Pharynx Flashcards
What are the three distinct regions of the pharynx?
- Nasopharynx
- Oropharynx
- Laryngopharynx
At what vertebral level does the pharynx become continuous with the esophagus?
C6
**Note: C6 is also the level of the cricoid cartilage
The pterygoid Process, Medial pterygoid plate, hamulus, and lateral pterygoid plate are all features of which bone?
Sphenoid
The styloid process is a feature of what bone?
Temporal
The mylohyoid line is a feature on what bone?
Mandible
The pharyngeal tubercle is a feature of what bone?
Occipital Bone
What ligament spans between the tip of the pterygoid hamulus and a trianglular roughening that is immediately posterior to the 3rd molar?
Pterygomandibular Rahpe
What muscles are jointed by the pterygomandibular raphe?
- Superior Constrictor (lateral pharyngeal wall)
- Buccinator (lateral wall of oral cavity)
What are the 3 different anterior attachments for the pharynx?
- nasal cavity
- oral cavity
- larynx
What separates the pharynex from the vertebral column?
- Retropharyngeal Space
What does the stylohyoid ligament attach to superiorly and inferiorly?
Superior:
Styloid Process
Inferior:
Lesser Horn of Hyoid bone
Where is the oblique line on the thyroid cartilage?
- on the lateral part
Where is the tendinous arch or the pharynx located?
- Between the lower aspect of the oblique line of thyroid cartilage and the cricoid cartilage
What supports the epithelial lining of the pharyngeal wall?
Pharyngobasilar Fascia
What lies just anterior to the buccopharyngeal fascia?
The constrictor muscles
**Remember buccopharngeal fascia is the anterior lining of the retropharyngeal space
What lies under the posterior wall of the nasopharynx?
- Pharyngeal Tubercle of Occipital Bone
Where can the pharyngeal tonsil be found?
In MUCOSA lying along OCCIPTAL Bone
What are the openings from the nasal cavity into the pharynx called?
- What splits these?
Choanae
- split by the nasal Septum
What closes off access from the oropharynx to the nasopharynx?
Tensors and elevators of the palate and palatopharyngeal sphincter of the superior constrictor
What is the torus tubarius?
Auditory tube penetrates Pharynx here
**Note: cartilage of auditory tube creates a bump here that is covered in mucosa
What verticle extension of mucosa extends inferiorly from torus tubaris?
- What muscle does it overlie?
- Salpingopharyngeal Fold
- Overlies Salpingopharygeus Muscle
Where is the pharyngeal Recess?
- Just posterior to torus
- Extends behind upper part of salphingopharyngeal fold
What muscle contracts to open the pharyngotympanic (auditory) tube?
- what activity naturally causes this to happen?
Salphigopharygeous
- Swallowing
***Note: this equalizes the pressure on both sides of the eardrum
T or F: the hyoid bone is at about the same level at the upper limit of the epiglottis?
True
What is the area where respiratory and digestive systems cross?
Oropharynx
Where does the oropharynx meet the posterior limit of the oral cavity?
- What muscles underly these structures?
Tonsilar Pillars
Anterior to Tonsil:
Palatoglossus Muscle and overlying mucosa
Posterior to Tonsil:
Palatopharyngeus Muscle and overlying mucosa
What is a more specific junction between oral cavity and pharynx than Tonsilar Pillars?
- Underlying muscle
- Palatoglossal Fold
- Palatopharyngeus muscle
Where is Palatopharyngeal Fold?
- Underlying muscle
- Lateral wall of the Throat in same plane as uvula
- Overlies Palatopharyngeal Muscle
What fold extends between the Palatopharyngeal Fold and the epiglottis?
Pharyngoepiglottic Fold
What is the relationship of the stylopharyngeus muscle to the palatopharyngeal fold?
Stylopharyngeus attaches to the superior border of the thyroid cartilage just deep to this
What structures are separated by the piriform recess?
Separates:
- Posterior Border of Thyroid Cartilage from Cricoid Cartilage
What is the clinical significance of the piriform recess?
- Underlying Structures involved.
- Things you swallow tend to lodge here
- INFERIOR LARYNGEAL underlies this recess
T or F: the ring of tonsils around the nasal and oral cavities provides a first line of defense against toxins and pathogens
True
Where do all pharyngeal constrictors insert?
Posteriorly on the Pharyngeal Raphe with then inserts on the PHARYNGEAL TUBERCLE of the occipital bone
What muscle descends from the styloid process and passes between the superior and middle constrictors?
Stylopharyngeus
*****LANDMARK for separating superior and middle constrictors
What two longitudinal muscles of the pharynx both originate and insert on the inside of the pharynx?
Salpingopahryngeus and Palatopharyngeus
You need to pop your ears. What muscle do you flex?
- Flex salpingopharyngeus because it originates from the cartilage portion of the auditory tubes
What muscles are responsible for raising larynx and wall of the pharynx during swallowing?
Longitudinal Pharyngeal muscles aka:
- Stylopharyngeus
- Salpingopharyngeus
- Palatopharyngeus
C6:
- Cricoid
- Pharynx –> esophagus
- Entrance of Vertebal Artery to foramen in C6 transverse process
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T or F: the Buccopharyngeal fascia covers the ENTIRE pharynx from base of the scukk and extends out OVER the buccinator muscles in the face
True
Where is the pharyngeal wall essentially devoid of muscle?
- What provides support in this area?
- Uppermost aspect of the pharyngeal wall
**ONLY supporting structures are Pharyngobasilar and Buccopharyngeal Fasciae
*Important because this is one less layer separating the outside world from the retropharyngeal space
A guy is chewing on a pencil and accidentally pokes it into the back of his throat until it hit a vertebra. What layers were punctured?
- Mucosa
- Pharyngobasilar Fascia
- Longitudinal mm. (maybe - lateral enough)
- SUPERIOR constrictor
- Buccopharyngeal Fascia
- Retropharyngeal Space
- Prevertebral Fascia
What goes through the gap located at the superior part of the superior constrictor muscle near the base of the skull?
- Cartilaginous Portion of the auditory tubue
- Levator Veli Palatini
- Ascending Palatine artery (=> Facial a. => External Carotid)
- Ascending Phanyngeal (=> External Carotid)
**This upper part of the muscle doesn’t contract
What goes through the gap between the superior and middle constrictor muscles?
- STYLOPHARYNGEUS MUSCLE
- Glosspharyngeal N. (IX)
- Lingual Artery (=> External Carotid)
Where does the pharyngobasilar fascia thin out?
- Below the hyoid bone
What Fills the gap between the middle and inferior constrictor?
- Thryohyoid membrane (Fills gap)
2. Superior Laryngeal n. and a. (MUST pass through APERATURE in Thryohyoid membrane to get in)
What goes through the gap between the inferior constrictor and esophagus?
- Recurrent Larygeal n. (changes name to inferior laryngeal n. after passing through)
- Laygeal Branch of Inferior Thyroid (=> Subclavian)
***THIS AREA IS COVERED WITH BUCCOPHARYNGEAL FASCIA
What types of fibers make up the pharyngeal plexus (GSA, GVA, GSE, GVE, SA, BE) ?
- GSA
- BE
What nerves make up the Pharyngeal Plexus?
CN IX (Glossopharyngeal) CN X (Vagus n.)
What region is supplied mostly from the glossopharyngeal portion of the pharyngeal plexus?
- Contribution of fiber type (GSA, GVA, GSE, GVE, SA, BE)?
- Nasopharynx (GSA)
- Oropharynx (GSA)
- Stylopharyngeous (BE)
What region is supplied mostly from the vagus portion of the pharyngeal plexus?
- Contribution of fiber type (GSA, GVA, GSE, GVE, SA, BE)?
- Pharyngeal Constrictors (GSA)
- Salphingopharyngeous (GSA)
- Palatopharyngeous (GSA)
- Laryngopharynx (BE)
T or F: parasympathetic branches that are supplied to mucosal lining and mucous glands of the pharnyx via. CN X are part of the pharyngeal Plexus
FALSE, These GVE fibers supply the INTERIOR surface so is not part of the pharyngeal plexus
What sympathetic ganglion sends out fibers to blood vessels of the pharynx?
- Superior Cervical Ganglion.
What contributor(s) of the pharyngeal plexus can be found on the posterior surface of the stylopharyngeus muscle? - where does it go after this?
- Glossopharyngeal (IX)
- Wraps around lateral border of stylopharyngeus to enter posterior aspect of the tongue (posterior 1/3)
What CNs sent GSA fibers to the upper nasopharynx?
- Trigeminal (V)
- Glossopharyngeal (IX)
What are the 5 sources of blood for the pharyngeal tissues
- Ascending Pharyngeal a. (=> External Carotid)
- Ascending Palatine a. and Tonsilar (=> Facial a. => External Carotid)
- Descending Palatine and Pharyngeal branches (=> Maxillary a. => External Carotid)
- Unnamed Branches of lingual a.
- Muscular Branches of Inferior Thryroid a. (=> Thryocervical trunk => Subclavian)
Where are the two venous plexuses of the pharynx located?
- External Surface
2. Between Pharyngeal Musculature and Pharyngobasilar Fascia
Where do the venous plexuses of the pharynx drain?
- Pterygoid Plexus
- Pharyngeal Plexus
- Internal Jugular (via. facial and thyroid veins)
Where are Retropharyngeal Lymph Nodes Located and where do they drain?
- Between Pharynx and Vertebral Column
- Drain to Chain of Deep Cervical Nodes
What node(s) does the nasopharynx drain to?
- Jugulodigastric Node
What Drains Fluid from the Deep Cervical Nodes into the thoracic duct?
Deep Cervical Nodes
What is the lateral pharyngeal space?
- Space around the carotid sheath on either side of the retropharyngeal space
Where do infections from gums, teeth, tongue, and pharynx often go before getting to the retropharyngeal space?
- Lateral Pharyngeal Space
**Note: this is continuous with the retropharyngeal space
Describe the flow of infection in Ludwig’s Angina?
- Submandibular space infected
- Lateral Pharyngeal Space Infected
- Retropharyngeal Space infected
What would result if Ludwig’s Angina were not treated?
- Retropahryngeal infection could spread to thorax and/or cause respiratory obstruction (pressing on trachea from behind)
What is the Oral Phase of Swallowing?
Mastication and Bolus Formation
What is the Propulsive Phase of Swallowing?
Closure of nasopharynx and propulsion of bolus into pharynx by the tongue
What is the pharyngeal Phase of Swallowing?
- Pharynx pulled foward, widened and shortened by SUPRAHYOID and LONGITUDINAL LARYNGEAL mm. (access to larynx closed)
- Progressive wave of pharyngeal mm. contraction move bolus THROUGH PYRIFORM reccesses past upper esophageal sphincter into esophagus
- Upper eso. spincter relaxes for bolus to pass into proximal eso. and then closes to prevent stuff coming back up
What is the esophageal phase of swallowing?
- Upper eso. sphincter relaxes and bolus moves into the esophagus and propelled through lower esophageal sphincter
Where are the sensory receptors that detect the size of the bolus?
- Nerves in these places?
- Base of Tongue
- Facial Pillars
- Pharyngeal Wall
Afferent axons of IX (glossopharyngeal) and X (vagus)
What happens after sensory information is received in the pharygeal phase of swallowing reflex?
- Efferent Motor neurons act to get bolus from pharynx through the esophagus
What stimulates gag reflex (afferent, sensory)?
- Sensory receptors in:
1. Base of Tongue
2. Facial Pillars
3. Pharyngeal Wall
Detect an improperly prepared, sized, or desired bolus of food
What is the motor component of the gag reflex?
- Elevation of Soft Palate
2. Bilateral Constriction of Pharyngeal Constrictors
What is Zenker’s Diverticulum?
- Structures involved
- Outpouching of Mucosa
-
WEAKNESS BTWN*
1. Cricopharyngeus
2. Lower Inferior Constrictor
Describe the typical patient with Zenkers Diverticulum (pharyngeal Pouches)
- 2/3 male
- 70s - 80s
- Have GERD or hiatal Hernias
