Pharynx and Pre-Vertebral Region

Question 1

Where does the pharynx extend from, and to

Answer 1

The cranial base to the inferior border of the C6 vertebrae posteriorly

Question 2

Describe the inner lining of the pharynx

Answer 2

Superiorly = ciliated columnar epithelium
Inferiorly = stratified squamous epithelium

Question 3

Name the 3 regions of the pharynx

Answer 3

1. Nasopharynx (posterior to nasal cavities)
2. Oropharynx (posterior to the mouth)
3. Laryngopharynx (posterior to the larynx, and blends with the oesophagus)

Question 4

Describe the muscular layers underneath the fibrous layer

Answer 4

1. Circular constrictor muscles

2. Longitudinal muscles

Question 5

What tube exists in the lateral wall of the nasopharynx, and describe its function

Answer 5

Auditory tube = communicates with the middles air, equalising pressure either side of the tympanic membrane

Question 6

Describe the borders of the nasopharynx

Answer 6

Roof = sphenoid, occipital, and pharyngeal tonsil
Floor = soft palate
Anterior = nasal passages
Posterior = roof and C1 level
Lateral = auditory tube

Question 7

What are the tonsils

Answer 7

Aggregations of lymphoid tissue

Question 8

Describe the borders of the oropharynx

Answer 8

Roof = soft palate
Floor = posterior 1/3rd tongue, lingual tonsil, and glossoepiglottic folds
Anterior = mouth
Posterior = C2/3 level
Lateral = palatoglossal and palatopharyngeal folds (arches) with palatine tonsils

Question 9

Where are the palatine tonsils located

Answer 9

Either side of the oropharynx in the interval between the palatine arches

Question 10

Describe the borders of the laryngopharynx

Answer 10

Anterior = larynx
Posterior = C3-6 vertebrae
Lateral = supported by thyroid cartilage, aryepiglottic fold, and thyrohyoid membrane

Question 11

Name the 3 pharyngeal constrictor muscles

Answer 11

1. Superior
2. Middle
3. Inferior

Question 12

Describe the arrangement of each pharyngeal constrictor muscle

Answer 12

Right and left parts meet in the posterior midline to form a fibrous raphe

Question 13

Describe the innervation to the pharyngeal muscles

Answer 13

All (except the stylopharyngeus) vagus nerve (CN X) running in the pharyngeal plexus

Question 14

What is the action of the superior pharyngeal constrictor muscle

Answer 14

Pull the posterior pharyngeal wall anteriorly to close off the nasopharynx

Question 15

What is the action of middle pharyngeal constrictor muscle

Answer 15

Propel the bolus towards the inferior constrictor

Question 16

What is the action of the inferior pharyngeal constrictor muscle

Answer 16

Propel the bolus towards the oesophagus

Question 17

Describe the overall action for the longitudinal pharyngeal muscles

Answer 17

Elevate the larynx and shorten the pharynx during swallowing and speaking

Question 18

Name the 3 pharyngeal longitudinal muscles

Answer 18

1. Palatopharyngeus
2. Stylopharyngeus
3. Salpingopharyngeus

Question 19

Describe the innervation to the stylopharyngeus

Answer 19

Branches of the glossopharyngeal nerve (CN IX)

Question 20

Describe the sensory innervation to the different regions of the pharynx

Answer 20

Nasopharynx = CNV2 (maxillary division)
Oropharynx = glossopharyngeal nerve (CN IX)
Laryngopharynx = vagus nerve (CN X)

Question 21

Describe the arterial supply to the pharynx

Answer 21

1. Pharyngeal branches from the maxillary artery

2. Ascending pharyngeal artery from the ‘medial’ surface of the external carotid

Question 22

Describe the venous drainage of the pharynx

Answer 22

Pharyngeal veins form a large venous plexus which communicate with:

1. Facial vein
2. Internal jugular vein

Question 23

What tonsils form the pharyngeal lymphatic ring

Answer 23

1. Palatine
2. Lingual
3. Pharyngeal

Question 24

Describe the lymphatic drainage pathway of the pharynx

Answer 24

Lymph drains to retropharyngeal and paratracheal nodes; then onto deep cervical nodes

Question 25

What nerves contribute to the pharyngeal plexus

Answer 25

1. Glossopharyngeal (CN IX) 2. Vagus (CN X) 3. Sympathetic fibres 4. Cranial part of the accessory nerve (CN XI) via the vagus nerve

Question 26

What significant structures exist in the area immediately posterior to the pharynx

Answer 26

1. Anterior pre-vertebral muscles | 2. Sympathetic ganglia

Question 27

Name the 4 anterior pre-vertebral muscles

Answer 27

1. Longus capitis 2. Longus colli 3. Rectus capitis anterior 4. Rectus capitis lateralis

Question 28

Describe the innervation to the 4 anterior pre-vertebral muscles

Answer 28

Longus capitis = anterior rami C1-3 Longus colli = anterior rami C2-6 Rectus capitis anterior = anterior rami C1-2 Rectus capitis lateralis = anterior rami C1-2

Question 29

What is the overall action of the anterior pre-vertebral muscles

Answer 29

Support the head on the neck, as well as flexion

Question 30

Where does the sympathetic ganglia extend from, and to

Answer 30

Base of the skull to join the thoracic chain inferiorly

Question 31

Describe the location of the sympathetic ganglia

Answer 31

Behind the internal and common carotid arteries, medial to the vagus nerve

Question 32

Name the 3 regions of the sympathetic ganglia

Answer 32

1. Superior cervical ganglia 2. Middle cervical ganglia 3. Inferior cervical ganglia

Question 33

Name the 3 ganglion regions of the sympathetic ganglia

Answer 33

1. Superior cervical ganglion 2. Middle cervical ganglion 3. Inferior cervical ganglion

Question 34

What level does the superior cervical ganglion exist

Answer 34

C1 and C2 vertebrae

Question 35

Where do the grey rami communicantes head out from the superior cervical ganglion

Answer 35

1. C1-4 anterior rami | 2. Form plexus' around the common and external carotid arteries

Question 36

What cranial nerves are supplied by the superior cervical ganglion

Answer 36

CN's IX, X, and XII

Question 37

At what level does the middle cervical ganglion exist

Answer 37

At the level of the cricoid cartilage; very small, and occasionally absent

Question 38

Name other branches that exit from the middle cervical ganglion

Answer 38

1. Thyroid branches to the thyroid gland 2. Middle cardiac branch to the cardiac plexus 3. Ansa cervicalis loops around the subclavian artery 4. Grey rami communicantes to anterior rami of C5-6

Question 39

In around 80% of people, what happens to the inferior cervical ganglion

Answer 39

It fuses with the first thoracic ganglion to form the stellate ganglion

Question 40

Where is the stellate ganglion located

Answer 40

Anterior to the transverse process of the C7 vertebra, superior to the neck of the 1st rib

Question 41

Name the branches of the stellate ganglion

Answer 41

1. Grey rami communicantes to the anterior rami of C7-8 | 2. Branches to the deep cardiac plexus