PHARYNX-I

Introduction
• Pharynx is a fibromuscular tube.
• It is a common channel for both food and air.
Location- Behind the cavities of nose, mouth and the larynx.
Shape - funnel shaped.
Extent- From the base of the skull to the esophagus.

Regions of the Pharynx

Posterior Choana

Hard Palate

Hyoid bone

Lower border of
Cricoid cartilage
Boundaries
Superior-
• Base of skull [ posterior part of body of Sphenoid & Basilar part of Occipital bone in front of
pharyngeal tubercle.
Inferior-
• Continuous with esophagus at the level of lower border of cricoid cartilage anteriorly and
lower border of C6 vertebra posteriorly
 Boundaries contd…
Posterior-
• Prevertebral fascia.
Anterior-
• Opens into cavities of nose, mouth and larynx.
Lateral-
• Neurovascular bundle of neck.
• Styloid process with its attached muscles and ligaments.
 Subdivisions
3
 From above downwards:

• Nasopharynx.

• Oropharynx.

• Laryngopharynx.
 Nasopharynx
Location-
• Behind choanae (posterior nasal apertures) and above soft palate.

Communications-
Anteriorly- with nasal cavities.
Inferiorly- with oropharynx.
Emad A. Magdy, M.D.
 Pharyngeal Isthmus [Nasopharyngeal Isthmus]
• An opening bounded anteriorly by the
soft palate and posteriorly by the
posterior wall of pharynx
( Passavant’s ridge).
 Nasopharynx contd…
Features:
• Nasopharyngeal (Pharyngeal) Tonsil).
• Orifice of Pharyngo-tympanic tube (Auditory tube
or Eustachian tube).
• Tubal elevation.
• Tubal tonsil.
• Salpingopharyngeal fold.
• Salpingopalatine fold.
• Pharyngeal recess (Fossa of Rosenmüller).

Nasopharyngeal (Pharyngeal) Tonsil [Adenoids]-

• A collection of lymphoid tissue.
Location- At the junction of roof and posterior wall of
nasopharynx.
• Contains nasopharyngeal bursa.
Nasopharyngeal (Pharyngeal) bursa [Pouch of
Luschka]-
• A mucous diverticulum which extends upwards into
the substance of pharyngeal tonsil from its apex.
• It is developed due to adhesion of notochord to the
dorsal wall of pharyngeal part of foregut.
 Nasopharynx
Orifice of Pharyngo-tympanic tube (Auditory tube or Eustachian tube)-
Location-
• On lateral wall of nasopharynx, approximately 1.25 cm behind inferior nasal concha.
Tubal elevation-
•Upper and posterior margins of orifice of eustachian tube are elevated due to collection of lymphoid tissue.
•These elevated margins are known as tubal elevation.
Tubal tonsil-
• Collection of lymphoid tissue in tubal elevation is known as tubal tonsil.
 Nasopharynx contd…
Salpingopharyngeal fold-
•A mucous fold which extends vertically downwards on the side wall of pharynx from tubal
elevation.
•It contains Salpingopharyngeus muscle.
Salpingopalatine fold-
•A mucous fold which extends downwards and forwards to the soft palate from tubal elevation.
•It contains Levator Palati muscle.
Pharyngeal recess (Fossa of Rosenmüller).
•It is a deep depression behind the tubal elevation.
 APPLIED ANATOMY OF PALATINE (FAUCIAL)
TONSILS
Palatine tonsils are two in number. Each tonsil is an ovoid mass
of lymphoid tissue situated in the lateral wall of oropharynx
between the anterior and posterior pillars. Actual size of the
tonsil is bigger than the one that appears from its surface as parts
of tonsil extend upwards into the soft palate, downwards into the
base of tongue and anteriorly into palatoglossal arch. A tonsil
presents two surfaces—a medial and a lateral, and two poles—an
upper and a lower. Medial surface of the tonsil is covered by
nonkeratinizing stratified squamous epithelium which dips into
the substance of tonsil in the form of crypts. Openings of 12–15
crypts can be seen on the medial surface of the tonsil.
One of the crypts, situated near the upper part of
tonsil is very large and deep and is called crypta
magna or intratonsillar cleft (Figure 51.1). It
represents the ventral part of second pharyngeal
pouch. From the main crypts arise the secondary
crypts, within the substance of tonsil. Crypts may
be filled with cheesy material consisting of
epithelial cells, bacteria and food debris which can
be expressed by pressure over the anterior pillar.
Lateral surface of the tonsil presents a well-defined fibrous
capsule. Between the capsule and the bed of tonsil is the loose
areolar tissue which makes it easy to dissect the tonsil in the
plane during tonsillectomy. It is also the site for collection of
pus in peritonsillar abscess. Some fibres of palatoglossus and
palatopharyngeus muscles are attached to the capsule of the
tonsil. Upper pole of the tonsil extends into soft palate. Its
medial surface is covered by a semilunar fold, extending
between anterior and posterior pillars and enclosing a potential
space called supratonsillar fossa. Lower pole of the tonsil is
attached to the tongue. A triangular fold of mucous membrane
extends from anterior pillar to the anteroinferior part of tonsil
and encloses a space called anterior tonsillar space.
The tonsil is separated from the tongue by a sulcus
called tonsillolingual sulcus which may be the seat of
carcinoma.
Bed of the tonsil. It is formed by the superior
constrictor and styloglossus muscles. The
glossopharyngeal nerve and styloid process, if
enlarged, may lie in relation to the lower part of
tonsillar fossa. Both these structures can be surgically
approached through the tonsil bed after tonsillectomy.
Outside the superior constrictor, tonsil is related to the
facial artery, submandibular salivary gland, posterior
belly of digastric muscle, medial pterygoid muscle and
the angle of mandible
HYPOPHAYNX
BLOOD SUPPLY

The tonsil is supplied by five arteries (Figure

51.3).
1. Tonsillar branch of facial artery. This is the
main artery.
2. Ascending pharyngeal artery from external
carotid.
3. Ascending palatine, a branch of facial
artery.
4. Dorsal linguae branches of lingual artery.
5. Descending palatine branch of maxillary
artery.
Definition:
Ring of Lymphoid tissue guarding entrance to the digestive & respiratory tracts.
It plays an important role in early recognition of pathogenic microorganisms & initiation of an immune response.
Waldeyer’s Ring
Definition:
Ring Definition:
Ring of Lymphoid tissue
guarding entrance to
the digestive &
respiratory tracts.
It plays an important
role in early recognition
of pathogenic
microorganisms &
initiation of an immune
response.
important role in early
recognition of pathogenic
 FUNCTIONS OF TONSILS
They act as sentinels to guard against foreign intruders like viruses, bacteria and
other antigens coming into contact through inhalation and ingestion. There are
two mechanisms:
1. Providing local immunity.
2. Providing a surveillance mechanism so that entire body is prepared for
defense. Both these mechanisms are operated through humoral and cellular
immunity.
• Local immunity. Tonsils and adenoids are lined by squamous epithelium,
surface area of which is further increased by several crypts of tonsils and
folds of adenoid. This epithelium is specialized and contains M-cells, antigen
processing cells and micropores. Through them antigenic material is brought
into contact with subepithelially situated lymphoid follicles. Follicles have a
germinal centre rich in B-cells and a mantel zone rich in large lymphocytes.
B-cells when stimulated change to plasma cells and produce antibodies.
Bacteria and viruses are also phagocytosed by the macrophages and
destroyed. Low-dose antigens and chronic infections are dealt with in this
manner.
Surveillance mechanism. It identifies the intruder
and alerts the body for wider response. If the dose
of antigen is high, B-cells of the germinal centre
proliferate and undergo hyperplasia and also enter
the blood stream. Complex immune system comes
into play with antigen processing cells, memory
cells, dendritic cells, macrophages, T-helper and T-
suppressor cells. Antibodies produced by the plasma
cells prepare the antigen to be phagocytosed by
neutrophils and other phagocytes. The antibodies
also get attached to macrophages and give them
enhanced ability to catch the antigens.
 Applied Aspects
Adenoids-
•Enlarged nasopharyngeal tonsils due to
infection.
•Block the posterior nares.

Clinical Features-
•Nasal obstruction.
•Nasal discharge.
•Mouth breathing.
•Snoring.
•Protrusion of tongue.
•Toneless voice
•Small nose.
•Epistaxis (Nose Bleeding).

Nasopharyngeal tonsils are prominent in

children up to the age of 6 years.
They gradually undergo atrophy at puberty.
They completely disappear by the age of 20
years.
 Adenoid Facies [Long Face Syndrome]
 Long, open-mouthed face of children with
adenoid hypertrophy.

 These children are ‘Obligatory Mouth

Breathers’.

 Persistent mouth breathing may be associated

with development of craniofacial anomalies.

 The characteristic facial appearance consists

of:

• Underdeveloped thin nostrils

• Short upper lip
• Prominent upper teeth
• Crowded teeth
• Narrow upper alveolus.
• High-arched palate
• Hypoplastic maxilla
Nasopharyngeal Swab