1/13/2009

1

Anatomy & PhysiologyAnatomy & PhysiologyAnatomy & Physiology Anatomy & Physiology of the Pharynxof the Pharynx

Emad A. Magdy, M.D.Emad A. Magdy, M.D.Emad A. Magdy, M.D.Emad A. Magdy, M.D.Assistant Professor,Assistant Professor,

Department of Otorhinolaryngology,Department of Otorhinolaryngology,Faculty of Medicine, Alexandria University.Faculty of Medicine, Alexandria University.

Regions of the PharynxRegions of the Pharynx

Posterior Choana

Hard Palate

Hyoid bone

Lower border of Cricoid cartilage

Emad A. Magdy, M.D.

1/13/2009

2

Regions of the PharynxRegions of the Pharynx

Emad A. Magdy, M.D.

NASOPHAYNXNASOPHAYNX

Emad A. Magdy, M.D.

1/13/2009

3

Relationships of NasopharynxRelationships of Nasopharynx

Emad A. Magdy, M.D.

Lateral wall of NasopharynxLateral wall of Nasopharynx

Fossa of Rosenmuller

Tubal elevation(Torus tubarius)

Salpingopharyngeal fold

ET orifice(1.5 cm behind post. end of IT)

Salpingopharyngeal fold

Salpingopalatine fold

Emad A. Magdy, M.D.

1/13/2009

4

Lateral wall of NasopharynxLateral wall of Nasopharynx

Levator palati muscle

Salpingopharyngeus muscle

Emad A. Magdy, M.D.

OROPHAYNXOROPHAYNX

Emad A. Magdy, M.D.

1/13/2009

5

PARTS OF OROPHAYNXPARTS OF OROPHAYNX

Sup. wall:Sup. wall: Soft palate & Soft palate & p wp w ppUvula.Uvula.Lat. wall:Lat. wall: Ant. & Post. pillars Ant. & Post. pillars +Tonsillar fossae & Palatine +Tonsillar fossae & Palatine Tonsils. Tonsils. Ant. wall:Ant. wall: Tongue base (&Tongue base (&Ant. wall:Ant. wall: Tongue base (& Tongue base (& lingual tonsils) + Valleculae.lingual tonsils) + Valleculae.Post. wall:Post. wall: extends from soft extends from soft palate to tip of epiglottis.palate to tip of epiglottis.

Emad A. Magdy, M.D.

Lateral wall of OropharynxLateral wall of Oropharynx

Palatoglossus muscle (Anterior pillar)

Palatine Tonsil

Palatopharyngeus muscle (Posterior pillar)

Emad A. Magdy, M.D.

1/13/2009

6

OROPHAYNXOROPHAYNX

Velopharyngeal isthmusVelopharyngeal isthmus

Oropharyngeal isthmus

Emad A. Magdy, M.D.

Physiological considerationsPhysiological considerations

Velopharyngeal sphincter:Velopharyngeal sphincter:Cl f th hi tCl f th hi t lik h i b t th hlik h i b t th hClosure of the sphincterClosure of the sphincter--like mechanism between the oropharynx like mechanism between the oropharynx & nasopharynx is essential for normal & nasopharynx is essential for normal deglutition deglutition && speechspeech..

It is effected by combined:It is effected by combined:-- PosteroPostero--superior movement of the soft palate.superior movement of the soft palate.-- Medial movement of the lat. ph. walls.Medial movement of the lat. ph. walls.Medial movement of the lat. ph. walls.Medial movement of the lat. ph. walls.-- Slight anterior movement of post. ph. wall (Slight anterior movement of post. ph. wall (Passavant’s ridgePassavant’s ridge))

The The uvulauvula plays an important role in the perfection of this closure.plays an important role in the perfection of this closure.

Emad A. Magdy, M.D.

1/13/2009

7

Physiological considerationsPhysiological considerations

Functions of the Oropharynx:Functions of the Oropharynx:1.1. Common pathway for food & air.Common pathway for food & air.

2.2. Respiratory function (Patent pathway between nose & larynx).Respiratory function (Patent pathway between nose & larynx).

3.3. Reflex actions (sneezing, coughing & vomiting).Reflex actions (sneezing, coughing & vomiting).

4.4. Speech resonance (articulation of vowels).Speech resonance (articulation of vowels).dd5.5. Deglutition (2Deglutition (2ndnd “pharyngeal” phase of swallowing).“pharyngeal” phase of swallowing).

6.6. Drainage of mucus from nasopharynx.Drainage of mucus from nasopharynx.

Emad A. Magdy, M.D.

The Palatine tonsilsThe Palatine tonsilsA pair of lymphoid tissue masses lying on either side of A pair of lymphoid tissue masses lying on either side of the oropharynx.the oropharynx.Normal tonsils are flush with the edges of the fauces.Normal tonsils are flush with the edges of the fauces.

Medial surface is covered by mucous Medial surface is covered by mucous membrane showing 8membrane showing 8--30 depressions 30 depressions (crypts).(crypts).

Th l (Th l ( ))

Emad A. Magdy, M.D.

The largest crypt (The largest crypt (crypta magnacrypta magna) separates ) separates the upper pole from the tonsillar body.the upper pole from the tonsillar body.

1/13/2009

8

The Palatine tonsilsThe Palatine tonsilsIts lateral (deep) surface is bounded by a fibrous tissue Its lateral (deep) surface is bounded by a fibrous tissue capsule,capsule, which separates the tonsil from its bed that is which separates the tonsil from its bed that is made up of:made up of:

Superior constrictor muscle.Superior constrictor muscle.Glossopharyngeal nerve.Glossopharyngeal nerve.Facial artery.Facial artery.Buccopharyngeal fascia.Buccopharyngeal fascia.

Emad A. Magdy, M.D.

The lower pole may extend to the The lower pole may extend to the BOT & become continuous with BOT & become continuous with the lingual tonsil.the lingual tonsil.

Blood supply of palatine tonsilsBlood supply of palatine tonsils

Tonsillar branch of Tonsillar branch of F i lF i l ( i )( i )Facial arteryFacial artery (main).(main).Ascending palatine a. Ascending palatine a. Dorsalis linguae a.Dorsalis linguae a.Descending palatine a.Descending palatine a.Ascending pharyngeal a.Ascending pharyngeal a.g p y gg p y g

Emad A. Magdy, M.D.

Lymphatic drainage:Lymphatic drainage:Upper deep cervical LNs (esp. the Jugulo-diagastric LN)

1/13/2009

9

Waldeyer’s RingWaldeyer’s RingDefinition:Ring of Lymphoid tissue guarding entrance to the digestive & respiratory tracts.I l i l i l i i f h i

1.1. Nasopharyngeal Nasopharyngeal Tonsil (Adenoid).Tonsil (Adenoid).

2.2. Tubal Tonsils.Tubal Tonsils.

It plays an important role in early recognition of pathogenic microorganisms & initiation of an immune response.

3.3. Palatine Tonsils.Palatine Tonsils.

4.4. Lingual Tonsils.Lingual Tonsils.

5.5. Lat. Pharyngeal bands.Lat. Pharyngeal bands.Emad A. Magdy, M.D.

HYPOPHAYNX HYPOPHAYNX (LARYNGOPHARYNX)(LARYNGOPHARYNX)

Emad A. Magdy, M.D.

1/13/2009

10

PARTS OF HYPOPHAYNXPARTS OF HYPOPHAYNXPosterior Pharyngeal wall

Post-cricoid region

Piriform fossaeEmad A. Magdy, M.D.

PARTS OF HYPOPHAYNXPARTS OF HYPOPHAYNX

Emad A. Magdy, M.D.

1/13/2009

11

Muscles ofMuscles ofMuscles of Muscles of Pharynx Pharynx

((Lateral viewLateral view))

Emad A. Magdy, M.D.

Constrictor muscles of PharynxConstrictor muscles of Pharynx

Emad A. Magdy, M.D.

1/13/2009

12

Constrictor muscles of PharynxConstrictor muscles of Pharynx

Emad A. Magdy, M.D.

Inferior constrictor muscle of PharynxInferior constrictor muscle of Pharynx

Emad A. Magdy, M.D.

1/13/2009

13

Nerve supply Nerve supply of the Pharynxof the Pharynxof the Pharynxof the Pharynx

Emad A. Magdy, M.D.

Nerve supply of the PharynxNerve supply of the Pharynx

Emad A. Magdy, M.D.

1/13/2009

14