PHARYNX

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By: maneeshjain (41 month(s) ago)

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By: maneeshjain (41 month(s) ago)

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Presentation Transcript

ANATOMY OF PHARYNX : 

ANATOMY OF PHARYNX 1

INTRODUCTION : 

INTRODUCTION Pharynx is a wide muscular tube which lies at the crossroads of respiratory and digestive tract 2

EMBRYOLOGY OF PHARYNX : 

EMBRYOLOGY OF PHARYNX 3

Saggital midline section of 23-25 day embryo showing position of foregut,2 and stomatodaeum,3 . : 

Saggital midline section of 23-25 day embryo showing position of foregut,2 and stomatodaeum,3 . Endodermal lining of foregut differentiates into : -Part of nasal cavity -Endodermal lined part of buccal cavity -Pharynx, with glands and other structures like thymus pharyngotympanic tube, tonsils, middle ear etc -Larynx, tracheobronchial tree -Oesophagus, stomach, duodenum…… 4

Branchial System : 

Branchial System Branchial System- 6 pairs of pharyngeal arches separated by endodermally lined pouches and ectodermally lined clefts Each arch consists of a nerve, artery, and cartilaginous structures The remaining neck musculature gains contributions from cervical somites 5

Slide 6: 

Maxillary and mandibular (Meckel’s) process regress to form the malleus and incus Ossification of maxillary process forms maxilla ,premaxilla ,zygomatic bone and part of temporal bone Ossification around Meckel’s cartilage gives rise to Mandible ,sphenomandibular ligament,and anterior malleolar ligaments Muscle : .temporalis, .masseter, .pterygoids, .mylohyoid (mus. Of mastication) .ant belly of digastric,.tensor tympani,.tensor veli palatini Nerve: - mandibular br of CN. V Pouch: dorsal part of pouch forms .Eust tube, middle ear .Temporal bone Cleft: .EAC/TM 6 First Branchial Arch

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Reichert’s cartilage contributes to: superstructure of the stapes upper body and lesser cornu of the hyoid styloid process and stylohyoid ligament. Muscles: platysma muscles of facial expression posterior belly of digastric stylohyoid stapedius Nerve- 7th cranial nerve Artery- stapedial artery Pouch:dorsal part forms Eust. Tube, ventral part forms palatine tonsil 7 Second Branchial Arch

Third Branchial Arch : 

Third Branchial Arch Lower body of the hyoid and greater cornu Muscles: .stylopharyngeus .superior & middle pharyngeal constrictors. Nerve- 9th cranial nerve(Glossopharyngeal N.) Artery: .common carotid .proximal portions of the internal and external carotid Pouch . Inferior parathyroids(dorsal part) . Thymus gland and thymic duct(ventral part) 8

Fourth Branchial Arch : 

Fourth Branchial Arch 9 Fourth and Sixth Branchial arches fuse to form the laryngeal cartilages. Fourth Arch Muscles- cricothyroid, inferior pharyngeal constrictors Nerve- Superior Laryngeal Nerve Artery- Right Subclavian, Aortic arch Pouch- - superior parathyoid glands -parafollicular thyroid cells(along with fifth pharyngeal pouch)

Sixth Branchial Arch : 

Sixth Branchial Arch 10 Muscles- remaining/intrinsic laryngeal musculature Nerve- Recurrent Laryngeal Nerve Artery- Pulmonary Artery and ductus arteriosus

PHARYNX : 

PHARYNX Size- 12-13 cm (approx. 5 inches) The pharynx is divided into three parts: - Nasopharynx - Oropharynx - laryngopharynx. Pharyngeal wall a] Mucosa b] Submucosa c] Pharyngiobasilar fascia d] Muscular coat e] Buccopharyngeal fascia 11

NASOPHARYNX : 

NASOPHARYNX - Extends from the bony base of the skull to the soft palate BOUNDARIES: Anterior wall - choanae, through which the nasopharynx communicates with the nasal cavity Roof - the lower wall of the sphenoid sinus,base of skull Posterior wall – arch ofAtlas vertebra and prevertebral M. Floor – ant. by soft palate , def. post. Lateral wall - orifices of the Eustachian tubes, bordering on the pharyngeal recess (fossa of Rosenmüller) 12

PHARYNGEAL RECESS(FOSSA OF ROSENMULLER) : 

PHARYNGEAL RECESS(FOSSA OF ROSENMULLER) Behind the ostium of the auditory tube is a deep recess, the pharyngeal recess At the base of this recess is the retropharyngeal lymph node (the Node of Rouvier) Clinical significance: Nasopharyngeal cancer 13

Slide 14: 

Epithelial lining of Nasopharynx : ciliated columnar epithelium Nerve supply : pharyngeal br. Of pterygopalantine ganglion Function of Nasopharynx : 1. Acts as conduit for air 2. Ventilates middle ear 3. Elevation of soft palate against post. Pharyngeal wall and Passavant’s ridge[mucosal ridge raised by fibers of Palatopharyngeus] helps cut of nasopharynx from oropharynx. 14

OROPHARYNX : 

OROPHARYNX The oropharynx extends from the soft palate to the edge of the epiglottis BOUNDARIES: Posterior wall- 2nd and 3rd cervical vertebrae Anteror wall- Oral cavity , through the fauces Lateral wall- the tonsils surrounded by the pharyngeal arches as well as the two fossa between the root of the tongue and the epiglottis 15

Slide 16: 

Function of Oropharynx: 1. Common pathway for food and air 2. Speech resonance[articulation of vowels] 3. Deglutition[ 2nd pharyngeal phase of swallo wing] 4. Reflex action[ coughing, sneezing,vomiting] 5. Drainage of mucus from nasopharynx Epithelium : lined by stratified squamous nonkeratinised epi. Nerve supply: Pharyngeal plexus 16

LARYNGOPHARYNX(HYPOPHARYNX) : 

LARYNGOPHARYNX(HYPOPHARYNX) Lowest part of the pharynx, extending from the upper edge of the epiglottis to the lower edge of the lamina of the cricoid cartilage. BOUNDARIES: Anteror wall- laryngeal inlet and post. Surface of cricoid and arytenoid cartilage. Posterior wall- 3rd to 6th cervical vertebrae. Lateral wall- Piriform fossa on both sides 17

Slide 18: 

Laryngopharynx includes three major sites: .pyriform sinus .post-cricoid area (common site of carcinoma in females suffering from Plummer-Vinson syndrome) .posterior pharyngeal wall 18

Slide 19: 

Function of Hypopharynx: hypopharynx serves as a passageway for food and air Epithelium: stratified squamous epithelium Nerve supply: pharyngeal plexus 19

Relations Of Pharynx : 

Relations Of Pharynx 20

Slide 21: 

The Lymphoid Tissue of Pharynx 21

Slide 22: 

THE PALATINE TONSILS A pair of lymphoid tissue lying on either side of oropharynx Medial surface covered by mucous membrane showing 8-30 crypts The largest being CRYPTA MAGNA EPITHELIUM- Non keratinized stratified squamous 22

Slide 23: 

Bed of Palatine Tonsil a] The Pharyngobasilar fascia b] Superior constrictor and palatopharyngeus muscle c] Buccopharyngeal fascia d] Styloslossus in lower part e] Glossopharyngeal nerve 23

Slide 24: 

Blood supply of Tonsil ARTERIAL DRAINAGE: . Tonsilar br. Of Facial A.[main source] . Ascending palatine br. Of Facial A. . Dorsal lingual br. Of Lingual A. . Ascending pharyngeal br. Of ECA. . Decending palatine br. Maxillary A. VENOUS DRAINAGE: To paratonsillar v. to facial v. to common facial v. to IJV LYMPHATICS: Drain to Juglodigastric node. NERVE SUPPLY: Glossopharyngeal N. and Lesser palatine N. Paratonsilar V. can be injured during Tonsillectomy. 24

WALDEYER’S RING : 

WALDEYER’S RING 25

Muscular coat of Pharynx : 

Muscular coat of Pharynx 26

Slide 27: 

Outer Circular Layer: - Superior constrictor - Middle constrictor - Inferior constrictor[ Thyropharyngeal and Cricopharngeal part] . Inner Longitudinal layer: -stylopharyngeus -salpingopharyngeus -palatopharyngeus 27

Applied Anatomy : 

Applied Anatomy Sinus of Morgagni Space at the upper back part of each side of the pharynx where the walls are deficient in muscular fibers between the upper border of the superior constrictor and the base of the skull and closed only by the aponeurosis of the pharynx Passavant’s ridge Prominence on the posterior wall of the nasopharynx formed by contraction of the superior constrictor of the pharynx during swallowing Killian’s dehiscence . at the posterior wall of the pharynx between the diagonal and horizontal inferor constrictor muscle fascicles, a triangular hiatus occurs called killian’s triangle, the place where Zenker’s diverticulum, a diverticulum of the mucosa of the lower pharynx typically occurs 28

Killian’s Dehiscence : 

Killian’s Dehiscence 29

Structures Entering Pharynx : 

Structures Entering Pharynx Above superior constrictor and base of skull Eustachian tube Ascending palatine A. Levator palati Between middle and superior constrictor Stylopharyngeus M Glossopharyngeal N Between middle and inf constrictor Internal laryngeal N Sup laryngeal vessels Below inf constrictor Recurrent laryngeal N Inf laryngeal A 30

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NERVE SUPPLY OF PHARYNX MOTOR SENSORY Mainly arise from Cranial Division of Acc. Nerve, except stylopharyngeus m. supplied by Glossopharyngeus n. Via Glossopharyngeal Nerve. Autonomic Via Vagus N. 31

…To Conclude : 

…To Conclude Pharynx: Muscular tube Specific points to remember Fossa of rosenmuller Waldeyer’s ring Sinus of morgagni Killian’s Dehiscence

Slide 33: 

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