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PHARYNX

PHARYNX. Introduction. Musculomembranous tube, 12 cms Basiocciput to cricoid lower border (C6) Relation Superior basiocciput Inferior oesophagus Posterior prevertebral fascia with muscles Lateral digastric and carotid triangle Anterior

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PHARYNX

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  1. PHARYNX

  2. Introduction Musculomembranous tube, 12 cms Basiocciput to cricoid lower border (C6) Relation • Superior • basiocciput • Inferior • oesophagus • Posterior • prevertebral fascia with muscles • Lateral • digastric and carotid triangle • Anterior • Wall deficient, communicate with naso, oro, & laryngopharynx • Pharyngeal isthmus : junction with NP & OP • Oropharyngeal isthmus : junction with OP & oral cavity

  3. Parts of pharynx Nasopharynx Oropharynx Laryngopharynx

  4. Oropharyngeal isthmus

  5. Oropharyngeal isthmus Oropharynx behind palatoglossal arch

  6. Oropharyngeal isthmus

  7. Median Section: Pharyngeal isthmus Pharyngeal isthmus

  8. Laryngeal msls Posterior view : wall of pharynx dissected

  9. Nasopharynx Base of skull to soft palate Features • Opening of ET : lateral wall • Tubal elevation(upper post to ET): cartilagenous part of ET • Folds : (post to tubal elevation) • Salpingopharyngeal fold : salpingopharyngeus • Salphingopalatine fold: levator palati • Pharyngeal recess (fossa of Rosenmuller) • Behind opening of AT • Misguided catheter may perforate ICA • Pharyngeal tonsil • Lymphatic tissue at roof (adenoids) • Tubal tonsil • Lymphatic tissue at region of TE

  10. Nasopharynx Parts of pharynx

  11. Sagittal section

  12. Features of Nasopharynx

  13. Oropharynx SP lower border to epiglottis superior border • Palatoglossal arch • Palatopharyngeal arch • Palatine tonsil Laryngopharynx Epiglottis sup border to cricoid cart inf border • Ant : cavity of larynx • Aryepiglottic fold • Piriform recess • lateral to folds and behind lateral glossoepiglottic fold

  14. Larynx seen from behind with pharyngeal wall cut

  15. Pharynx – features of laryngopharynx

  16. Coats of pharynx • Mucous membrane • NP : pseudostratified columnar • LP/OP : stra. squamous ciliated columnar • Fibrous layer (pharyngobasilar fascia) • Thickened upper part : support NP, keep patent • Median raphe : basiocciput to cricoid • Muscular layer • Inner longitudinal • Outer circular • Fascial layer (buccopharyngeal fascia) • Formed of epimysium of constrictors

  17. Muscles of pharynx Inner longitudinal • Stylopharyngeus • Salpingopharyngeus • Palatopharyngeus • All insertions to post border of thyroid cart • Salpingopharyngeus blends with palatopharyngeus • Action : pull pharynx during 3rd stage of deglutition

  18. Stylopharyngeus • From base of styloid pr to post border of thyroid • Enter b/t SC & MC Salpingopharyngeus • From AT cart, and merges with PP, inserts to post border of Thyroid Palatopharyngeus • From palate to post border of thyroid & side of pharynx • Form Passavant’s ridge on post pharyngeal wall

  19. Relation of SP, PP & Salpingopharyngeus to constrictors Form Passavant’s ridge

  20. Muscles of pharynx

  21. SP PP SP

  22. Stylopha-ryngeus entering b/t SC and MC

  23. Muscles of pharynx Outer circular - Constrictors • constrict in sequential manner to push bolus down • Types • Superior constrictor • Middle constrictor • Inferior constrictor

  24. Superior constrictor Origin • Lower medial pterygoid plate • Pterygoid hamulus • Pterygomandibular raphe • Mylohoid line posterior part • Tongue laterally in the posterior part Fibres insertion • Upper – Pharyngeal tubercle, medial raphe, • Lower – medial raphe till cricoid cart • Middle - horizontal

  25. Shows ligaments, raphe & sites of attachments of muscles Thyrohyoid membrane

  26. Pharyngeal muscles arrangement

  27. Muscles of Pharynx Stylopharyngeus entering b/t SC and MC

  28. MUSCLES OF PHARYNX

  29. Muscles of pharynx

  30. Muscles of pharynx

  31. Muscles of pharynx - SC & MC

  32. Lateral view : with pharyngeal constrictors

  33. muscles of pharynx Lat view

  34. Middle constrictor Overlaps sup constrictor Origin • Styloid lig • Lesser horn hyoid bone • Greater horn upper border Fibres • Upper – horizontal, enclose Sup constrictor • Lower – run obliquely down to medial raphe

  35. Inferior constrictor Two parts : Thyropharyngeus • Origin – thyroid oblique line, tendinous arch • Fibres • Upper – run upwards • Lower – run horizontal to median raphe • Propulsive action Cricopharyngeus • Origin – cricoid cart lat surf • Fibres – • run horizontal uninterruptedly from one side to other (does not insert to median raphe) • Sphincteric action at lower extent of pharynx • Continuous with circular mls of oesophagus

  36. ligaments, raphe & sites of attachments of muscles Thyrohyoid membrane

  37. Pterygomandibular raphe Structures passing through gaps between constrictors

  38. Gaps between constrictors • Space of Morgagni • Space b/t SC & MC • Space b/t MC & IC • Space b/t IC & oesophagus

  39. Pharyngeal muscle arrangement

  40. Gaps between constrictors Killian’s dehiscence Weak muscular wall b/t thyropharngeus & cricopharyngeus Pharyngeal diverticulum Space of Morgagni • Covered by Pharyngobasilar fascia • LP, TP, Auditory tube • Ascending palatine art Space b/t SC & MC • Stylopharyngeus • Nerve : IX, Lingual Space b/t MC & IC • Covered by Thyroglossal membrane • IL nerve • Sup laryngeal Vs Space b/t IC & oesophagus • RL nerve • Inf laryngeal vessel

  41. Structures passing between Pharyngeal Constrictors

  42. Structures passing through gaps between constrictors

  43. Nerve supply Pharyngeal plexus – (supply pharynx except SP) • Over MC, formed by : • X nerve pharyngeal br – motor and sensory • IX nerve pharyngeal br (purely afferent i.e. sensory) • Superior cervical ganglion for sympathetic supply motor : • By pharyngeal plexusexceptstylopharyngeus (IX cranial nerve) • Cr part of XI nerve, travel along X nerve • Cricopharyngeus : RLN or ELN (NA – Nucleus ambiguus is a motor nucleus for IX, X and XI nerves) Sensory: • NP : Maxillary nerve through pterygopalatine ganglion • OP : IX nerve • LP : X nerve br Sympathetic supply : vasomotor From pharyngeal plexus components

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