Pharynx Flashcards
Pharynx extends from …..to …..
Length of pharynx.
Base of skull to C6 vertebrae
10cm
Parts of pharynx
- Nasopharynx:
Skull base to palatal sphincter & passavant’s ridge at C2. - Oropharynx:
Level of Palatal sphincter to tip of epiglotitis-C4 - Hypopharynx:
C4- C6 lower border.
3 sub regions of hypopharynx
- Piriform sinus ( fossa)
- Posterior cricoid region
- Posterior pharyngeal wall
Extrinsic muscles of pharynx is …..layer
Contains ….muscles (5)
Circular layer
Superior constrictor
Middle constrictor: thyropharyngeus
Cricopharyngeus
Inferior constrictor
Intrinsic muscles of pharynx are ……..layer.
Contains ….(3)
Longitudinal layer
Stylopharyngeus
Salpingopharyngeus
Palatopharyngeus
Sinus of morgagni is present in ….
How does nasopharynx differ from oro or laryngopharynx?
Nasopharynx
Np Always patent
What is sinus of morgagni? Structures passing through this sinus?
Space between base of skull and upper border of superior constrictor muscle.
- Auditory tube
- Lavator palatine muscle
- Ascending palatine artery
Contents of nasopharynx (5)
Absent NP bursa causes ….
- Adenoid tissue: lymphoid tissue more prominent in children
- ET tube opening
- NP bursa
- Ratke’s pouch
- Sinus of morgagni
Thornwald disease
What is killian dehiscence?
Area between thyropharyngeus and cricopharyngeus. Weak area-no muscular support.
Zenkers diverticulum: pharyngeal muscle herniation through pharyngeal diverticulum or pharyngeal pouch.
What is waldeyers lymphatic ring?
Consists of : (4)
In nasopharynx isthmus, several aggregates of lymphoid tissue constitute waldeyers ring.
Consists of :
Pharyngeal tonsil
Tubal tonsil
Palatine tonsil
Lingual tonsil
Importance of waldeyers ring?
What is Gerlach’s tonsil?
Guards oropharynx and nasopharynx from foreign pathogens launching immune response.
Tubal tonsil
Palatine tonsil lined by …..
Largest crypt in tonsil is …..
Stratified squamous
Intra tonsillar cleft-crypta magna
Main blood supply of tonsil is …..
5 arteries supply tonsil (5)
Tonsillar branch of facial artery
- Ascending pharyngeal a
- Ascending palatine a
- Descending palatine a
- Branch of lingual a
- Tonsillar branch of facial a
Main blood vessel bleed during tonsillectomy.
Features of adenoid hypertrophy.
Paratonsillar vein
School aged child 6-7 yrs having mouth breathing pattern + adenoid facies- protrusion of teeth, high palate, pinched nose.
Mouth breathing in child plus HL s/o…
Rx of adenoid hypertrophy.
Position for sx is …
Adenoid hypertrophy+ glue ear.
Rx: surgery
Adenoidectomy under GA
Rose position
What is grisel syndrome?
Atlantoaxial subluxation of C1-C2- if overextension of neck during adenoidectomy/ tonsillectomy.
……….adenoid curette is used.
Mc cause of tonsillitis in:
<5 yr old
5-15yrs old:
St claire thomson
Viral tonsillitis
GpA beta hemolytic streptococcus
C/f of acute tonsillitis
Fever, dysphagia,foul breath, odynophagia, tender cervical LN.
Anatomy structure where quinsy happens?
C/f (5)
Collection of pus between fibrous capsule of tonsil and superior constrictor muscle of pharynx.
Severe throat pain
Fever, drooling, foul breath
Trismus, hot potato voice.
In peritonsillar abscess ……not present
If present it’s …..
Neck swelling not seen
If +ve: parapharyngeal abscess
Define quienke’s disease
2 structures that lie in bed of tonsils
Angioneurotic edema of uvula
Styloid process
Cn9
What is eagle syndrome?
What is tonsillolith?
Styalgia
Long styloid process touching cn9–> throat pain referred to ear.
Tonsils have crypts.
Invagination of epithelium of tonsils—>crypts; where keratinaceous debris is stuck up.
Causes and Rx for snoring
- Palatal weakness- Palatal flutter
Rx: strengthen palate->laser palatoplasty - Adenoid/ tonsillar hypertrophy:
Rx: uveopalatopharyngeoplasty.
Whitish membrane over tonsils (7)
- Acute membranous tonsils-
Caused by Strept pyogenes - Infectious mononucleosis -EBV
- Diphtheria:
- Pseudomembranes
- Bleeds on removal.
- Candida
- Vincent angina
- Malignancy of tonsil
- Leukemia
Rx for diphtheria
Neck features seen in diphtheria
Conservative -6mo for spontaneous recovery
Bull neck
Complications of tonsillectomy
- Primary : during surgery
- Reactionary: <24hrs
Due to disruption of ligature
Emergency reexploration. - Secondary: >24hrs -within 5days
Mild bleeding only when pt spits.
Due to infection of tonsillar fossa.
Rx: readmit and give iv antibiotics.
Vincent angina due to ……org (2)
Fusiform bacteria
Spirochete denticola
Retropharyngeal abscess seen in …..region
Pathology of retropharyngeal abscess
Posterior wall of nasopharynx
Retropharyngeal space—> prevertevral space—>vertebrae-retropharyngeal LN increased —> acute retropharyngeal abscess.
C/f of retropharyngeal abscess (4)
Young sick child with:
1. Respiratory distress
2. Inspiratory stridor
3. Drooling of saliva
4. Hot potato voice
Xray feature of retropharyngeal abscess
Rx:
Prevertebral abscess is …..
Widening of prevertebral shadow. Cervical spine normal
Immediate airway mgt
Tb cervical spine -Potts spine
