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Where is the pharynx located?
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What is the pharynx divided into?
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Anatomy
Pharynx
| Question | Answer |
|---|---|
| Where is the pharynx located? | musculotendinous tube which extends from the base of the skull to the level of the C6 vertebra where it is continuous with the esophagus |
| What is the pharynx divided into? | 3 parts: nasopharynx, oropharynx, & laryngopharynx, which are open anteriorly via choanae (for nasopharynx), oropharyngeal isthmus (for oropharynx), & laryngeal inlet (for laryngopharynx) |
| Thus the wall of the pharynx form its ____ & ____ surfaces. | lateral; posterior |
| What 2 general functions does the pharynx serve? | both respiratory & digestive functions |
| Describe the passage of air starting from the nasal cavity: | from the nasal cavity into nasopharynx (and/or through the oral cavity and oropharynx during “mouth breathing”) and passes anteriorly to enter the larynx |
| Describe the passage of food starting from the oral cavity: | from the oral cavity, through the oropharynx and laryngopharynx, being propelled with the aid of the pharyngeal muscles, into the posteriorly lying esophagus, while the laryngeal inlet is closed by the epiglottis |
| What type of tissue are the walls of the pharynx abundant in and what is this important for? | lymphoid tissue; impt in sensing/reacting to Ag's entering thru nasal & oral cavities |
| Pharyngeal constrictors constitute the external, largely ____ layer of ____ muscle of the pharynx. | circular; skeletal |
| How many paired muscles meet their partner posteriorly on the median pharyngeal raphe? | 3 |
| Where does the pharyngeal raphe extend from and to? | from pharyngeal tubercle above to the lower limit of inferior constrictor below |
| What is the relationship of the 2 most inferior paired muscles w/ the constrictor above them? | the 2 most inferior paired muscles overlap the constrictor above them, thus having a relationship similar to stacked flower pots |
| What do these muscles do? | contract sequentially, from superior to inferior & propel food towards esophagus |
| superior constrictor | quadrilateral; anteriorly attaches to pterygoid hamulus of medial pterygoid plate, pterygomandibular raphe, mylohyoid line of mandible, and side of tongue; posteriorly, inserts into pharyngeal raphe & thru this to pharyngeal tubercle |
| pterygomandibular raphe | a tendinous structure extending from pterygoid hamulus to mylohyoid line of mandible & serving as common site of attachment for buccinator & superior pharyngeal constrictor muscles |
| middle constrictor: | fan-shaped muscle that arises from greater & lesser cornua of hyoid bone & inferior portion of stylohyoid ligament; its lower fibers descend deep to inferior constrictor muscle while upper fibers ascend and overlap superior constrictor muscle |
| inferior constrictor: | thickest of the constrictors; arises from oblique line of thyroid cartilage & cricoid cartilage; its fibers ascend as they sweep posteriorly, overlapping middle constrictor & ending in pharyngeal raphe; inf fibers designated as cricopharyngeus muscle |
| cricopharyngeus muscle: | tonically contracted until swallowing has begun--thus acting as a sphincter for upper esophagus |
| longitudinal/oblique muscles: | skeletal muscles whose fibers course internal to constrictor muscles; contraction of these muscles elevates pharynx which is impt during swallowing & in speech |
| stylopharyngeus: | narrow muscle that arises from medial aspect of base of styloid process; passes thru gap b/w superior & middle pharyngeal constrictor muscles; spreads out deep to pharyngeal mucosa, inserts into post/superior borders borders of thyroid cartilage of larynx |
| palatopharyngeus: | arching, narrow muscle that attaches to palatine aponeurosis of soft palate & post. border of hard palate; descends in lateral oropharynx wall, raising fold of mucosa (palatopharyngeal fold) |
| palatopharyngeus (cont'd): | inserts as thin, longitudinal layer in pharyngeal wall alongside stylopharyngeus; besides elevating pharynx, this muscle also assists in constricting opening of oropharyngeal isthmus |
| salpingopharyngeus: | small muscle that arises from inf. part of cartilage of auditory tube near its ostium & passes inferiorly to blend w/ fibers from palatopharyngeus |
| The act of swallowing relies on: | the coordinated action of muscles of tongue, soft palate & pharynx |
| As the bolus of food enters the oropharynx, the ____ & ____ muscles elevate the pharynx over the bolus. | stylopharyngeus & superior pharyngeal constrictor |
| How does the bolus then get sequentially moved inferiorly? | pharyngeal constrictors then sequentially move bolus inferior in a "stripping" pattern while palatopharyngeus & superior constrictor help to close off oropharynx & nasopharynx by opposing soft palate, tongue & posterior pharyngeal wall |
| What does the inferior portion of inferior constrictor do? | the inf portion of the inferior constrictor (the cricopharyngeus muscle) relaxes to allow the bolus to enter the esophagus |
| Where are the pharyngeal muscles? | sandwiched b/w 2 layers of fascia which help to reinforce the pharyngeal wall, esp. in areas where muscle layers are deficient |
| What is the buccopharyngeal fascia/ where does it attach? | external covering of pharynx & can be considered posterior portion of pretracheal fascia of neck; attaches superiorly to pharyngeal tubercle of occipital bone |
| What does buccopharyngeal fascia cover? | completely covers superior constrictor, attaching ant'ly to medial pterygoid plate, pterygomandibular raphe (extending ant'ly to cover buccinator); covers middle/inf constrictors, attaching to their attachment sites on hyoid/laryngeal cartilages |
| What lies posterior to buccopharyngeal fascia? | the clinically important retropharyngeal space |
| Where does pharyngobasilar fascia lie? | internal to pharyngeal muscles, forming strong fibrous submucosal layer |
| What are the attachments of pharyngobasilar fascia? | superiorly delineate the limits of pharyngeal wall; attaches to basilar portion of occipital bone ant to pharyngeal tubercle, extends laterally to attach to petrous portion of temporal bone, then turns forward to cartilage of auditory tube, GO 2 NEXT CARD |
| What are the attachments of pharyngobasila fascia (cont'd)? | medial pterygoid plate, & the pterygomandibular raphe; this fascia forms a significant supporting structure, esp above the superior, free border of superior constrictor muscle, an area called SINUS of MORGAGNI |
| What do the gaps b/w muscles in the pharyngeal wall allow? | for passage of vessels, nerves, & muscles into the pharynx |
| Superior to superior constrictor muscle is bridged by: | pharyngobasilar & buccopharyngeal fascia |
| What things pass through this gap? | levator veli palatini, pharyngotympanic tube, & ascending palatine & ascending pharyngeal arteries |
| Between superior & middle constrictor muscles pass: | stylopharyngeus, stylohyoid ligament, styloglossus, hyoglossus, lingual artery & vein, & glossopharyngeal nerve |
| Between middle & inferior constrictor muscles pass: | internal branch of superior laryngeal nerve & superior laryngeal artery & vein |
| Inferior to inferior constrictor muscle passes: | recurrent laryngeal nerve & inferior laryngeal artery & vein |
| The nasopharynx lies ______ to the choanae, ____ to the soft palate, _____ to the body of the sphenoid bone and basilar part of the occipital bone, and ______ to the anterior arch of the atlas and the body of C2 vertebra. | The nasopharynx lies POSTERIOR to the choanae, SUPERIOR to the soft palate, INFERIOR to the body of the sphenoid bone and basilar part of the occipital bone, and ANTERIOR to the anterior arch of the atlas and the body of C2 vertebra. |
| Are the walls of the nasopharynx bony? | yes (except for soft palate) & thus opening normally cannot be obliterated |
| What does the nasopharynx communicate with? | w/ oropharynx thru PHARYNGEAL ISTHMUS which is closed during swallowing by elevation of soft palate & constriction of PALATOPHARYNGEAL SPHINCTER (Passavant's ridge) which is part of superior constrictor muscle |
| The pharyngeal tonsil is: | collection of lymphoid tissue that lies in mucosa of roof of nasopharynx; when enlarged, termed "adenoids" |
| ____ may obstruct airflow thru the nasopharynx, necessitating "mouth breathing." | adenoids |
| pharyngeal orifice of pharyngotympanic tube (auditory or Eustachian tube): | in lateral walls of nasopharynx; allows communication b/w nasopharynx & tympanic cavity of ear, equalizing air P on the 2 sides of tympanic membrane (eardrum) |
| torus tubarius: | is the mucosa overlying protruding end of cartilage from auditory tube |
| tubal tonsil: | collection of lymphoid tissue immediately posterior to pharyngeal ostium |
| salpingopharyngeal fold: | fold of mucosa that overlies salpingopharyngeus muscle as it descends from the tubal elevation |
| pharyngeal recess (fossa of Rosenmuller): | slit-like depression posterior to this fold & is most common location of nasopharyngeal carcinoma |
| torus levatorius: | fold of mucosa just below the tubal opening formed by underlying levator veli palatini muscle passing to the soft palate |
| boundaries of oropharynx: | post to oral cavity w/ connection b/w = oropharyngeal isthmus (fauces), demarcated by palatoglossal arch; ant wall has post aspect of dorsum of tongue; soft palate lies superiorly while C2,C3 vertebrae lie post'ly; inf limit = superior border epiglottis |
| What is the main component of the lateral walls of oropharynx? | palatine tonsil, a collection of lymphoid tissue commonly called "the tonsil" |
| What forms the tonsillar ring (Waldeyer's ring)? | palatine tonsil + tubal tonsil & pharyngeal tonsil in nasopharynx, as well as lingual tonsils on dorsum of post aspect of tongue together form area of lymphoid tissue that surrounds openings from oral & nasal cavities & = tonsillar ring (Waldeyer's ring) |
| Where is the palatine tonsil located? | b/w tonsillar pillars which are palatoglossal & palatopharyngeal folds which are formed by mucosa overlying the muscles w/ the same name |
| What is the tonsillar bed formed by? | superior pharyngeal constrictor & styloglossus muscles |
| What's the largest artery to the palatine tonsil & enters the tonsil's inferior pole after penetrating thru superior constrictor muscle? | tonsillar branch of facial artery |
| Where do other tonsilar branches arise from? | other tonsilar branches arise from the ascending pharyngeal, lingual, descending palatine, and ascending palatine arteries |
| The ______ vein descends w/in the tonsilar bed & can cause hemorrhage during tonsillectomy. | external palatine (paratonsillar) vein |
| The ____ nerve passes close to lower pole of palatine tonsil. | glossopharyngeal |
| Why are tonsillectomies performed? | remove palatine tonsils, relatively common procedure that's performed in cases of recurrent tonsillitis or hypertrophied tonsils which are causing airway obstruction, it is not without potential complications |
| What is the most common complication of tonsillectomy? | hemorrhage which sometimes requires return to surgery and can be fatal; infections can occur & if abscesses reach internal carotid artery which lies deep but close to tonsilar bed, death from hemorrhage can result |
| A significant # of individuals have transient alterations in taste sensation due to damage to the ______ branch of the _____ nerve which can be closely associated with the tonsilar capsule. | lingual; glossopharyngeal |
| Boundaries of laryngopharynx: | “hypopharynx" extends from superior border epiglottis to inf border cricoid cartilage where continuous w esophagus; post'ly, C3-C6; ant'ly, opens into larynx via laryngeal inlet superiorly;inf'ly, ant wall related to cricoid/arytenoid cartilages of larynx |
| components of walls of laryngopharynx: | lateral to laryngeal inlet/internal to thyroid cart,both sides=mucosa lined piriform recess(piriform fossa);intern/recurr laryng branches=deep 2 mucosa in recess,damage by lodged foreign bods; Valleculae join tongue base to anterior epiglottis surface |
| What are valleculae? | depressions on either side of mucosal fold that connects base of tongue to anterior surface of epiglottis |
| What structures lie lateral to the pharynx? | internal & common carotid arteries, IJV, cervical sympathetic trunk, & CN IX, X, XI, & XII |
| What is innervation on posterior surface of pharynx? | pharyngeal nerve plexus, especially on middle constrictor |
| What is the pharyngeal nerve plexus formed by? | pharyngeal branches from CN IX, CNX, & superior cervical sympathetic ganglion |
| What do fibers from CN X innervate? | all of skeletal muscles of pharynx except for stylopharyngeus, which is innervated by CN IX |
| ____ innervation differ among the 3 parts of the pharynx. | sensory |
| CN ____ to laryngopharynx, CN ____ supplies oropharynx, & _____ branch of CN ____ to nasopharynx | X, IX, pharyngeal branch of CN V2 |
| The sympathetic input to pharynx is vasomotor w/ ____ neuron cell bodies in lateral horn of upper thoracic spinal cord, _____ neuron cell bodies in superior cervical ganglion, & ____ fibers accompanying blood vessels to pharyngeal wall. | preganglionic; postganglionic; postganglionic |
| There are also some from pharyngeal nerves off ____. | pterygopalatine ganglion |
| Parasympathetic is secretomotor to glands and involves _____ ganglion for nasopharynx & most likely _____ nerve for oropharynx & laryngopharynx | pterygopalatine ganglion; vagus |
| What is the arterial supply to the pharynx? | ascending pharyngeal artery (direct branch from external carotid), ascending palatine & tonsilar branches of facial artery, descending palatine & pharyngeal branches of maxillary artery, & branches from superior & inferior thyroid arteries |
| Describe venous drainage of pharynx: | both external & internal venous plexus in pharynx; plexuses drain into pterygoid plexus located in infratemporal fossa, as well as into facial & internal jugular veins |
Created by:
aostromecki