HNNS Anatomy - Pharynx

Question 1

Define the borders of the 3 parts of pharynx.

Answer 1

Nasopharynx = Base of skull > C1 
Oropharynx = Soft palate at C1 to Epiglottis at C3 
Laryngopahrynx = C3 to C6 @ oepning to trachea ad esophagus

Question 2

Compare the epithelium lining at 3 parts of the pharynx?

Answer 2

Naso = Respiratory epithelium

Oro- and Laryngo- = Stratified Squamous epithelium

Question 3

Define the location of the tonsils in the pharynx? Drainage?

Answer 3

Pharyngeal tonsils = roof of nasopharynx
Lingual tonsils = behind sulcus terminalis of tongue at orophraynx
Palatine tonsils = Between palatoglossal and palatopharyngeal arches in oropharynx

All drain to deep cervical LN

Question 4

Route of spread of infection to middle ear?

Answer 4

Auditory tube at lateral wall of nasal cavity&raquo_space; middle ear&raquo_space; otitis media

Question 5

Common location for NPC?

Answer 5

Behind elevated part/ Tubal elevation of auditory tube = Pharyngeal recess

Question 6

Sensory supply of nasopharynx?

Answer 6

V2

Question 7

Explain how nasopharynx infection can reach the mastoid antrum?

Answer 7

Nasopharynx > auditory tube > middle ear > mastoid antrum

Question 8

List the soft palate muscles?

Answer 8

Tensor veli palatini 
Levator veli palatini 
Palatoglossus 
Palatopharyngeus 
Musculus uvulae 

All supplied by Pharyngeal plexus EXCEPT TENSOR VELI PALATITNI BY V3

Question 9

Which nerves form the pharyngeal plexus?

Answer 9

CN 9,10,11 + sympathetic branches from superior cervical ganglion C1

Motor = cranial root of CN 9 carried by CN 10 
Sensory = CN 9

Question 10

Define the circular muscles of the oropharynx and nasopharynx.

Answer 10

Superior constrictor = from floor of mouth, interdigitate with buccinator at pterygomandibular raphe

Middle constrictor = from hyoid bone

Inferior constrictor: 2 parts:

1) Upper = Thyropharyngeus (attach to thyroid cartilage)
2) Lower = Cricopharyngeus (attach to cricoid arch)

Question 11

Overall function of the constrictor muscles of the pharynx?

Answer 11

All push food into esophagus except cricopharyngeus

Cricopharyngeus = sphincter for esophagus, prevent swallowing

Question 12

Define the internal and external lining of the pharyngeal constrictor muscles?

Answer 12

Internal = Pharyngobasilar fascia (thick)
External = Bucopharyngeal fascia

Question 13

Define the parts of the prevertebral fascia?

Answer 13

Alar part and Prevertebral part

Question 14

Define the location of the retropharyngeal space and clinical significance?

Answer 14

Between Alar part of prevertebral fascia and Bucopharyngeal fascia down to level of esophagus

= Danger space, communicate with posterior mediastinum, route for spread of infections

Question 15

Where does pharyngeal diverticulum ocur?

Answer 15

Region between thyropharyngeus and cricopharyngeus muscles

only region where constricotrs dont overlap

Question 16

List the muscles that lift up the larynx during swallowing.

Answer 16

Salpingopharyngeus (attached to cartilage of auditory tube)
Palatopharyngeus (arise from soft palate)
Stylopharyngeus (arise from styloid process)
Thyrohyoid

All attach to thyroid cartilage

Question 17

What structure sets the boundary between oral cavity and oropharynx?

Answer 17

Palatoglossal arch

Question 18

Describe the connection between palatine tonsils and neck LN?

Answer 18

Palatine tonsils drain to Upper cervical lymph nodes - Jugulodiagastric LN

Question 19

Blood supply of palatine tonsils?

Answer 19

Facial artery and Ascending palatine artery

Question 20

List the structures lateral to the palatine tonsils?

Answer 20

Fibrous capsule
CN9
ICA
Paratonsillar vein*

profuse bleeding if breached in tonsillectomy
All structures vulnerable to damage if fibrous capsule is breached

Question 21

Nerve supply of all pharyngeal muscles and soft palate?

Answer 21

Pharyngeal plexus

EXCEPT: stylopharyngeus (CN9) + Cricopharyngeus (CN 10) + Tensor veli palatini (V3)

Question 22

General blood supply and drainage of pharynx?

Answer 22

Supply = Ascending pharyngeal artery + branches of Facial and Maxillary arteries (all ECA)

Drain = Pharyngeal venous plexus&raquo_space; IJV and Pterygoid venous plexus

Question 23

LN drainage of Pharynx?

Answer 23

Retropharyngeal LN > Jugulodiagastric LN > IJV

Question 24

What is the recess found on both sides of the laryngopharynx

Answer 24

Piriform fossa

Deep to mucosa = internal laryngeal nerve (irritated by food stuck in the fossa)

Question 25

Sensory nerve supply of the pharynx?

Answer 25

CN 9 + internal laryngeal branch of CN 10

Question 26

Location of pharyngeal plexus?

Answer 26

Lateral side of middle constrictor