anatomy & physiology of pharynx
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Anatomy of PharynxDr. B. Arvind Sangavi
M.S.(ENT)Associate ProfessorDept of ENT & HNS
RIMS
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PharynxPharynx is a conical fibromuscular tube
forming upper part of aero-digestive tract12-14 cms, extends from base of skull to
lower border of cricoid cartilage (C6).Width is 3.5 cms at base & 1.5 cms at
pharyyngo-oesophageal junction, which is the narrowest part in GIT.
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Mucous membranePharyngeal aponeurosis / Pharyngobasilar fascia
Muscular coatBuccopharyngeal fasciaCiliated columnar in nasopharynx &
stratified squamous in rest of pharynx
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Killian’s dehiscenceInferior constrictor muscle- thyropharyngeus –oblique fibres
cricopharyngeus – transverse fibresPotential gap- Killian’s Dehiscence“Gateway of tears” – perforation can occur at
this site during oesophagoscopy.Pharyngeal pouch- herniation of pharyngeal
mucosa
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Waldeyer’s RingSubepithelial layer of lymphoid tissueNasopharyngeal tonsil/adenoidsPalatine tonsilTubal tonsilLateral pharyngeal bandsNodules-posterior pharyngeal wall
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Pharyngeal SpacesRetropharyngeal space- from base
of skull to bifurcation of trachea between buccopharyngeal fascia & prevertebral fascia. Divided by median raphe into two (space of Gillette)
Prevertebral space - between vertebral bodies & prevertebral fascia, extends from base of skull to coccyx
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Parapharyngeal spaceMedial: buccopharyngeal fascia covering
constrictorsPosterior: prevertebral fasciaLateral: medial pterygoid muscle,
mandible.Styloid complex- divides into anterior &
posterior compartment. Antr- tonsillar fossa medially & pterygoid
muscle laterally Postr- pharyngeal wall med & parotid
laterally. Carotid art, jugular vein, IX, X, XI, XII CN, & nodes
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PharynxNasopharynx, Oropharynx & HypopharynxNasopharynxEpipharynx: from base of skull to plane
passing through hard palateRoof: basisphenoid & basiocciputPosterior wall: atlas vertebra with musclesFloor: anteriorly soft palate & posteriorly
communicates with the oropharynx through nasopharyngeal isthmus
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Lateral wall: E.tube 1.25cms behind IT Torus tubaris- elevation behind tubal opening Fossa of Rosenmuller- site for origin of
Nasopharyngeal Carcinoma Salpingopharyngeal foldTubal tonsil: part of Waldeyer’s ring
Adenoids-Nasopharyngeal tonsil upto12 years, later atrophies
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Nasopharyngeal bursaEpithelial lined median recess within adenoids
Extends from pharyngeal mucosa to basiocciput
Represents attachment of notochord to pharyngeal entoderm during embryonic life
Infection – persistent postnasal discharge
Thornwaldt’s disease- abscess
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Rathke’s pouch: remniscent of buccal mucosal invagination,forming antr lobe of pituitary. Craniopharyngioma may arise from this site
Sinus of Morgagni: space between base of skull & upper free border of superior constrictor . E.tube, tensor veli palatine, levator veli paltine enters along with ascending palatine artery br of facial artery
Passavant’s ridge: mucosa ridge raised by palatopharyngeus. Deglutition, cuts off NP from OP
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Lined by pseudostratified ciliated columnar epithelium
Lymphatics drain into upper deep cervical nodes either directly or thro’ retro/parapharyngeal nodes
FunctionsConduit of humidified air into larynx/tracheaVentilates ME thro’ E.tube, equalizes air
pressure.Cuts off oropahrynx during deglutition, vomiting,
speechResonating chamberDrainage channel for mucous secreted by nasal
glands
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Oropharynx Extends from plane of hard palate above to plane of
hyoid bone belowCommunicates with oral cavity thro’ oropharyngeal
isthmus.Posterior wall: related to retropharyngeal space, C2-C3Anterior wall: above opens into oral cavity, & below
related to base of tongue, lingual tonsil, valleculaeLateral wall: anterior & posterior pillars, faucial tonsilLower limit is by upper border of epiglottis &
pharyngoepiglottic folds
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Lymphatics drain into upper jugular chain-JD nodes, also to retro & para pharyngeal nodes.
FunctionsConduit for passage of air & foodPharyngeal phase of deglutitionVocal tract for certain speech soundsTaste sensation-BOT, soft palate, pillars,
PP wallLocal defence & immunity at entrance of
aerodigestive tract- Waldeyer’s ring
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Hypopharynx (Laryngopharynx)It lies behind & sides of larynxExtends from plane passing from hyoid
bone to lower border of cricoid cartilage, (C3-C6).
Three regions: Pyriform sinus, post cricoid region & posterior pharyngeal wall.
Pyriform fossa: either side of larynx. Internal laryngeal nerve runs submucosally in lat wall, cause referred pain in carcinoma
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Post-cricoid region: cricoid lamina, site for carcinoma in pt’s with Plummer-Vinson syndrome
Posterior pharyngeal wall: from level of hyoid bone to crcoarytenoid joint.
Lymphatic drainage: upper jugular chain, parapharyngeal nodes, supraclavicular.
Functions:Conduit for air & food, Vocal tract resonanceTakes part in deglutitionFailure of cricopharyngeal sphincter to relax
when pharyngeal muscles contract- hypopharyngeal diverticulum
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Structures passing throughAbove superior constrictorE.tube, tensor palati, levator palati musclesPalatine br ascending pharyngeal arteryBetween superior & middle constrictorStylopharyngeus muscle, glossopharyngeal nBetween middle & inferior constrictorInternal laryngeal n, superior laryngeal vessels.Below inferior constrictorRecurrent laryngeal nerve, inferior laryngeal
art
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Blood supply: branches of external carotid artAscending pharyngeal, Dorsal lingual arteryAscending palatine & tonsillar arteryBranches of internal maxillary arteryNerve supply: pharyngeal plexus formed byPharyngeal br of vagus & glossopharyngealPharyngeal br of superior cervical
sympathetic ganglionVagal fibres are motor, glossopharyngeal is
sensory & sympathetic is vasomotor
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Functions of PharynxDeglutitionProtection from aspirationPart of respiratory & food passageSpeech adds resonance to the voiceWaldeyer’s ring is involvedTaste sensationMucous from respiratory tract is
swallowedE.tube ventilates & drains the middle ear
cleft
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