Anatomy of Oral Cavity,

Pharynx and Esophagus

Dr. Krishna Koirala

2017-11-27
Oral Cavity
 Anatomical regions (Oncological)
• Buccal Mucosa
– Mucosal surfaces of upper and lower lips , cheeks
– Retromolar trigone, upper and lower buccoalveolar
sulci
• Upper alveolus and gingiva
• Lower alveolus and gingiva
• Hard Palate
• Anterior 2/3 of tongue
• Floor of Mouth
Floor of mouth
Lymphatic Drainage
 Intrinsic Tongue Muscles

• Three groups
– Transverse
– Longitudinal
– Vertical
• Function
– Alter the shape
of tongue
Extrinsic tongue muscles
 Action of tongue muscles
• Inferior and superior longitudinal : move the tip up
and down
• Transverse : narrow and lengthen the tongue
• Vertical : flatten and depress the tongue
• Genioglossus : Prevents tongue from falling back
• Styloglossus : Pulls tongue up and back
• Palatoglossus : Pulls and raises the tongue
• Hyoglossus : Depresses the tongue
 Nerve Supply of Tongue
Anterior 2/3 Posterior 1/3

Sensory Lingual Glossopharyngeal

Motor Genioglossus, Styloglossus and Hyoglossus

supplied by Hypoglossal
Palatoglossus supplied by spinal accessory

Taste Chorda tympani Glossopharyngeal

 Papillae in tongue

Lingual taste buds lie on lateral borders of papillae

• Fungiform : Tip & sides of tongue

• Circumvallate : Just in front of terminal sulcus

• Foliate : Posterior lateral margins of tongue

• Filiform : Centre of tongue, have no taste buds

Papillae in tongue
Tongue Map
Pharynx
Divisions
 Lower Limit of

Nasopharynx Lower border of soft palate or

Junction between hard & soft palate

Oropharynx Tip of epiglottis or

Body of hyoid bone or
Base of vallecula

Hypopharynx Lower border of cricoid or

Lower border of C6 vertebra
Anterior Relations
Nasopharynx
 Nasopharyngeal Isthmus

• Separates nasopharynx from oropharynx

• Bounded anteriorly by soft palate & posteriorly by

mucosal ridge on nasopharyngeal wall ( Passavant’s

ridge) - due to palatopharyngeus)

• Closure of this isthmus prevents nasal regurgitation

and nasal intonation
Parts of Oropharynx
 Oropharyngeal Isthmus
• Separates oral cavity from
oropharynx

• Boundaries

– Superior: Junction between

hard & soft palate

– Inferior: Circumvallate papillae

– Lateral: Anterior tonsillar

pillars (palatoglossus)
 Waldeyer's tonsillar ring

• Vertically oriented, sub-epithelial lymphoid tissue

ring located in pharynx

• Thought to function as a barrier to infection in first

few years of life

• Named after nineteenth century German anatomist

Heinrich Wilhelm Gottfried von Waldeyer

Waldeyer’s Tonsillar Ring
Parts of Hypopharynx
 Layers of pharyngeal wall
• Mucosa: ciliated columnar in nasopharynx and
stratified squamous in other areas

• Pharyngo-basilar fascia

• Longitudinal muscles : stylo-pharyngeus + salpingo-

pharyngeus + palato-pharyngeus

• Constrictor muscles: superior + middle + inferior

• Bucco-pharyngeal fascia
Coronal section of Pharynx
Muscles
 Structures Passing
Between Skull Base & Eustachian tube + Levator
Superior Constrictor (Sinus palatini + Tensor palatini +
of Morgagni) Ascending palatine artery

Between Superior & Middle Glossopharyngeal nerve &

Constrictors Stylopharyngeus muscle

Between Middle & Inferior Internal Laryngeal nerve &

Constrictors Superior Laryngeal artery

Below Inferior Constrictor Recurrent Laryngeal nerve &

Inferior Laryngeal artery
 Nerve Supply
• Nasopharynx : pterygo -palatine ganglion (V2)

• Oropharynx : glossopharyngeal & vagus nerve

• Hypopharynx : Superior & recurrent laryngeal nerve

• All muscles supplied by pharyngeal nerve plexus

(vagus nerve carrying cranial part of accessory nerve)
except stylopharyngeus (glossopharyngeal nerve) &
cricopharyngeus ( by recurrent laryngeal nerve)
 Arterial Supply
• Facial artery

• Lingual artery

• Ascending pharyngeal artery

• Ascending palatine artery

• Greater palatine artery

• Artery of pterygoid canal

• Superior laryngeal artery

 Venous Drainage
Upper pharynx

• Pharyngeal venous plexus situated on middle

constrictor  pterygoid venous plexus & internal

jugular vein

Lower pharynx

• Inferior thyroid veins

 Lymphatic Drainage
• Nasopharynx :upper deep cervical + retro-
pharyngeal + parapharyngeal +
posterior triangle
• Oropharynx : upper deep cervical + retro-
pharyngeal + parapharyngeal
• Hypopharynx : deep cervical + parapharyngeal +
paratracheal + supraclavicular
Killian’s Dehiscence
• Triangular weak area between thyropharyngeus

& cricopharyngeus part of inferior constrictor

• Mucosa herniates through it to form hypo-

pharyngeal pouch (Zenker’s diverticulum)

• Perforation occurs here during forceful

esophagoscopy (gateway of tears)

Oesophagus
• Fibromuscular tube

• 23 to 25 cm long in adults

• Extends from crico-pharyngeal sphincter (C6

vertebra) to cardiac orifice of stomach (T11 vertebra)

• Anteroposterior curvature

– Follows antero-posterior
curve of vertebral column
through neck, thorax
(posterior mediastinum)
and upper abdomen
 Lateral curvatures :

Starts in midline → deviates

to left at C7 → returns to

midline at T5 → deviates

to left again at T7 to reach

gastric cardia
Natural Constrictions
 Natural Constrictions
Site Vertebral Level Distance from
central incisor
Cricopharynx C6 15 cm

Aortic arch T4 23 cm

Lt main T5 28 cm
bronchus
Esophageal T 10 40 cm
hiatus
 Importance of constrictions

• Common sites

–Lodgement of esophageal foreign

bodies

–Caustic stricture of esophagus

 Blood Supply
Part Arterial Venous

Cervical Inferior thyroid Inferior thyroid

Thoracic Descending aorta, Azygos,

Bronchial Hemi-azygos

Abdominal Left gastric, Left gastric,

Inferior phrenic Abdominal azygos
 Nerve Supply
• Cervical : recurrent laryngeal nerve &

cervical sympathetic trunks

• Thoracic : vagal trunks, esophageal

plexus & thoracic sympathetic

trunks

• Abdominal : vagal trunks & thoracic sympathetic

trunks
 Histology

• Four coats from inside outwards

– Mucous coat

– Submucous coat

– Muscular coat (muscularis propria)

– Fibrous coat (adventitia)

 Mucous coat
• Epithelium

– Non-keratinizing stratified sqamous

• Lamina propria

– Loose areolar tissue with lymphoid aggregates

• Muscularis mucosae

– Produces local movement of mucosa and helps in

drainage of gland secretions
Pink, smooth, protective oesophageal mucosa leads
to redder, mamillated, secretory gastric mucosa
across Z line
 Submucous coat
• Loose supporting areolar tissue contains

– Seromucous glands

– Blood vessels

– Lymphatic channels

– Parasympathetic ganglia forming Meissner's nerve

plexus
 Muscularis propria
• Outer longitudinal muscles and
inner circular muscles

• Parasympathetic ganglia forming

Auerbach's nerve plexus b/w them

• Upper 1/3: striated muscle

• Middle 1/3: striated and smooth

• Lower 1/3: smooth muscle

 Fibrous coat (adventitia)
• Layer of loose, supportive fibrous tissue

• Conducts major vessels & nerves longitudinally

• A serosa formed by visceral peritoneum replaces

adventitia of intra-abdominal segment of
oesophagus