Pharynx

Question 1

How can the pharyx be divided into 3 sections and state the vertebral height of each

Answer 1

1. Nasopharynx: 1 vertebral height (C1)
2. Oropharynx: 2 vertebral heights (C2-3)
3. Laryngopharynx (Hypopharynx): 3 vertebral heights (4-6)

Question 2

What 2 structures comprise the nasopharynx?

Answer 2

Adenoids and Eustachian tube orifices

Question 3

Where is the pharynx and where does it extend from and to?

Answer 3

A Musculofascial tube that is progressively longer and narrower from top to bottom and Incomplete anteriorly

It extends from the base of skull to oesophagus (C6) and is the common entrance to GI and respiratory tracts

Question 4

Label the 3 sections of the pharynx

Answer 4

Question 5

Give the boundries of the nasopharynx

Answer 5

Superior: skull base and sphenoid sinus

Inferior: soft palate and continuous below with oropharynx

Anterior: choanae of nasal cavities

Posterior: Body of C1

Question 6

What type of epithelium lines the nasopharynx

Answer 6

Both respiratory type and stratified squamous epithelium

Question 7

When does the pharynx open and close?

Answer 7

TRICK QUESTION… ALWAYS OPEN

Question 8

What tonsils are found in the nasopharynx

Describe this

Answer 8

Nasopharyngeal Tonsil (Adenoids)

This is a collection of lymphoid tissue beneath posterior roof epithelium which produces IgA, IgG, IgM

(This along with palatine tonsils helps to form → Waldeyer’s Ring)

Question 9

What elevation on the side wall is an opening connecting nasopharynx with middle ear?

Obstruction can lead to what?

Answer 9

Pharyngotympanic Tube (Eustachian Tube) Orifice

Obstruction can lead to “Glue Ear”

Question 10

When is the max size of our adenoids reached and then what occurs?

Give another example of where these may enlarge

Answer 10

Maximal size 3-8 years (then regress)

Enlargement with viral/bacterial infections

Question 11

Where is the oropharynx located and give its boundries

Answer 11

Behind oral cavity and tongue

Boundaries:

• Superior – level of soft palate
• Inferior – superior edge of epiglottis
• Anterior – oral cavity
• Posterior – C2 – C3

Question 12

What epithelium lines the oropharynx?

Answer 12

Stratified squamous epithelium

Question 13

What marks the boundary between the oral cavity and oropharynx

Answer 13

Palatoglossal folds (arches)

Question 14

Give the contents of the oropharynx

Describe the structure, epithelium and muscles involved in these structures

Answer 14

1) Palatine tonsils are (encapsulated)
2) Anterior and posterior tonsillar (faucial) pillars

The tonsillar fossa floor is formed by the superior constrictor muscle. The lymphoid tissue is covered with squamous epithelium and there are many crypts found here.

Question 15

Label the palantine arches

Answer 15

Question 16

What tends to occur to the tonsils as we age

Answer 16

Atrophies after puberty

Question 17

Where are the Palatine tonsils located?

Answer 17

Lie in tonsillar fossae (between ant. and post. pillars)

Question 18

The Anterior pillar is also known as what arch?

Describe this

Answer 18

Palatoglossal arch:

• Boundary between buccal cavity and oropharynx
• Fuses with lateral wall of tongue
• Contains palatoglossal muscle

Question 19

The Posterior pillar is also known as what arch?

Describe this

Answer 19

Palatopharyngeal arch

• Blends with wall of pharynx
• Contains palatopharyngeus muscle

Question 20

What is the blood supply to the Palatine tonsils?

Answer 20

Tonsillar branch of facial artery (branch of ECA)

Also lingual/ ascending palantine/ ascending pharyngeal BUT tonsilar is the main

Question 21

What is the venous drainage of the Palatine tonsils?

Answer 21

pharyngeal plexus (also paratonsillar vein)

Question 22

What structure must we be carful of when removing the tonsils or draining a quinsy?

Answer 22

We must be carful of the ICA because this runs in close proximity

Question 23

Describe the lymph drainage of the Palatine Tonsils

Answer 23

Lymphatics pierce superior constrictor muscle ➞
Pass to nodes along internal jugular vein ➞ Jugulodigastric node (angle of mandible)

Question 24

What node is indicated by the arrow and what 3 structures does it drain?

Answer 24

Jugulo-digastric: drains tonsil, pharynx, posterior tongue

Question 25

What 2 structures is the piriform fossa located between and what is its function?

Answer 25

Recess between the central layrnx and lateral thyroid cartilage (in the laryngopharynx) Functions to channel solids/liquids from oral cavity around raised laryngeal inlet INTO oesophagus

Question 26

What is the largest part of the pharynx and below what structure is this located?

Answer 26

Laryngopharynx (Hypopharynx) located below epiglottis

Question 27

Give the boundries of the Laryngopharynx

Answer 27

Superior – superior edge of epiglottis Inferior – level of inferior edge of cricoid cartilage Anterior – larynx Posterior – C3 – C6 vertebrae

Question 28

What is the laryngopharynx continuous with inferiorly?

Answer 28

The oesophagus

Question 29

What epithelium lines the laryngopharynx?

Answer 29

Stratified squamous epithelium

Question 30

What are the 2 main muscles groups of the pharynx and how are they arranged?

Answer 30

There are 2 layers of muscle which supply the pharynx: * Inside we have longitudinal * Outside we have have constrictor muscles

Question 31

What are the 3 constrictor muscles of the pharynx?

Answer 31

* Superior Constrictor * Middle Constrictor * Inferior Constrictor

Question 32

The 3 constrictor muscles _____ each other and are located Immediately anterior to the \_\_\_\_\_\_\_\_\_ They open _______ to nasal, buccal and \_\_\_\_\_\_\_and are attached posteriorly by the \_\_\_\_\_\_\_ They sequentially contract to propel food down the \_\_\_\_\_\_\_

Answer 32

overlap, prevertebral fascia, anteriorly, laryngeal cavities, median raphe, oesophagus

Question 33

Label the 3 contrictor muscles + other addition impt muscle

Answer 33

Question 34

Which contrictor muscle forms the floor of the tonsilar fossa?

Answer 34

Superior Constrictor

Question 35

What are the 3 stages of swallowing?

Answer 35

Oral (voluntary) Pharyngeal (involuntary/reflex) Oesophageal (involuntary/reflex)

Question 36

What is the function or the oral phase? What occurs during this phase?

Answer 36

Lubrication and formation of food bolus by mastication * Tongue pushes bolus to back * Oesophageal sphincter contracted * (Epiglottis raised)

Question 37

What occurs during the pharyngeal phase?

Answer 37

1) Soft palate raised (nasopharynx closed off and eustachian tube opens) 2) Hyoid and Larynx raised 3) Epiglottis down and Tongue blocks off mouth 4) Sequential contraction of constrictors moves bolus into hypopharynx 6) Oesophageal sphincter relaxed

Question 38

What 3 muscles raise the Hyoid and Larynx during the pharyngeal phase

Answer 38

Action of tongue, longitudinal pharyngeal muscles and suprahyoid muscles

Question 39

What protects the larynx during the pharyngeal phase of swallowing?

Answer 39

Overhanging tongue, Epiglottis, Vocal cords

Question 40

When the nasopharynx closes why does our eustachian tube open?

Answer 40

To equalise pressure!

Question 41

What separates the nasopharynx from the oropharynx during swallowing?

Answer 41

Elevation of soft palate + constriction of the palatopharyngeal sphincter This is why food doesn't go up our nose when we swallow!!

Question 42

What happens with the Oropharynx AFTER chewing?

Answer 42

1) When holding food in mouth: oropharynx is sealed off 2) Opens for swallowing → THEN Oropharyngeal opening CLOSES 3) Laryngeal cavity is CLOSED 4) Food is directed towards oesophagus

Question 43

Can we breathe and swallow at the same time and why?

Answer 43

You CANNOT breathe and swallow at same time because airway is closed at 2 sites → the pharyngeal opening and the larynx

Question 44

What occurs during the oesophageal phase?

Answer 44

1) Epiglottis up 2) Hyoid and Larynx down 3) Oesophageal sphincter (cricopharyngeus) contracted 4) Peristalsis moves bolus to stomach

Question 45

What anatomical considerations must be made for swallowing and breathing

Answer 45

Pathway of breathing shown by yellow line Pathway of swallowing is red line There is overlap!! Hence we must consider where things may go wrong here... Eg. after a stroke we can get swallowing difficulties which can lead to aspiration pneumonia Also in aesthetics we MUST protect the airways from anything going down airway (NBM)

Question 46

What is the sensory supply to each of the 3 sections of the pharynx?

Answer 46

Nasopharynx – Maxillary division of Trigeminal (V2) Oropharynx – Glossopharyngeal (IX) Layrngopharynx – (X)

Question 47

What is the motor supply to muscles of the pharynx?

Answer 47

All pharynx muscles = Vagus (X) EXCEPT: * Stylopharyngeus - Glossopharyngeal (IX) * Tongue - Hypoglossal (XII) * Stylohyoid - Facial (VII)

Question 48

What is the blood supply to the pharynx

Answer 48

Superior Thyroid and Ascending Pharyngeal \*Both branches off ECA

Question 49

What is the venous drainage of the pharynx?

Answer 49

Pharyngeal venous plexus → Drains into IJV

Question 50

Label this X-ray

Answer 50

A.epiglottis B. hyoid C.laryngeal vestibule D.cricoid E.trachea F.Cx6