Anatomy of Pharynx

Dr. B. Arvind Sangavi

M.S.(ENT)

Associate Professor Dept of ENT & HNS RIMS

Pharynx
Pharynx is a conical fibromuscular tube

forming upper part of aero-digestive tract 12-14 cms, extends from base of skull to lower border of cricoid cartilage (C6). Width is 3.5 cms at base & 1.5 cms at pharyyngo-oesophageal junction, which is the narrowest part in GIT.

 Mucous membrane Pharyngeal aponeurosis / Pharyngobasilar

fascia Muscular coat Buccopharyngeal fascia Ciliated columnar in nasopharynx & stratified squamous in rest of pharynx

Killians dehiscence
Inferior constrictor muscle-

thyropharyngeus oblique fibres cricopharyngeus transverse fibres Potential gap- Killians Dehiscence Gateway of tears perforation can occur at this site during oesophagoscopy. Pharyngeal pouch- herniation of pharyngeal mucosa

Waldeyers Ring
Subepithelial layer of lymphoid tissue Nasopharyngeal tonsil/adenoids Palatine tonsil Tubal tonsil Lateral pharyngeal bands Nodules-posterior pharyngeal wall

Pharyngeal Spaces
Retropharyngeal space- from base of skull

to bifurcation of trachea between buccopharyngeal fascia & prevertebral fascia. Divided by median raphe into two (space of Gillette) Prevertebral space - between vertebral bodies & prevertebral fascia, extends from base of skull to coccyx

Parapharyngeal space
Medial: buccopharyngeal fascia covering

constrictors Posterior: prevertebral fascia Lateral: medial pterygoid muscle, mandible. Styloid complex- divides into anterior & posterior compartment. Antr- tonsillar fossa medially & pterygoid muscle laterally Postr- pharyngeal wall med & parotid laterally. Carotid art, jugular vein, IX, X, XI, XII CN, & nodes

Pharynx
Nasopharynx, Oropharynx & Hypopharynx

Nasopharynx
Epipharynx: from base of skull to plane

passing through hard palate Roof: basisphenoid & basiocciput Posterior wall: atlas vertebra with muscles Floor: anteriorly soft palate & posteriorly communicates with the oropharynx through nasopharyngeal isthmus

 Lateral wall: E.tube 1.25cms behind IT

Torus tubaris- elevation behind tubal opening Fossa of Rosenmuller- site for origin of Nasopharyngeal Carcinoma Salpingopharyngeal fold Tubal tonsil: part of Waldeyers ring Adenoids-Nasopharyngeal tonsil upto12 years, later atrophies

Nasopharyngeal bursa
Epithelial lined median recess within

adenoids Extends from pharyngeal mucosa to basiocciput Represents attachment of notochord to pharyngeal entoderm during embryonic life Infection persistent postnasal discharge Thornwaldts disease- abscess

 Rathkes pouch: remniscent of buccal

mucosal invagination,forming antr lobe of pituitary. Craniopharyngioma may arise from this site Sinus of Morgagni: space between base of skull & upper free border of superior constrictor . E.tube, tensor veli palatine, levator veli paltine enters along with ascending palatine artery br of facial artery Passavants ridge: mucosa ridge raised by palatopharyngeus. Deglutition, cuts off NP from OP

 Lined by pseudostratified ciliated columnar epithelium Lymphatics drain into upper deep cervical nodes

either directly or thro retro/parapharyngeal nodes

Functions
Conduit of humidified air into larynx/trachea Ventilates ME thro E.tube, equalizes air pressure. Cuts off oropahrynx during deglutition, vomiting, speech Resonating chamber Drainage channel for mucous secreted by nasal glands

Oropharynx
Extends from plane of hard palate above to plane of hyoid bone below Communicates with oral cavity thro oropharyngeal isthmus. Posterior wall: related to retropharyngeal space, C2-C3 Anterior wall: above opens into oral cavity, & below related to base of tongue, lingual tonsil, valleculae Lateral wall: anterior & posterior pillars, faucial tonsil Lower limit is by upper border of epiglottis & pharyngoepiglottic folds

 Lymphatics drain into upper jugular chain-JD

nodes, also to retro & para pharyngeal nodes.

Functions
Conduit for passage of air & food Pharyngeal phase of deglutition Vocal tract for certain speech sounds

Taste sensation-BOT, soft palate, pillars, PP

wall Local defence & immunity at entrance of aerodigestive tract- Waldeyers ring

Hypopharynx (Laryngopharynx)
It lies behind & sides of larynx
Extends from plane passing from hyoid

bone to lower border of cricoid cartilage, (C3-C6). Three regions: Pyriform sinus, post cricoid region & posterior pharyngeal wall. Pyriform fossa: either side of larynx. Internal laryngeal nerve runs submucosally in lat wall, cause referred pain in carcinoma

 Post-cricoid region: cricoid lamina, site for carcinoma in pts with Plummer-Vinson syndrome
Posterior pharyngeal wall: from level of hyoid bone

to crcoarytenoid joint. Lymphatic drainage: upper jugular chain, parapharyngeal nodes, supraclavicular. Functions: Conduit for air & food, Vocal tract resonance Takes part in deglutition Failure of cricopharyngeal sphincter to relax when pharyngeal muscles contract- hypopharyngeal diverticulum

Structures passing through

Above superior constrictor E.tube, tensor palati, levator palati muscles Palatine br ascending pharyngeal artery Between superior & middle constrictor Stylopharyngeus muscle, glossopharyngeal n Between middle & inferior constrictor Internal laryngeal n, superior laryngeal vessels. Below inferior constrictor Recurrent laryngeal nerve, inferior laryngeal art

Blood supply: branches of external carotid art Ascending pharyngeal, Dorsal lingual artery Ascending palatine & tonsillar artery Branches of internal maxillary artery Nerve supply: pharyngeal plexus formed by Pharyngeal br of vagus & glossopharyngeal Pharyngeal br of superior cervical sympathetic ganglion Vagal fibres are motor, glossopharyngeal is sensory & sympathetic is vasomotor

Functions of Pharynx
Deglutition Protection from aspiration Part of respiratory & food passage Speech adds resonance to the voice

Waldeyers ring is involved

Taste sensation Mucous from respiratory tract is swallowed E.tube ventilates & drains the middle ear cleft

Thank You..