Pharynx Flashcards
Length of pharynx
12-14 cm
From base of skull
To cricoid cartilage (lower border) anteriorly and level C6 posteriorly
Width of pharynx
3.5 cm at base
1.5cm at pharyngoesophageal junction
Narrowest part of digestive tract
Layers of pharyngeal wall (inwards to outwards)
Mucous membrane
Pharyngeal aponeurosis
Muscular coat
Buccopharyngeal fascia
Mucous membrane
Continuos with
Eustachian tube
Nasal cavity
Mouth
Larynx
Esophagus
Nasopharynx has ciliated columnar
Other region has Stratified squamous
Contributes to pharyngobasilar fascia
Pharyngeal aponeurosis
Fibrous
Thick near base of skull
Fills gap near sinus of morgagni
Muscular coat
2 layers (each 3 muscles)
External layer (inner circular)
Superior constrictor
Middle constrictor
Inferior constrictor
Internal layer (outer longitudinal)
Stylopharyngeus
Salpingopharyngeus
Palatopharyngeus
Buccopharyngeal fascia
Covers
Outer surface of constrictors
Upper part covers buccinator muscle
Blends with pharyngeal aponeurosis at upper border of superior constrictor
Inferiorly continues to pretracheal fascia
Killian’s Dehiscence
Potential gap between thyropharyngeus and cricopharyngeus
(2 parts of inferior constrictor muscles)
“Gateway of tears”- perforate during esophagoscopy
Site of herniation
Waldeyer’s ring
Ring throughout pharynx in subepithelial layer of aggregated lymphoid tissues
Nasopharyngeal tonsil / adenoids
Palatine tonsils
Lingual tonsil
Tubal tonsil (in fossa of rosenmuller)
Lateral pharyngeal bands
Nodules (in post. Pharyngeal wall)
Divisions of pharynx
Nasopharynx / Epipharynx
Oropharynx
Hypopharynx / Laryngopharynx
Anatomy of Nasopharynx
Roof - basisphenoid
Basiocciput
Post. Wall - arch of atlas
Prevertebral muscles+fascia
Floor - soft palate
Nasopharyngeal isthmus
Ant. Wall - Choanae
Lateral wall - Eustachian tube opening
Torus tubarius
Fossa of rosenmuller
Salpingopharyngeal fold
Lined by pseudostratified ciliated columnar epithelium
Nasopharyngeal Bursa
Epithelial lined median recess
From pharyngeal mucosa to periosteum of basiocciput.
Represents attachment of notochord to pharyngeal endoderm in embryonic life.
Abcess can form - Thornwaldt disease
Rathke’s pouch
Dimple above adenoids
Cricopharyngioma may arise
Tubal tonsil
Subepithelial lymphoid tissue
Form Waldeyers ring
Occludes eustachian tube during infection
Sinus of morgagni
Space between base of skull and sup. Constrictor muscle
Structures enter
Eustachian tube
Levator veli palatini
Tensor veli palatini
Ascending palatine artery(facial A)
Passavant’s Ridge
Mucosal ridge raised by palatopharyngeus fibres
Encircles post. And lateral walls of nasopharyngeal isthmus
Functions of Nasopharynx
Conduit of air
Ventilates middle ear + equalize air pressure +hearing
Elevation of soft palate (swallowing,vomiting,gagging,speech)
Resonating chamber (voice disorders)
Drainage channel of mucus
Anatomy of Oropharynx
Post. Wall - retropharyngeal space
Ant. Wall - Base of tongue
Lingual tonsil
Valleculae
Glossoepiglotic fold
Pharyngoepiglottic fold
Lateral wall - palatine / faucial tonsil
Anterior pillar
Posterior pillar
Tonsillar fossa (palatine tonsil)
Functions of Oropharynx
Conduit of air and food
Pharyngeal phase of deglutition
Speech sounds
Help in taste (taste buds)
Local defence + immunity
Anatomy of hypopharynx
Superiorly From plane of body of hyoid bone to posterior pharyngeal wall
Inferior limit is lower border of cricoid
Opp. To C3,C4,C5,C6 vertebra
Divided in 3 regions:-
Piriform sinus(fossa)
Postcricoid region
Post. Pharyngeal wall
Functions of hypopharynx
Pathway for air and food.
Speech sounds
Helps in deglutition
Failure of cricopharyngeal Sphincter causing hypopharyngeal diverticulum.
Acute pharyngitis clinical features
Mild
Throat discomfort
Malaise
Low grade fever
Pharynx congested
No lymphadenopathy
Moderate + severe
Throat pain
Dysphagia
Headache
Malaise
High fever
Pharynx (edema,exudate,enlarged tonsil,lymphoid follicles)
Very severe
Soft palate edema
Uvula edema
Enlarged cervical nodes
Viral infections
Mild
Rhinorrhoea
Hoarseness
Treatment of acute pharyngitis
Bed rest
Fluids
Warm saline gargles
Pharyngeal irrigation
Analgesics
Local discomfort relieved by lignocaine viscous before meal (facilitates swallowing)
Specific treatment of acute pharyngitis
Streptococcal
Penicillin / Benzathine Penicillin G
Erythromycin (to penicillin sensitive)
Diphtheria
Diphtheria antitoxin
Penicillin / Erythromycin
Gonococcal
Penicillin / Tetracyclin
Viral infections causing acute pharyngitis
Herpangina ( coxsackie virus)
Infectious mononucleosis (Epstein-Barr virus)
Cytomegalovirus
Pharyngoconjuctival fever (adenovirus)
Acute lymphonodular Pharyngitis
Measles
Chickenpox
Fungal pharyngitis
Candida
Extension of oral thrush
Immunosuppression, Diabetes,High dose steroids
Throat pain + Dysphagia
Hyphae and spores in microscope
Tt of Nystatin / Itraconazole
Chronic pharyngitis pathology
Hypertrophy of
Mucosa
Seromucinous glands
Subepithelial lymphoid follicles
Muscular coat
2 types of chronic pharyngitis
Chronic catarrhal
Chronic hypertrophic / granular
Factors causing chronic pharyngitis
Persistent infection
Mouth breathing (obstruction of nose / nasopharynx)
Chronic irritants
Pollution
Faulty voice production
Clinical features of chronic pharyngitis
Throat pain
Throat discomfort
Foreign body sensation in throat
Voice tiredness
Cough
Signs of chronic catarrhal pharyngitis
Post. Pharyngeal wall congested
Vessel engorgement
Thickened faucial pillar
Mucus secretion increased
Signs of chronic Hypertrophic / granular pharyngitis
Thick + edematous pharyngeal wall
Congested mucosa
Dilated vessels
Hypertrophy of lateral pharyngeal bands
Uvula elongated + edematous
Post. Pharyngeal wall reddish granules (hypertrophy of subepithelial lymphoid follicles
Treatment of chronic pharyngitis
Voice rest
Speech therapy
Avoid hawking and clearing of throat
Warm saline gargles
Mandl’s paint on mucosa
Cautery of lymphoid granules (touched with 10%-25% silver nitrate)
Atrophic pharyngitis
With atrophic rhinitis
Atrophy - pharyngeal mucosa
Scanty mucus
Crust formation
Foul smell (infected crusts)
Clinical features of atrophic pharyngitis
Throat dryness
Throat discomfort
Hawking + Dry cough
Crust formation
Dry + glazed pharyngeal mucosa
Treatment of atrophic Pharyngitis
Spray alkaline solution
Pharyngeal irrigation
Mandl’s paint
Potassium iodide 325mg (prevent crust + promote secretion)
Features of keratosis pharyngitis
Benign
Horny excrescences (on tonsil surface, pharyngeal wall, lingual tonsil)
White / yellowish dots
Hypertrophy + keratinised epithilium
Firmly adherent
No inflammation
No symptoms
May show spontaneous regression
Anatomy of Tonsil
Ovoid shaped
In lateral wall of Oropharynx
2 surfaces
Medial
Lateral
2 poles
Upper
Lower
Blood supply of tonsil
Facial artery
Tonsillar br
Ascending palatine br
External carotid
Ascending pharyngeal
Lingual
Dorsal linguae
Maxillary
Descending palatine
Nerve supply of tonsil
Sphenopalatine ganglion
Lesser palatine br
Glossopharyngeal nerve
Functions of tonsil
Local immunity
Surveillance mechanism
Tonsils consist of
Surface epithelium
Crypts
Lymphoid tissue
Acute tonsillitis classification
Acute catarrhal /superficial
Acute follicular
Acute Parenchymatous
Acute Membranous (exudation from crypts coalesces)
Causes of infection in acute tonsillitis
Haemolytic streptococcus
Staphylococcus
Pneumococci
H. Influenza
Symptoms of acute tonsillitis
Sore throat
Difficult swallowing
Fever (chills + rigor)
Earache (acute otitis media)
Headache
Body ache
Malaise
Constipation
Signs of acute tonsillitis
Breath - foetid
Tongue - coasted
Pillars, soft palate, uvula - Hyperaemia
Tonsil
Acute follicular
Red
Swollen
Yellowish spots
Acute membranous
Whitish membrane (medial surface)
Acute parenchymatous
Enlarged
Congested
Oedema (uvula + soft palate)
Meet in midline
Jugulodigastric lymph nodes
Enlarged
Tender
Treatment of acute tonsillitis
Bed rest
Fluids
Analgesics
Antimicrobial (penicillin /erythromycin, ampicillin, amoxicillin)
Complication of acute tonsillitis
Chronic tonsillitis
Peritonsillar abscess
Paraphyrangeal abscess
Cervical abscess
Acute otitis media (recurrent)
Rheumatic fever (grp A beta hemolytic)
Acute glomerulonephritis
Subacute bacterial endocarditis (viridans)
Differential diagnosis in acute tonsillitis
Membranous tonsillitis
Diphtheria
Vincent angina
Infectious mononucleosis
Agranulocytosis
Leukemia
Aphthous ulcers
Malignancy tonsil
Traumatic ulcer
Candida infection of tonsil
Clinical features of faucial diphtheria
Oropharynx
Greyish white membrane
Tonsil
Soft palate
Posterior pharyngeal wall
Bleeding when removed
Tenacious
Cervical lymph nodes
Jugulodigastric
Enlarged
Tender
Bull neck appearance
Fever not rise above 38°
Complications of faucial tonsillitis
Exotoxin
Cardiac
Myocarditis
Cardiac arrhythmia
Acute circulatory failure
Neurological
Paralysis
soft palate
Diaphragm
Ocular muscles
Larynx
Membrane cause airway obstruction
