pharynx

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Presentation Description

anatomy of pharynx, muscles, blood supply,nerve supply & applied anatomy of pharynx

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Presentation Transcript

THE PHARYNX : 

THE PHARYNX

Anatomy of The pharynx Site : 

Anatomy of The pharynx Site Midline of the neck From skull base to esophagus In front of upper 6 Cervical vertebra Behind : The Nose The Mouth The larynx Seen from behind

Anatomy of The pharynx Shape : 

Anatomy of The pharynx Shape Irregular Fibromuscular tube lined by mucous membrane Length: 15 cm Extends from the base of the skull to level of the 6th cervical vertebra

RELATIONS : 

RELATIONS

Pharynx : 

Pharynx The anterior wall is deficient and shows (from above downward): Posterior nasal apertures Opening of the oral cavity Laryngeal inlet N OC L

Slide 9: 

Nasopharynx Oropharynx Laryngopharynx (Hypopharynx) Seen from lateral

Division : 

Division Pharynx is divided into three parts: Nasopharynx: Superior part, communicates with the nasal cavity through posterior nasal apertures Oropharynx: Middle part, communicates with the oral cavity through the oropharyngeal isthmus Laryngopharynx: Inferior part, communicates with the larynx through the laryngeal inlet

Nasopharynx : 

Nasopharynx Boundaries: Roof: body of sphenoid & basal part of the occipital bone. Pharyngeal tonsils (adenoides) present in the submucosa Floor: upper surface of soft palate & the pharyngeal isthmus (opening between the free margin of soft palate and posterior pharyngeal wall)

Slide 12: 

Anterior wall: shows posterior nasal apertures Posterior wall: supported by anterior arch of atlas (C1) Lateral wall shows: Opening of auditory tube Tubal elevation (produced by posterior margin of tube) Pharyngeal recess Tubal tonsil Salpingopharyngeal fold (raised by salpingo-pharyngeus muscle)

Oropharynx : 

Oropharynx Behind the oral cavity (in front of 2nd&3rd Cervical vertebra) From the soft palate superiorly to tip of epiglottis inferiorly Communicates: Anteriorly with the oral cavity Superiorly with the nasopharynx Inferiorly with the hypopharynx The paatine tonsils lie laterally between the anterior and posterior pilars

Slide 14: 

The anterior pillar formed by palatoglossus muscle The posterior pillar formed By palatopharyngeus m The tonsils lie between the Two pillars

Oropharynx : 

Oropharynx Lies behind the mouth Extends from soft palate to upper border of epiglottis Boundaries: Roof: soft palate and pharyngeal isthmus Floor: posterior one third of tongue, median & lateral glossoepiglottic folds, and the valleculae

Slide 16: 

Anterior wall: opening of the oral cavity Posterior wall: supported by body of C2 and upper part of body of C3 vertebra Lateral wall shows: Palatopharyngeal folds posterior to the palatoglossal folds. Palatine tonsil located between them in the Tonsillar fossa

Hypopharynx : 

Hypopharynx Behind the Larynx (in front of 3rd to 6th Cervical vertebra) From the tip of epiglottis superiorly to the lower border of cricoid cartilage Inferiorly Communicates: Anteriorly with the Larynx Superiorly with the oropharynx Inferiorly with the esophagus

Slide 19: 

The hypopharynx does not only lie behind the larynx BUT also Projects laterally on each side of the larynx So it is formed of : Postcricoid region ( behind the larynx) Two pyriform fossa (on each side of the larynx Seen from behind Cross section

Piriform Fossa : 

Piriform Fossa A small depression situated on either side of the laryngeal inlet Leads obliquely backward and downwrd from the region of the back of the tongue to the esophagus It is a common site for the lodging of foreign bodies Bounded: Medially by the aryepiglottic fold Laterally by the lamina of thyroid cartilage & the thyrohyoid membrane. Branches of internal laryngeal (& recurrent laryngeal) nerve lie deep to the mucous membrane of the fossa and are vulnerable to injury during removal of a foreign body

Anatomy of The pharynx Structure : 

Anatomy of The pharynx Structure The wall is formed of 4 layers 1-Mucous membrane 2- pharyngeal aponeurosis 3-muscle layer 4-Bucco-pharyngeal fascia Stratified squamous epithelium except the nasopharynx, it is pseudo-stratified with goblet cells Loose connective tissue which contains lymphoid tissue that aggregates in some areas forming tonsils (Waldayer’s ring) Formed of 3 muscles, superior middle and inferior constrictor muscles A thin coat of connective tissue

Pharyngeal Wall : 

Pharyngeal Wall It is a musculo-membranous wall, composed of: Mucosa & submucosa Pharyngobasilar fascia Muscles: circular & longitudinal Buccopharyngeal fascia The buccopharyngeal fascia is separated from the prevertebral fascia by the retropharyngeal space.

Circular (Constrictor) Muscles : 

Circular (Constrictor) Muscles Three in number: Superior, Middle & Inferior Extend around the pharynx and are inserted posteriorly into a fibrous raphe that extends from the pharyngeal tubercle on the occipital bone to the esophagus The three muscles overlap each other The gap between the superior border of the superior constrictor and the occipital bone is filled by thickened pharyngobasilar fascia M S I

Slide 24: 

Superior constrictor Origin: medial pterygoid plate, pterygoid hamulus, pterygomandibular ligament, mylohyoid line Insertion: pharyngeal tubercle, pharyngeal raphe Middle constrictor Origin: lower part of stylohyoid ligament, greater & lesser cornu of hyoid bone Insertion: pharyngeal raphe

Slide 26: 

Inferior constrictor Origin: lamina of thyroid cartilage, cricoid cartilage Insertion: pharyngeal raphe Functions: The constrictor muscles propel the bolus of food down into the esophagus Cricopharygeus (lower fibers of the inferior constrictor) act as a sphincter, preventing the entry of air into the esophagus between the acts of swallowing

Zenker’s diverticulum : 

Zenker’s diverticulum

Longitudinal Muscles : 

Longitudinal Muscles Three in number: Stylopharyngeus Salpingopharyngeus Palatpharyngeous Function: Elevate the larynx & pharynx during swallowing

Slide 31: 

Stylopharyngeus Origin: styloid process Insertion: posterior border of thyroid cartilage Salpingopharyngeus Origin: auditory tube Insertion: blends with palatoglossus Palatopharyngeus Origin: palatine aponeurosis Insertion: posterior border of thyroid cartilage

Blood supply : 

Blood supply From the External Carotid Artery & its branches 1- Tonsillar artery (from Facial Artery) 2-Ascending palatine artery (from Facial Artery) 3-Ascending pharyngeal Artery (from external carotid) 4-Descending palatine artery ( from Maxillary artery. 5-Dorsalis lingulae artery (from Lingual artery)

Nerve Supply : 

Nerve Supply Motor ---► X Except : Stylopharyngeus --►IX Sensory --► Nasopharynx: V Oropharynx: IX Laryngopharynx: X Autonomic: sympathetic: SCG Parasympathetic: through VII

Clinical Notes : 

Clinical Notes Adenoides (enlarged pharyngeal tonsils) & adenoidectomy. Adenoids results in obstruction to nasal breathing and make mouth breathing necessary. The patient develops a typical facial expression called the ‘adenoid facies’. May also cause impaired hearing Otitis media (middle ear infection), secondary to infection of nasopharynx Tonsillitis & Tonsillectomy Adenoid facies

Slide 40: 

Peritonsillar abcess (quinsy), is a complication of tonsillitis and consists of a collection of pus beside the tonsil (peritonsillar space). Piriform fossa: a common site for the lodging of foreign bodies Pharyngeal pouch, posteromedial herniation of mucosal diverticulum between thyropharyngeal and cricopharyngeal parts of the inferior constrictor muscle leading to dysphagia (difficulty in swallowing) . It occurs mainly in older people Retropharyngeal abcess , may spread to the superior mediastinum

Swallowing (Deglution) : 

Swallowing (Deglution)

Stages of Swallowing (Deglutition) : 

Stages of Swallowing (Deglutition) Oral stage (voluntary) Pharyngeal stage Esophageal stage

Slide 46: 

Thank You