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ANATOMY S2 U2 > Lecture 12 = Pharynx > Flashcards

Lecture 12 = Pharynx Flashcards

1
Q

What is the pharynx? And where are the nasopharynx, oropharynx and laryngopharynx located?

A
  • it extends from the skull base to inferior border of cricoid cartilage (level of C6)
  • consists of circular and longitudinal mm. wrapped in fascia
  • lined with mucosa membrane containing mucous glands
  • nasopharynx extends from the base of sphenoid down to top of soft palate and uvula
  • oropharynx is the posterior extent of the nasal cavity - extends from end of nasopharynx at soft palate to epiglottis
  • laryngopharynx is down till the inferior extent to cricoid cartilage - till the anterior extent of C6
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2
Q

What is the skeletal overview of the pharynx?

A

The attachment of the cricoid mm is not to the muscle - it is a CT anchoring muscle and can still hold down the anchoring of all muscles

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3
Q

What are the regions and layers of the pharynx?

A

-lies posterior to the nasal and oral cavities and the larynx
-there are 3 regions:
* nasopharynx
* oropharynx
* laryngopharynx
-there are 5 layers:
* mucosa (mucous membrane)
* submucosa
* pharyngobasilar fascia
* Muscular layer -
~ 3 longitudinal mm. (stylo-, salpingo-, palato- pharyngeus mm.)
~ 3 outer circular or constrictor mm.
*buccopharyngeal fascia

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4
Q

What are the mucous membranes of the pharynx?

A
  • nasopharynx is from base of skull to soft palate
  • oropharynx is from soft palate to epiglottis and is the ting butterfly shape for access to oropharynx (top of that is the root of the tongue)
  • laryngopahryx is from epiglottis to base of C6 where cricoid cartilage is
    • below is the esophagus
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5
Q

What are some nasopharynx structures?

A
  • auditory (eustachian or pharyngotympanic) tube orifice: posterior to inferior concha
    • serves as connection between pharynx and middle ear
  • torus tubarius: posterior to auditory tube orifice (cartilage of auditory tube)
  • pharyngeal recess: posterior to torus tubarius
    • groove along lateral pharyngeal wall
  • pharyngeal tonsil: postero-superioir to torus tubarius
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6
Q

Tell me about the nasopharynx

A
  • epithelium inside is ciliated pseudo stratified columnar
  • as we age, the lymphoid tissue diminished in size
  • pharyngeal tonsils can get larger with age - adenoids
  • another name for auditory tube is eustachian and pharyngeotympanic tube
  • posterior to auditory tube is pharyngeal recess
  • salpingopharyngeal fold - if you remove this then you can see the salpingo. m,
  • torus tubarius is not a complete cartilage - it’s just superior and inferior around the mucosal membrane around the membranous portion of the auditory tube
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7
Q

What’s the oropharynx?

A
  • is the posterior extension of oral cavity
  • between the soft palate and epiglottis
  • passes thru 2 sets of arches laterally
    • palatoglossal archa
    • palatopharyngeal arch - this is second fold on other side of palatine fossa
  • palatoglossal arch separates oral cavity and oropharynx
  • posterior tongue is part of the oropharynx
  • structure at the very base of the tongue and anterior to epiglottis is the vallecula (fold posterior to the root of tongue) which is a reservoir for spit/saliva so you have a place to pool while the epiglottis is up so you can break
    • vellacula are 2 bilateral folds at base of tongue
    • temporarily hold place for saliva during breathing
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8
Q

What are some parts of the oropharynx?

A
  • palatoglossal arch: mucosal fold over palatoglossus m.
  • palatopharyngeal arch: mucosal fold over palatopharyngeus m. - posterior extent of oral cavity proper - line of demarkation between oral cavity and pharynx
  • palatine tonsil: in tonsillar bed between 2 palatine arches
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9
Q

What is the palatopharyngeus m?

A
  • peristalsis moves food down esophagus but how about in the oropharynx?
  • palatopharyngeus m. is a specialized muscle - it comes off of the hamulus and it lands at the palatal pharyngeal spinster so have a specialized band that will close in around the bowl of the soft palate so can seal off the superior extent of the oropharynx when swallowing.
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10
Q

What is the laryngopharynx?

A
  • route air and food into trachea and esophagus
  • functions of the larynx:
    1) phonation
    2) regulate size of the opening between the vocal folds - we have true and false vocal folds. The combo of 2 are creating sounds
    3) prevent foreign bodies from entering the airway-breathing
    4) act as a sphincter
  • beings superiorly at the epiglottis
  • continues till the level of C6 and top of esophagus
  • opening at the beginning of epiglottis is the laryngeal inlet - this is the marginal opening
  • piriform fossa/recess are at either side of larynx - this is the lateral gutter system that the vellacula drains into
  • the epiglottis don’t seal over larynx
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11
Q

What are the structures of the laryngopharynx?

A
  • epiglottis
  • laryngeal cartilages
  • piriform recess: extends laterally to thyroid cartilage
  • internal laryngeal n.: descends beneath mucous membrane
  • superior laryngeal vessels: run with internal laryngeal n.
  • recurrent laryngeal n.: ascend beneath mucous membrane
  • inferior laryngeal vessels: run with recurrent laryngeal n.
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12
Q

What are the 5 laryngopharynx nerves?

A
  • internal laryngeal n.
  • external laryngeal n.
  • vagus n.
  • inferior laryngeal n.
  • right recurrent laryngeal n,
  • all are branches of CN 10
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13
Q

What are the laryngopharynx vessels:

A
  • superior laryngeal artery and vein

- inferior laryngeal artery

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14
Q

What are the pharyngeal muscles?

A
  • all 3 constrictor (superior/middle/inferior) mm are overlapping each other as we move inferiorly
  • are anchored at the midline
  • cricopharyngeal m. is circular and serves as the upper esophageal m
  • elevator mm. are the salpingopharyngeus m. and palatopharyngeous m.
    • need pharyngeal elevators because need more room
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15
Q

What is the stylopharyngess m.?

A

it is innervated by CN IX which does taste and general sensory of the posterior tongue
-it come from the jugular foramen

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16
Q

What are the muscles of the pharynx?

A

-a special band of muscle, the palatopharyngeal sphincter originate from the anteriolateral surface of the soft palate and circles the inner aspect of the pharyngeal wall, blending with the inner aspect of the superior constrictor.
-thus, the palatopharyngeus m. functions to elevate the pharynx and in closure of the oropharyngeal isthmus
-when the superior constrictor constricts during swallowing, it forms a prominent ridge on the deep aspect of the pharyngeal wall that catches the margins of the elevated soft palate, which then seals close the pharyngeal isthmus between the nasopharynx and oropharynx
I. superior pharyngeal constrictor m.
- arises from pterygomandibular raphe and medial pterygoid plate and mandible
- meets buccinator m. anteriorly
- anchored to pharyngeal tubercle of skull superiorly
II. middle pharyngeal constrictor m.
- arises from greater horn of hyoid bone and inferior portion of stylohyoid ligament
- overalls superior constrictor m.
- stylohyoid ligament, stylopharyngess m. and CN IX pass between superior and constrictor mm.
III. inferior pharyngeal constrictor m.
- arises from thyroid and cricoid cartilages
- overlaps middle constrictor m.
- internal laryngeal n. and superior laryngeal a. pass between middle and inferior constrictor mm.
* then these pierce the thyrohyoid membrane
IV. stylopharyngess m.
- arises from styloid process
- descends to blend with fibers of lower constrictor mm.
V. Salpingopharyngeus m.
- arises from auditory tube
- descends to blend with fibers of palatopharyngeus m.
- covered by salpingopharyngeal fold of mucosa

17
Q

What are the gaps in the pharyngeal wall?

A
  • oropharyngeal triangle:where everything is passing in and out of the oral cavity
  • hypoglossal n. gets into the oral cavity through this triangle
  • triangle is between the superior constrictor and middle constrictor and mylohyoid mm.
18
Q

What is the pharynx innervation?

A

I. pharyngeal plexus - superior cervical ganglion- supplie sympa nn to plexus
- pharyngeal branch of CN X
- branch of external laryngeal n. from the superior laryngeal branch of vagus (CN X)
- pharyngeal branches of CN IX
- some CN V2
II. Sensory innervation
- nasopharynx V2 - the nasopharynx is innervated by a pharyngeal branch of CN V2 that originates in the pterygopalatine fossa and passes through the palatovaginial canal in the sphenoid bone to reach the roof of the pharynx
- oropharynx - IX
- laryngopharynx - CN X via internal branch of the superior laryngeal n.
- the internal laryngeal n. is a contribution of the superior laryngeal n. through the thyrohyoid membrane
III. Motor Innervation
- all muscles of the pharynx are innervated by the vagus n., except the stylopharyngess m. which is innervated by the glossopharyngeal n. (CN IX)

  • motor and most sensory innervation (except for the nasal region) of the pharynx mainly through branches of CN X and CN IX nn., which form a plexus in the outer fascia of the pharyngeal wall.
  • all muscles of the pharynx are innervated by CN X except the stylopharyngeus m. which is innervated by CN IX
19
Q

What is the arterial supply of the pharynx?

A
  • predominately via ascending pharyngeal and superior thyroid aa. (branches of ECA)
  • additional supply via branches of facial and maxillary aa. (branches of ECA)
  • lingual branches innervates the middle constrictor
  • maxillary branches gives rise to pharyngeal arches
  • asceding pharyngeal artery
  • ascending palatine a.
  • facial a.
20
Q

What is the arterial supply of the palatine tonsils?

A
  • tonsillar branches of lingual and facial aa.
    • both branches of external carotid a.
  • ascending pharyngeal a.
    • branch of external carotid a.
  • tonsillar branch of ascending palatine a.
  • lesser palatine a.
    • branch of descending palatine a.
  • all ultimately branches of ECA
21
Q

What is the venous drainage of the pharynx?

A
  • predominantly via pharyngeal plexuses of vv.
    • external and internal plexuses surrounding constrictor mm.
  • anastomoses with pterygoid plexus, superior thyroid, lingual, facial, and IJV
  • drains superiorly from the pharynx to the pterygoid plexus in the infratemporal fossa and inferiorly into the facial and internal jugular vv.
22
Q

What are the clinical notes for the pharynx’s innervation?

A
  • loss of motor nn. to pharynx leads to marked dysphagia (difficulty swallowing)
  • loss of sensory nn. to pharynx may cause loss of gag reflex
23
Q

What are the clinical notes of the pharyngeal tonsils?

A
  • consists of lymphoid tissue in roof of nasopharynx
  • when enlarged, referred to as adenoids
  • large adenoids obstruct air flow from nose to nasopharynx
    • make mouth breathing necessary
    • may also impinge upon torus turbarius and auditory tube orifice
  • obstructs air exchange between nasopharynx and middle ear
24
Q

What are the clinical notes for the piriform recess?

A
  • accidentally swallowing objects may become trapped here
  • induce choking sensation and severe coughing
    • due to stimulation of int. and rec. laryngeal nn.
  • sharp objects may pierce mucosa
    • leads to infection
    • injures underlying nn. and/or vessels

ANATOMY S2 U2 (15 decks)

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