THE INTERIOR OF THE PHARYNX. By Dr. Muhammad Imran Qureshi

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1 THE INTERIOR OF THE PHARYNX By Dr. Muhammad Imran Qureshi

2 The Cavity The cavity of the pharynx is divided into: 1. The Nasal part (called Nasopharynx) 2. The Oral part (called the Oropharynx), 3. And the Laryngeal part, (often called Hypopharynx)

3 Nasopharynx The nasal part of the pharynx has a roof, lateral and posterior walls. There is, essentially, no anterior wall, since the choanae open here. The Roof, called the fornix, consists of mucous membrane closely applied to the basal portions of the sphenoid and occipital bones. The Lateral and Posterior walls consist of the superior constrictors, the pharyngobasilar fascia that lines their internal surfaces, and the mucosa.

4 Nasopharynx the floor of the anterior part of the nasal pharynx is formed by the soft palate. It is the only really mobile wall of this part of the pharynx Thus, the nasal pharynx remains constantly open. Above the soft palate, on its each lateral wall is the pharyngeal ostium / aperture /opening of the auditory tube. (the tube to the middle ear cavity)

5 Nasopharynx Above and posterior to the ostium is an elevation, the torus tubarius, or tubal torus. It is produced by the cartilage of the tube. Proceeding down from the torus is a slight fold, the salpingopharyngeal fold (as it overlies the salpingopharyngeus muscle).

6 Nasopharynx

7 Nasopharynx Behind the torus and the salpingopharyngeal fold is a slitlike lateral projection/extension of the pharynx, the pharyngeal recess. A small salpingopalatine fold runs from the anterior border of the torus tubarius toward the palate. Below the torus tubarius and in front of the salpingopharyngeal fold is another fold or bulge, the torus levatorius, or levator torus. It is formed by the levator veli palatini muscle and becomes especially evident when the muscle contracts.

8 Nasopharynx Behind the soft palate, the nasopharynx opens into the oral pharynx. This opening is usually called the pharyngeal isthmus. At this level the nasal part of the pharynx can be completely closed off from the oral part, as the soft palate can be pulled backward and upward by the levator veli palatini to meet the posterior wall. The meeting of soft palate and posterior pharyngeal wall is necessary for proper phonation, especially of consonants. It is also necessary if fluid swallowed under pressure is to be kept from running into the nose (for instance, one can drink bending over, or standing on one's head, because of the complete closure here).

9 Nasopharynx In the posterior part of the roof and the upper part of the posterior wall of the nasal part of the pharynx is an accumulation of lymphoid tissue, the pharyngeal tonsil. This may be prominent in children but becomes indistinct or disappears by adulthood. In children there is a similar accumulations of lymphoid tissue associated with the posterior lip of the ostium of the auditory tube which are called the tubal tonsils. When the pharyngeal and tubal tonsils are enlarged, they are referred to as adenoids. These may cause difficulty in nasal breathing because of obstruction of the nasal pharynx, and if the ostium of the tube is occluded, there may be hearing loss because of gradual absorption of the air in the middle ear cavity.

10 Oropharynx Above, behind the soft palate, the oral part of the pharynx opens into the nasal part. Anteriorly, above, it opens into the oral cavity, and below this, it is bordered by the dorsum of the posterior one third of the tongue. Behind the tongue, the oral part of the pharynx extends downward lateral and posterior to the upwardly projecting epiglottis, (a portion of the larynx), to become continuous with the laryngeal part.

11 Oropharynx The fauces (throat): The lateral boundaries of the opening of the mouth (faucial isthmus), into the pharynx, are called the faucial pillars. Each pillar consists of two folds between which lies the palatine tonsil. The anterior fold, called the palatoglossal arch, curves downward and forward from the soft palate to the tongue. The posterior fold, called the palatopharyngeal arch, extends downward from the posterolateral border of the soft palate along the wall of the pharynx.

12 Oropharynx

13 Oropharynx Each arch contains a similarly named muscle, that is, palatoglossus and palatopharyngeus muscles. Between these two arches is an almond shaped mass of lymphoid tissue that constitutes the palatine tonsil and that largely fills the space between the folds, the tonsillar fossa. The roof and floor of the faucial isthmus are not well defined. However, they are the soft palate and the dorsum of the tongue.

14 Oropharynx A fold of mucous membrane extends between the palatoglossal and palatopharyngeal arches across the upper part of the tonsil. It is called the semilunar fold. Between it and the tonsil is a slit, the supratonsillar fossa. A second fold, the triangular fold, projects backward from the palatoglossal arch and either may be fused to the tonsil or may leave a slit that usually is called the anterior tonsillar fossa.

15 Oropharynx The palatine tonsil varies considerably in size and shape. It may bulge markedly between the folds when inflamed or enlarged Normally, it lies flat and almost hidden in the tonsillar fossa. It often extends into the soft palate deep to the semilunar fold. Its surface is covered with epithelium that has pits, the tonsillar crypts, passing into the lymphoid substance. The superior pharyngeal constrictor forms most of its muscular bed. Between it and the tonsil is the pharyngobasilar fascia. The part of the pharyngobasilar fascia adjacent to the tonsil sends septa into it and often is described as the tonsillar capsule. Loose connective tissue between the capsule and the superior constrictor muscle forms a line of cleavage that facilitates removal of the tonsil.

16 Oropharynx The largest artery of the tonsil is the tonsillar branch of the facial artery. It enters its lower pole. The ascending pharyngeal, lingual, descending palatine and ascending palatine branch of the facial usually also are described as having small tonsillar branches.

17 Oropharynx After passing across the gap between the superior and middle pharyngeal constrictors close to the lower pole of the tonsil, the glossopharyngeal nerve runs forward to the tongue medial to the hyoglossus muscle. Because of this relationship, edema about the nerve may result from tonsillectomy, and some patients complain of temporary loss of taste following this operation. The nerve gives off a tonsillar branch which, along with branches of the 9th from the pharyngeal plexus, supplies the region of the tonsil.

18 Oropharynx Below the fauces, the pharynx is bounded anteriorly by the posterior part of the dorsum of the tongue. This, in addition to presenting the vallate taste buds, also has an accumulation of lymphoid tissue beneath its mucosa. This lymphoid tissue on the pharyngeal surface of the tongue constitutes the lingual tonsil. It may also become sufficiently enlarged to need removal when other tonsillar tissue is removed.

19 Oropharynx The pharyngeal tonsils posteriorly and above, the palatine tonsils laterally, and the lingual tonsil anteriorly and below form an oblique ring of lymphoid tissue around the pharynx, called the Waldeyer's ring. This apparently has the function of tending to halt infection at this level, but when it becomes enlarged as a result of disease, it is no longer of use as a defense mechanism, and its enlargement may, of course, cause obstruction.

20 Oropharynx Behind the tongue, the epiglottis is united to it by a midline and two lateral folds, the median and the lateral glossoepiglottic folds, respectively. The paired depressions between the median and lateral glossoepiglottic folds are the epiglottic valleculae

21 Laryngopharynx The oral part of the pharynx is continuous with the laryngeal part at the level of the upper border of the epiglottis It is wide above but narrows rapidly below, at the level of the lower border of the cricoid cartilage of the larynx where it become continuous with the esophagus. The anterior wall of this part of the pharynx is the larynx: Above is the posterior surface of the epiglottis and below the opening into the larynx are certain muscles of the larynx and the lamina or expanded posterior part of the cricoid cartilage, covered posteriorly by pharyngeal mucous membrane.

22 Laryngopharynx

23 Laryngopharynx The pharynx also extends lateral to the larynx, being separated from it by the aryepiglottic folds that run from the upper posterior border of the larynx to the sides of the epiglottis. These lateral extensions are the piriform recesses (also called sinuses / Fossae). As the pharynx narrows at the cricoid level, the piriform recesses are obliterated. Thus they are blind forward extensions of the pharynx.

24 Laryngopharynx Each Piriform recess is a mucous lined space that is bounded: Medially by the Quadrangular membrane of the larynx, and Laterally, Above by the Thyrohyoid membrane, and Below by the lamina of the Thyroid cartilage. A malignancy may develop in the space provided by the Piriform fossa without producing symptoms, until the patient presents with metastatic cervical lymphadenopathy. The recesses are liable to be perforated by the endoscope.

25 Laryngopharynx Since each epiglottic vallecula is a shallow basin, an object ( safety pin etc.) that is thought to have been swallowed or inspired may sometimes lodge in it, or such an object may lodge in a piriform recess. Both the valleculae and the recesses, therefore, usually are examined for objects thought to be inhaled, before a child is subjected to bronchoscopy.

26 Laryngopharynx Swallowing (deglutition) is a complex act typically involving contraction of the pharyngeal constrictors and the esophagus from above downward. As the bolus is passed into the oral part of the pharynx, the soft palate is raised to come in contact with the posterior pharyngeal wall, and the pharynx as a whole is raised by the action of its longitudinal muscle. Contraction of the superior pharyngeal constrictor passes the bolus into the region of the relaxed middle constrictor, which in turn contracts, followed by the inferior constrictor.

27 Laryngopharynx The cricopharyngeal part of the inferior constrictor cricoesophageal sphincter relaxes as swallowing is started, and a descending contraction of the esophagus passes the bolus into the stomach. The larynx is protected in part by contraction of its sphincteric muscles and in part by the fact that the food or liquid tends to pass to the sides of the epiglottis rather than directly over the laryngeal aditus

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