Clinical anatomy, physiology of

throat.

PHARYNX

Lecturer : Dr.Aziza Tilemishova

 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.
Introduction contd…
Dimensions-

Length- 12-14 cm

• At base- 3.5 cm

• At pharyngo-esophageal
junction- 1.5 cm
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.
 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 contd…
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 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.
 Oropharynx
• The oropharynx is the middle part of
the pharynx, located between the
soft palate and the superior border of
the epiglottis.
• It contains the following structures:
• Posterior one-third of the tongue.
• Lingual tonsils – lymphoid tissue at
the base of the tongue.
• Palatine tonsils – lymphoid tissue
located in the tonsillar fossa
(between the palatoglossal and
palatopharyngeal arches of the
oral cavity).
• Superior constrictor muscle
• The oropharynx is involved in the
voluntary and involuntary phases
of swallowing
 Oropharynx

Extent- From lower surface of

soft palate to upper border of
epiglottis.

Communications
• Anteriorly- with Oral cavity.
• Above- with Nasopharynx.
• Inferiorly- with Laryngopharynx
 Oropharynx
The oropharynx is the part
of the pharynx through which air
and food pass; the alimentary and
respiratory tracts meet in this
region. Anteriorly the oropharynx
opens into the mouth (fauces),
The
fauces is confined in the
space between the edge of the
soft palate(1), the uvulа, the
anterior and posterior palatine
arches (2,3), and the root of the
tongue.
 Waldeyer’s ring
• Waldeyer’s ring is the ring of
lymphoid tissue in the naso- and
oropharynx formed by:
1. Pharyngeal tonsil
2. Tubal tonsils (x2)
3. Palatine tonsils (x2)
4. Lingual tonsil
The tonsils are classified as mucosa-
associated lymphoid tissue (MALT),
and therefore contain T cells, B cells
and macrophages.
They have an important role in
fighting infection – the first line of
defence against pathogens entering
through the nasopharynx or
oropharynx.
 Laryngopharynx [Hypopharynx]

• The most distal part of the

pharynx, the laryngopharynx is
located between the superior
border of the epiglottis and
inferior border of the cricoid
cartilage (C6). It is continuous
inferiorly with the esophagus.
• It is found posterior to the larynx
and communicates with it via the
laryngeal inlet, lateral to which
one can find the piriform fossae.
• The laryngopharynx contains the
middle and inferior pharyngeal
constrictors.
 Laryngopharynx [Hypopharynx]

• Vertical Extent
• Anteriorly- • From upper border
of epiglottis to lower border of
lamina of cricoid cartilage.
• Posteriorly- • From C3 vertebra to
the lower border of C6 vertebra.
Communications
• Anteriorly- with Laryngeal cavity.
• Superiorly- with Oropharynx.
• Inferiorly- with Esophagus. 
Laryngopharynx communicates
with laryngeal inlet through
Laryngeal Inlet.
 Muscles of Pharynx

• There are two main groups

of pharyngeal muscles:
1. longitudinal
2. circular. (Constrictor)
• The muscles of the pharynx are
mostly innervated by the vagus
nerve – the only exception
being the stylopharyngeus
(glossopharyngeal nerve).
 Constrictor Muscles
Circular

Constrictor muscles form the

bulk of muscle layer.
• Origin
From the margins of posterior
openings of nasal, oral, and
laryngeal cavities.
Insertion
Into the median fibrous raphe on
the posterior aspect of pharynx.

Inferior constrictor overlaps the

middle constrictor.
Middle constrictor overlaps the
superior constrictor.
 Superior Constrictor

Origin-
• Pterygoid hamulus.
• Pterygomandibular raphe.
• Medial surface of mandible at upper end
of mylohyoid line.
• Side of posterior part of tongue.
Insertion-
•Pharyngeal tubercle.
•Pharyngeal raphe.
Nerve supply-
•Pharyngeal branch of Vagus nerve
( carrying fibers of cranial root of
accessory nerve).
Action-
•Helps in deglutition
 Middle Constrictor
Origin-
•Lower part of Stylohyoid
ligament.
•Lesser cornu of hyoid bone.
•Upper border of greater cornu of
hyoid bone.
Insertion-
•Pharyngeal raphe.
Nerve supply-
•Pharyngeal branch of Vagus
nerve ( carrying fibers of cranial
root of accessory nerve).
Action- •Helps in deglutition.
 Inferior Constrictor

It has 2 parts:
•Thyropharyngeus. •Cricopharyngeus.
Thyropharyngeus
Origin-
•Oblique line on lamina of thyroid
cartilage.
•Tendinous band between thyroid
tubercle and cricoid cartilage
Insertion-
•Pharyngeal raphe.
Nerve supply-
•Pharyngeal plexus. •External laryngeal
nerve [b/o Superior Laryngeal Nerve].
Action- •Helps in deglutition
 Inferior Constrictor
Cricopharyngeus
• Origin-
•Cricoid cartilage.
Insertion-
•Pharyngeal raphe.
Nerve supply-
•Recurrent laryngeal nerve [b/o
Vagus nerve].
Action- •Helps in deglutition
 longitudinal muscles

• The longitudinal muscles are:

1. stylopharyngeus
2. palatopharyngeus
3. salpingopharyngeus.
• They act to shorten and widen
the pharynx, and elevate the
larynx during swallowing
 longitudinal muscles

1. Stylopharyngeus
Origin-
•Medial surface of base of Styloid
process.
Insertion-
•Posterior border of lamina of
Thyroid cartilage.
Nerve Supply-
•Glossopharyngeal Nerve.
longitudinal muscles

• Palatopharyngeus
Origin- by 2 fasciculi:
• Anterior fasciculus- from posterior
border of hard palate
• Posterior fasciculus- from upper
surface of palatine aponeurosis.
These fasciculi are separated by Levator
Palati muscle.
Insertion-
•Pharyngeal raphe.
•Posterior border of lamina of Thyroid
cartilage.
Nerve Supply-
•Cranial root of Accessory Nerve via
pharyngeal plexus.
 longitudinal muscles

• Salpingopharyngeus
Origin-
• Lower aspect of cartilaginous
part of auditory tube.
Insertion-
• Posterior border of lamina of
Thyroid cartilage.
Nerve Supply-
•Cranial root of Accessory Nerve
via pharyngeal plexus.
 Actions of Longitudinal Muscles

• Elevate the Larynx and

shorten the pharynx during
deglutition.

• Palatopharyngeal sphincter
closes the pharyngeal
isthmus during deglutition
and speech.
 Nerve Supply of Pharynx

• Motor-
All the muscles of pharynx are
supplied by cranial root of Accessory
Nerve except Stylopharyngeus.
Stylopharyngeus is supplied by
Glossopharyngeal nerve.
Sensory
Nasopharynx- by pharyngeal branch
of Pterygopalatine ganglion [carrying
fibres from maxillary nerve (V2)].
Oropharynx- by Glossopharyngeal
nerve [IX].
Laryngopharynx- by Internal
Laryngeal nerve [branch of Superior
Laryngeal Nerve]. Ph
 Arterial Supply of Pharynx

Following three arteries supply

the pharynx:
1. External Carotid Artery
[Ascending Pharyngeal &
Lingual branches].
2. Facial Artery [Ascending
Palatine & Tonsillar
branches].
3. Maxillary Artery [Greater
Palatine & Pharyngeal
branches].
Venous & Lymphatic Drainage of
Pharynx
Venous Drainage-
• Into Pharyngeal Venous Plexus.
• Pharyngeal Venous Plexus
drains into Internal Jugular
Vein.
Lymphatic Drainage-
• Upper and Lower deep cervical
lymph nodes.
• Retropharyngeal lymph nodes.
 CLINICAL PHYSIOLOGY OF THE
PHARYNX.
The pharynx is involved in the following vital functions:
(1) ingestion of food (sucking and swallowing);
(2) production of vocal sounds;
(3) respiration;
(4) protective function (during eating and respiration).
Ingestion of food during the first months of life can only be
accomplished by sucking. The passage of food by the pharynx, from the
mouth into the oesophagus, is accomplished by a complicated and well
coordinated swallowing reflex. The muscles of the tongue, pharynx and
the larynx contract in a specific sequence.
The vocal function of the pharynx includes intensification of sounds
produced in the larynx by resonance.
EXAMINATION OF THE PHARYNX

• Inspection and palpation.

The regional lymph nodes of the
pharynx are palpated: the
submandibular nodes, the nodes in
the retromandibular fossae, deep
cervical, posterior cervical nodes
• Mesopharyngoscopy.
Using a spatula the anterior two-thirds of
the tongue should be pressed down
(without touching the root of the tongue,
because this will stimulate the vomiting
reflex). A normal soft palate is readily
movable. The mucosa of the soft palate, of
the uvula, and the anterior and posterior
palatine arches should then be inspected.
 EXAMINATION OF THE PHARYNX

• Epipharyngoscopy.
A warmed naso-pharyngeal
speculum and a spatula are used
for this purpose. The superior parts
of the nasopharynx, the choanae,
the lateral walls of the pharynx are
visible in the mirror. Normal
choanae are empty; the mucosa of
the superior regions of the pharynx
is pink and smooth. The
nasopharyngeal tonsil can be seen
in the vault of the pharynx.
 EXAMINATION OF THE PHARYNX

• Palpation of the nasopharynx.

• The doctor's right index finger
should swiftly pass behind the
soft palate into the nasopharynx
to feel the choanae, the vault of
the nasopharynx, and the lateral
walls. The cheek of a child should
be pressed between the upper
and lower jaws using the left
index finger.
EXAMINATION OF THE PHARYNX

• Hypopharyngoscopy.
The lower portions of the pharynx
should be inspected using indirect
laryngoscopy with a warmed laryngeal
speculum.

The laryngeal speculum should be

held by its handle in the right hand
and moved into the mouth without
touching the root of the tongue and
the posterior wall of the pharynx. The
mirror surface should be directed
downwards. The patient is asked to
utter the sound 'ee' and gently
breathe in.