises
• Stylopharyngeus
• Palatopharyngeus
• Salpingopharyngeus
– named according totheir origins
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Nerve supply of the pharyngeal muscles
• Motor:
– all the muscles of pharynx is supplied by the cranial part ofaccessory nerve via the pharyngeal plexus exceptstylopharyngeus
– Stylopharyneus is supplied by glossopharyngeal nerve
– Inferior constrictor muscle also receive additional supplyfrom the external and recurrent laryngeal nerve
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• Sensory:
– Naso-pharynx : by maxillary nerve throughpharyngeal branch of pterygopalatine ganglion.
– Oro-pharynx : by glossopharyngeal nerve.
– Laryngo-pharynx : by the internal laryngeal nerve.
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Blood supply• Arterial supply
Ascendingpharyngeal,
Ascending palatineand tonsillarbranches of the facialartery.
Greater palatine,pharyngeal andpterygoid branchesof maxillary artery,and
Dorsal lingualbranches of thelingual artery.
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• Venous supply
Vein of the pharynx
form a pharyngeal
venous plexus
which join with the
pterygoid venous
plexus, and drain into
the internal jugular
vein.
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Applied Anatomy• Adenoids
• Tonsillitis may cause referred pain in ear asglossopharngeal nerve supplies both these area.
• Infection may pass from the throat to the middle airthrough the auditory tube. This is more common inchildren because the tube is shorter, wider andstraighter in them.
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