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PHARYNX
MAJ DR RISHI POKHREL
NAIHS
33 y old lady with
• c/o
– Discomfort and foreign body sensation in throat
since 2 days
• o/e
– an orange seed found embedded in ‘piriform
fossa’
• What precaution should be taken while
removing it?
PHARYNX
• Fibromuscular tube lined with
mucous membrane
• extends from base of skull to
lower border of cricoid cartilage
(C-6).
• 12-14 cm long
• At lower border of cricoid -
continues with esophagus
• Passage for respi & digestive tracts
PHARYNX
• Presents openings of
– auditory tubes
– two posterior nares
– larynx
– Esophagus
• Contains
– pharyngeal tonsils
– palatine tonsils
– lingual tonsils
– Tubal tonsils
Bony landmarks
Parts
Layers in pharyngeal wall
• Mucosa & submucosa
• Pharyngobasilar fascia
• Longitudinal muscles
• Circular muscles – constrictors
• Pharyngeal plexus of veins & nerves
• Buccopharyngeal fascia
Pharyngeal Fascia
• Separated into 2 layers, pharyngeal
muscles sandwiched between them
• Thick pharyngobasilar fascia inside
• Thin buccopharyngeal fascia outside
• Reinforces the pharyngeal wall
Pharyngeal Fascia
NASOPHARYNX
• Part of respiratory
tract – mucosa?
• Behind the nasal cavity
• Above and behind soft
palate.
• Communicates
through pharyngeal
isthmus with
oropharynx.
NASOPHARYNX• Opening of PT tube ½”
behind and at the level of
INC
• guarded by tubal elevation
• Salpingopharyngeal fold -
posterior margin of tubal
elevation to side-wall of
pharynx downwards.
• Salpingopharyngeus
• Behind salpingopharyngeal
fold - pharyngeal recess.
• Under mucous membrane
- nasopharyngeal tonsil.
Pharynx
• Behind mouth and
tongue.
• common to both
respiratory and digestive
systems
• Oropharyngeal isthmus
• Posterior wall is smooth
• Lateral walls shows
palatine tonsils between
palatoglossal and
palatopharyngeal arches.
OROPHARYNX
LARYNGOPHARYNX
• Behind larynx
• upper part - common to
digestive & respi tracts
• lower part continues with
esophagus
• Anterior & posterior walls
approximated except when
food is passing
LARYNGOPHARYNX
• Posterior wall and side - walls
are smooth.
• Anterior wall from above
downwards presents
– epiglottis
– aryepiglottic folds
– Arytenoids & cricoid
– inlet of larynx
– piriform fossa
• Anterior wall - back of larynx.
Pharynx
Muscles of pharynx
• Differ from rest GIT
• Skeletal muscles
• longitudinal muscles are placed inside
• circular muscles (constrictors) are incomplete
anteriorly & arranged in three layers
overlapping each other
Pharynx
Pharynx
Muscles of pharynx
Constrictors of pharynx
• Superior constrictor - attached to pharyngeal
tubercle, lowest fibers reach up to level of
vocal cords
• Middle constructor arises from stylohyoid
ligament, lesser and greater cornu of hyoid,
overlap SC and reach upto level of vocal cords.
• Inferior constrictor has two parts:
thyropharyngeus & cricopharyngeus
• Thyropharyngeus overlaps MC
• Cricopharyngeus continues with other side
Pharynx
longitudinal muscles
• Stylophryngeus, Salpingopharyngeus and
Palatopharyngeus
• Attached to posterior border of thyroid
cartilage
• Help in 2nd stage of deglutition by lifting the
pharynx
Pharynx
Structures b/w constrictors
• Base of skull & SC (space of
Morgagni): auditory tube &
tensor & levator palati.
• SC & MC : Stylophryngeus
and IX CN
• MC & IC: Superior laryngeal
nerve and vessels
• IC & esophagus: recurrent
laryngeal N & inferior
laryngeal vs.
Longitudinal muscles of pharynx and
spaces between them
Tonsils
• Pharyngeal tonsil (adenoids): midline on the
roof of the nasopharynx;
• Palatine tonsils: on each side of the
oropharynx between the palatoglossal and
palatopharyngeal arches
• Lingual tonsil : posterior one-third of the
tongue.
• Tubal tonsil: pharyngotympanic tube near its
opening into the nasopharynx, and on the
upper surface of the soft palate.
Pharynx
Pharynx
Blood supply - ECA
• Ascending
pharyngeal A
• Ascending palatine
and tonsillar
branches of facial A
• Maxillary & lingual A
Veins
• Superiorly:
pterygoid plexus
in infratemporal
fossa
• Inferiorly: facial
and IJV
Lymphatics
• deep cervical nodes:
retropharyngeal
paratracheal &
infrahyoid nodes
• Palatine tonsils :
jugulodigastric nodes
(inferior to posterior
belly of digastric muscle)
Find out
• Passavant’s ridge
• Killian’s dehiscence
• Palatine tonsil
• Physiology of deglutition

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Quality Improvement Programme to Creating Quality Culture in India through La...Quality Improvement Programme to Creating Quality Culture in India through La...
Quality Improvement Programme to Creating Quality Culture in India through La...
Dr Jitu Lal Meena
 

Pharynx

  • 1. PHARYNX MAJ DR RISHI POKHREL NAIHS
  • 2. 33 y old lady with • c/o – Discomfort and foreign body sensation in throat since 2 days • o/e – an orange seed found embedded in ‘piriform fossa’ • What precaution should be taken while removing it?
  • 3. PHARYNX • Fibromuscular tube lined with mucous membrane • extends from base of skull to lower border of cricoid cartilage (C-6). • 12-14 cm long • At lower border of cricoid - continues with esophagus • Passage for respi & digestive tracts
  • 4. PHARYNX • Presents openings of – auditory tubes – two posterior nares – larynx – Esophagus • Contains – pharyngeal tonsils – palatine tonsils – lingual tonsils – Tubal tonsils
  • 7. Layers in pharyngeal wall • Mucosa & submucosa • Pharyngobasilar fascia • Longitudinal muscles • Circular muscles – constrictors • Pharyngeal plexus of veins & nerves • Buccopharyngeal fascia
  • 8. Pharyngeal Fascia • Separated into 2 layers, pharyngeal muscles sandwiched between them • Thick pharyngobasilar fascia inside • Thin buccopharyngeal fascia outside • Reinforces the pharyngeal wall
  • 10. NASOPHARYNX • Part of respiratory tract – mucosa? • Behind the nasal cavity • Above and behind soft palate. • Communicates through pharyngeal isthmus with oropharynx.
  • 11. NASOPHARYNX• Opening of PT tube ½” behind and at the level of INC • guarded by tubal elevation • Salpingopharyngeal fold - posterior margin of tubal elevation to side-wall of pharynx downwards. • Salpingopharyngeus • Behind salpingopharyngeal fold - pharyngeal recess. • Under mucous membrane - nasopharyngeal tonsil.
  • 13. • Behind mouth and tongue. • common to both respiratory and digestive systems • Oropharyngeal isthmus • Posterior wall is smooth • Lateral walls shows palatine tonsils between palatoglossal and palatopharyngeal arches. OROPHARYNX
  • 14. LARYNGOPHARYNX • Behind larynx • upper part - common to digestive & respi tracts • lower part continues with esophagus • Anterior & posterior walls approximated except when food is passing
  • 15. LARYNGOPHARYNX • Posterior wall and side - walls are smooth. • Anterior wall from above downwards presents – epiglottis – aryepiglottic folds – Arytenoids & cricoid – inlet of larynx – piriform fossa • Anterior wall - back of larynx.
  • 17. Muscles of pharynx • Differ from rest GIT • Skeletal muscles • longitudinal muscles are placed inside • circular muscles (constrictors) are incomplete anteriorly & arranged in three layers overlapping each other
  • 21. Constrictors of pharynx • Superior constrictor - attached to pharyngeal tubercle, lowest fibers reach up to level of vocal cords • Middle constructor arises from stylohyoid ligament, lesser and greater cornu of hyoid, overlap SC and reach upto level of vocal cords. • Inferior constrictor has two parts: thyropharyngeus & cricopharyngeus • Thyropharyngeus overlaps MC • Cricopharyngeus continues with other side
  • 23. longitudinal muscles • Stylophryngeus, Salpingopharyngeus and Palatopharyngeus • Attached to posterior border of thyroid cartilage • Help in 2nd stage of deglutition by lifting the pharynx
  • 25. Structures b/w constrictors • Base of skull & SC (space of Morgagni): auditory tube & tensor & levator palati. • SC & MC : Stylophryngeus and IX CN • MC & IC: Superior laryngeal nerve and vessels • IC & esophagus: recurrent laryngeal N & inferior laryngeal vs.
  • 26. Longitudinal muscles of pharynx and spaces between them
  • 27. Tonsils • Pharyngeal tonsil (adenoids): midline on the roof of the nasopharynx; • Palatine tonsils: on each side of the oropharynx between the palatoglossal and palatopharyngeal arches • Lingual tonsil : posterior one-third of the tongue. • Tubal tonsil: pharyngotympanic tube near its opening into the nasopharynx, and on the upper surface of the soft palate.
  • 30. Blood supply - ECA • Ascending pharyngeal A • Ascending palatine and tonsillar branches of facial A • Maxillary & lingual A
  • 31. Veins • Superiorly: pterygoid plexus in infratemporal fossa • Inferiorly: facial and IJV
  • 32. Lymphatics • deep cervical nodes: retropharyngeal paratracheal & infrahyoid nodes • Palatine tonsils : jugulodigastric nodes (inferior to posterior belly of digastric muscle)
  • 33. Find out • Passavant’s ridge • Killian’s dehiscence • Palatine tonsil • Physiology of deglutition