PHARYNX

D R . WA R D I A N S A H , M . B I O M E D.
OUTLINE

• Overview and Topographic Anatomy

• Parts of the Pharynx
• Muscles
• Potential Apertures in Pharyngeal Wall
• Vascular Supply
• Nerve Supply
• Clinical Correlates
OVERVIEW AND TOPOGRAPHIC
ANATOMY
• Pharynx: 5-inch muscular tube from base of the skull (posterior
portion of the body of the sphenoid bone and basilar portion of
the occipital bone) to the lower border of the cricoid cartilage
(C6), where it is continuous with the esophagus
• Is funnel-shaped
• Posterior portion of the pharynx lies against the prevertebral
fascia
• The retropharyngeal and parapharyngeal spaces surround the
pharynx
OVERVIEW AND TOPOGRAPHIC
ANATOMY
• Lies posterior to the nasal and oral cavities and the larynx and
thus is divided into 3 parts:
– Nasopharynx
– Oropharynx
– Laryngopharynx
• Responsible for properly conducting food to the esophagus and air
to the lungs
• Composed of:
– 3 constrictor muscles
– 3 longitudinal muscles
– Cartilaginous part of the pharyngotympanic tube
– Soft palate
OVERVIEW AND TOPOGRAPHIC
ANATOMY
• The wall of the pharynx has 5 layers:
– Mucous membrane—the innermost layer
– Submucosa
– Pharyngobasilar fascia—the fibrous layer attached to the skull
anchoring the pharynx
– Muscular—3 inner longitudinal and 3 outer circular (constrictor)
muscles that overlap such that the superior constrictor is the
innermost, whereas the inferior constrictor is the outermost
muscle
– Buccopharyngeal fascia—loose layer of connective tissue
continuous with the fascia over the buccinator and pharyngeal
muscles, and the location of the pharyngeal plexus of nerves and
the pharyngeal plexus of veins
OVERVIEW AND TOPOGRAPHIC
ANATOMY
OVERVIEW AND TOPOGRAPHIC
ANATOMY
• Waldeyer's ring is the anatomical name for the ring of lymphatic tissue in the pharynx and oral
cavity:
– Lingual tonsil (posterior 1/3rd of tongue)
– Palatine tonsil (oropharynx)
– Tubal tonsil (nasopharynx)
– Pharyngeal tonsil (nasopharynx)
PARTS OF THE PHARYNX
NASOPHARYNX
• Roof —posterior portion of the body of the
sphenoid bone and basilar portion of the
occipital bone
• Floor —soft palate (upper surface)
• Anterior —choanae of the nasal cavity
• Posterior —mucosa covering superior
constrictor
• Lateral —mucosa covering superior
constrictor
• Vertebral Level: C1 (and dens of C2)
PARTS OF THE PHARYNX
NASOPHARYNX
• Ostium of the auditory tube opens into the
nasopharynx
• Torus tubarius is an elevation formed by the base
of the cartilaginous portion of the auditory tube,
which lies superior to the ostium of the tube
• Torus levatorius is an elevation of mucous
membrane that lies over the levator veli palatini
m.
• Salpingopharyngeal fold is mucous membrane that
lies over the salpingopharyngeus m., connecting
the torus tubarius to the lateral wall of the
pharynx
PARTS OF THE PHARYNX
NASOPHARYNX
• Pharyngeal recess is located posterior to the
salpingopharyngeal fold and contains the pharyngeal
tonsil (adenoid)
• Pharyngeal tonsil (adenoid) is mucosa-associated
lymphatic tissue (MALT) located along the midline
• Tubal tonsils are MALT located posterior to the
opening of each auditory tube and are considered by
some authors to be extensions of the pharyngeal
tonsil
• Nasopharynx epithelium:
– Anterior —pseudostratified columnar with cilia in
anterior portion near nasal cavity
– Posterior —stratified squamous nonkeratinized in
posterior portion
PARTS OF THE PHARYNX
NASOPHARYNX
• Has a respiratory function
• The auditory tube connects the middle ear with the
nasopharynx, which helps equalize air pressure on
both sides of the tympanic membrane
• The cartilaginous portion of the auditory tube
normally is closed, except during deglutition and
yawning
• The auditory tube allows spread of infections
between the middle ear and the nasopharynx
• The roof and walls tend to be firm and do not close
during muscular contraction of the pharyngeal and
palatal muscles
PARTS OF THE PHARYNX
OROPHARYNX
• Superior —nasopharynx
• Inferior —superior border of epiglottis
• Anterior —palatoglossal fold of the oral
cavity (oropharyngeal isthmus)
• Posterior —mucosa covering the superior
and middle constrictor mm.
• Lateral —mucosa covering the superior and
middle constrictor mm.
• Vertebral Level: C2-C3
PARTS OF THE PHARYNX
OROPHARYNX
• Palatine tonsils are located in the oropharynx
between the palatoglossal and palatopharyngeal
folds (tonsillar sinus)
• Palatopharyngeal fold is an elevation of mucous
membrane that lies over the palatopharyngeal m.
• Epiglottic vallecula is the depression immediately
posterior to the root of the tongue
• Oropharynx epithelium is stratified squamous
nonkeratinized
• Has a respiratory and a digestive function
PARTS OF THE PHARYNX
LARYNGOPHARYNX
• Superior —oropharynx
• Inferior —inferior border of cricoid
cartilage (where becomes continuous with
esophagus)
• Anterior —larynx
• Posterior —mucosa covering middle and
inferior constrictor mm.
• Lateral —mucosa covering middle and
inferior constrictor mm.
MUSCLES
Muscle Origin Insertion Actions Nerve Supply
Superior Pterygoid hamulus Pharyngeal tubercle Constricts the
constrictor Pterygomandibular Pharyngeal raphe upper portion of
raphe the pharynx
Retromolar trigone Pharyngeal plexus
of mandible (the motor portion
Side of tongue of this plexus is
formed by the
Middle constrictor Stylohyoid lig. Pharyngeal raphe Constricts the pharyngeal branch
Lesser cornu of middle portion of of the vagus n.)
hyoid the pharynx
Greater cornu of
hyoid
MUSCLES
Muscle Origin Insertion Actions Nerve Supply
Inferior constrictor Oblique line of Pharyngea Constricts the Pharyngeal plexus (the motor
(divided by some thyroid cartilage l raphe lower portion of this plexus is formed by
authors into: Side of cricoid portion of the the pharyngeal branch of the vagus
• Thyropharyngeus cartilage pharynx n.)
External laryngeal n. of the vagus
• Cricopharyngeus) (also helps supply the
cricopharyngeus portion of the
inferior constrictor)
Recurrent laryngeal n. of the vagus
(also helps supply the
cricopharyngeus portion of the
inferior constrictor)
MUSCLES
Muscle Origin Insertion Actions Nerve Supply
Palatopharyngeus Posterior border of Elevates pharynx
hard palate Helps close the Pharyngeal plexus
Palatine nasopharynx (the motor portion
aponeurosis of this plexus is
Posterior border of formed by the
Salpingopharyngeus Cartilage of Elevates the upper pharyngeal branch
the lamina of the
auditory tube and lateral portions of the vagus n.)
thyroid cartilage
of the pharynx
Stylopharyngeus Medial aspect of Elevates pharynx Glossopharyngeal
base of styloid Expands the sides n.
process of the pharynx
POTENTIAL APERTURES IN
PHARYNGEAL WALL
• The overlapping arrangement of the 3 constrictor muscles leaves 4 potential apertures in the
pharyngeal musculature
• Anatomic structures enter and exit the pharynx through these potential apertures
Location Anatomic Structures That Pass Through
Between base of the skull and the superior Auditory tube
constrictor m. Levator veli palatini m.
Ascending pharyngeal a.
Ascending palatine a.
Between the superior and middle constrictor Stylopharyngeus m.
mm. Glossopharyngeal n.
Tonsillar branch of the ascending palatine a.
Stylohyoid lig.
Between the middle and inferior constrictor Internal laryngeal n.
mm. Superior laryngeal a. and v.
Inferior to the inferior constrictor m. Recurrent laryngeal n.
Inferior laryngeal a. and v.
 Artery Source Course
The smallest branch arising

VASCULAR SUPPLY
from the external carotid a.
Ascends superiorly between
the lateral aspect of the
pharynx and the internal

ARTERIAL SUPPLY
carotid a.
The posterior portion of Has 2 major sets of branches :
the external carotid a. near -Pharyngeal—a series of 3
Ascending pharyngeal
the bifurcation of the small branches that supplies
common carotid a. the stylopharyngeus and the
middle and inferior constrictor
mm.
-Palatine—supplies the
superior constrictor, palatine
tonsil, soft palate, and auditory
tube
Ascends superiorly along the
lateral side of the pharynx,
typically between the
stylopharyngeus and the
styloglossus mm.
Ascending palatine
Passes through the aperture
between the base of the skull
and the superior constrictor
Facial a. m. to supply it and the soft
palate
While ascending superiorly
along the lateral side of the
pharynx, it passes into and
Tonsillar supplies the superior
constrictor m. until reaching
the palatine tonsil and root of
the tongue

VASCULAR SUPPLY
The 3rd part of the
Pharyngeal maxillary a. in the
pterygopalatine fossa
ARTERIAL SUPPLY
The 3rd part of the maxillary accompanying the nerve of
Artery of the pterygoid
a. in the pterygopalatine
canal
fossa
Descending palatine a. from descending palatine a. splits
Lesser palatine the 3rd part of the maxillary into the:
a.
The 1st branch of the
Superior thyroid
external carotid a.
Inferior thyroid Thyrocervical trunk
Passes posteriorly with
the pharyngeal n. into
the pharyngeal canal
Emerges to supply the
superior portion of the
nasopharynx and the
auditory tube
Passes posteriorly into the
pterygoid canal,
the pterygoid canal (vidian
n.)
Helps supply the auditory
tube
A branch of the descending
palatine a. that travels in the
palatine canal
Within the canal, the
-Greater palatine a.
-Lesser palatine a.
Lesser palatine a. supplies the
soft palate and palatine tonsil
Passes inferiorly along the
inferior constrictor m.,
providing small muscular
branches as it descends to
supply the thyroid gland
Has a series of muscular
branches that supply the
pharynx
VASCULAR SUPPLY
ARTERIAL SUPPLY
VENOUS DRAINAGE
Vein Course
Located on the outer surface
of the pharynx in the
buccopharyngeal fascia
Gives rise to pharyngeal vv.,
which drain into the internal
Pharyngeal plexus jugular v. and also into the
pterygoid plexus of veins
along the lateral pterygoid m.
The pharyngeal vv. also may
drain into the facial, lingual, or
superior thyroid v.
NERVE SUPPLY

• Supplies a majority of the motor and sensory innervation to the pharynx

• Is located on the lateral aspect of the middle constrictor muscle
• Composed of:
– Pharyngeal branch of the glossopharyngeal nerve
– Pharyngeal branch of the vagus nerve
– Sympathetic fibers (laryngopharyngeal branches) from the superior cervical ganglion (postganglionic
fibers)
 Nerve Function Course Sensory Motor
3 or 4 filaments unite to

NERVE SUPPLY
form 1 pharyngeal Sensory branches
branch opposite the contributing to the
The major branch of
middle constrictor m. plexus perforate the
the glossopharyngeal
Pharyngeal This branch, along with pharyngeal muscles
n. that contributes to
branch of the the pharyngeal branch and supply its
the pharyngeal
glossopharyngeal of the vagus and mucous membranes
plexus
laryngopharyngeal (mainly oropharynx
Sensory
branches from the and laryngopharynx
sympathetics, forms the region)
pharyngeal plexus

Arises from the upper

part of the inferior
ganglion of the vagus n.
Lies along the upper
border of the middle
constrictor m., where it Superior constrictor,
The major branch of
forms the pharyngeal middle constrictor,
Pharyngeal the vagus n. that
plexus inferior constrictor,
branch of the contributes to the
From the plexus, the palatopharyngeus,
vagus pharyngeal plexus
motor branches are salpingopharyngeus
Motor
distributed to the mm.
pharyngeal and soft
palate muscles (with the
exception of the
stylopharyngeus m. and
tensor veli palatini m.)
Sympathetic
A series of
fibers
laryngopharyngeal
(laryngopha-
Vasomotor branches pass along the Vasomotor
ryngeal branches)
lateral side of the
from the superior
middle constrictor m.
 OTHER INNERVATION OF THE
PHARYNX
Nerve Function
A small contributor to the motor
innervation of the muscles of the
Recurrent laryngeal branch of
pharynx
the vagus
Provides significant innervation to
the larynx
A small contributor to the motor
innervation of the muscles of the
External laryngeal n. pharynx
Provides innervation to the
cricothyroid m.
Pharyngeal A small sensory nerve
Course Sensory Motor
Branch of the vagus n.
Wraps around the aorta posterior
to the ligamentum arteriosum on
the left side
Wraps around the right subclavian Part of the inferior constrictor m.
a. on the right side (cricopharyngeus portion)
Ascends on the lateral aspect of the
trachea until reaching the pharynx,
where it passes deep to the inferior
constrictor to reach the larynx
A branch of the superior laryngeal
n. that branches from the vagus n.
Descends posterior to the
sternohyoid, traveling with the
superior thyroid a. Part of the inferior constrictor m.
Lies along the inferior constrictor (cricopharyngeus portion
m.
Passes deep to the inferior
constrictor m. to travel anteriorly
to the cricothyroid m.
Arises from the maxillary division
of the trigeminal in the
pterygopalatine fossa Supplies sensory fibers to the
Passes posteriorly through the nasopharynx and the auditory tube
pharyngeal canal with the artery to
enter the nasopharynx
CLINICAL CORRELATES
DEGLUTITION
• Deglutition , or swallowing, is a combination of voluntary and involuntary muscular contractions to move a
bolus of food from the oral cavity to the esophagus
• Deglutition begins when the tip of the tongue is placed into contact with the anterior portion of the palate and
the bolus is pushed posteriorly
• The soft palate begins to elevate, and Passavant's ridge starts to form in the posterior wall of the pharynx and
moves closer to the soft palate
• As more of the tongue is pushed against the hard palate, the bolus is moved into the oropharynx, and the soft
palate makes contact with Passavant's ridge to close off the nasopharynx from the oropharynx
• Once the bolus reaches the epiglottic vallecula, the hyoid and larynx are elevated and the tip of the epiglottis is
tipped down slightly over the laryngeal aditus
• A “stripping wave” is created on the posterior wall of the pharynx to help move the bolus
CLINICAL CORRELATES
DEGLUTITION
• Bolus splits into 2 streams that flow on either side of the epiglottis and unite to enter the
esophagus
• The soft palate is pulled down by the palatopharyngeus muscles and the pressure of the wave from
the movement of the bolus, while the stripping wave continues to help move the bolus from the
oropharynx
• The cricopharyngeal portion of the inferior constrictor relaxes to help the bolus enter the
esophagus
• Laryngeal vestibule and rima glottidis are closed to prevent the bolus from entering the larynx
• Stripping wave empties the last of the bolus from the epiglottic vallecula, and the major portion of
the bolus is already in the esophagus
• All structures return to their initial position as the stripping wave moves into the esophagus
CLINICAL CORRELATES
PHARYNGITIS
• Pharyngitis is an inflammation of the pharynx often caused by an upper respiratory infection
• The most common symptom is a sore throat (although often accompanied by a cough)
• Pharyngitis also can cause the tonsils to enlarge and become inflamed, leading to tonsillitis
• Etiology
• Various etiologic agents may cause infection associated with pharyngitis:
– Viral
• Adenovirus
• Herpes simplex virus
• Epstein-Barr virus (infectious mononucleosis)
• Influenza virus
• Rhinovirus
CLINICAL CORRELATES
PHARYNGITIS
• Bacterial
– Corynebacterium diphtheriae (diphtheria)
– Streptococcus (peritonsillar abscess, “strep throat”)
• Fungal
– Candida albicans (oral thrush)
• Treatment
– Most treatment is symptomatic
– Bacterial and fungal pharyngitis respond well to antibiotics and antifungals