PHARYNX & TONSILS

how long is the pharynx

12-14 cm

describe the pharynx using 2 words

musculomembranous tube

which tracts does the pharynx connect

the respiratory and gastrointestinal tract share a common path through the pharynx

course of the pharynx

the pharynx extends between the nasal cavity and the entrances to the larynx and in continuation with the osesophagus

what type of tissue is the pharynx partially surrounded by

the pharynx is partially surrounded by muscle

where is the pharynx in relation to the larynx

the pharynx is posterosuperior to the larynx

what are the divisions of the pharynx

regions of the pharynx

1. nasopharynx

2. oropharynx

3. laryngopharynx

important point about the divisions of the pharynx

• divisions of the pharynx are only descriptive

• not demarcated by physical borders, only anatomical landmarks

nasopharynx: borders

nasopharynx

• extends from behind the nose/ nasal cavities

• to the soft palate

nasopharynx: which tract is it a part of

the nasopharynx is a functional part of the respiratory tract

nasopharynx: what structures does it contain

• pharyngeal tonsils/ adenoids

• opening of auditory tubes (Eustachian)

• the tubal tonsils

oropharynx: borders

oropharynx

• from below the soft palate

• to the tip of the epiglottis

oropharynx: how does it open into the mouth

• via the oropharyngeal isthmus/ faucial isthmus

• demarcated by the palatoglossal arch - anterior border of oropharynx

oropharynx: what does its lateral wall consist of

• palatopharyngeal arch

• palatine tonsil

oropharynx: which vertebrae is it level with posteriorly

• body of the second cervical vertebrae

• upper part of the third cervical vertebrae

laryngopharynx: borders

laryngopharynx

• from the tip of the epiglottis

• to the lower border of the cricoid cartilage

laryngopharynx: at which vertebrae is the cricoid cartilage level with

the cricoid cartilage lies at the level of C6

laryngopharynx: what structure is anterior to it

the entire length of the larynx

laryngopharynx: what structure is it continuous with

the laryngopharynx is continuous with the oesophagus

laryngopharynx: laryngeal inlet

laryngopharynx: at which vertebrae is it level with posteriorly

• the laryngopharynx extends posteriorly from the third to the sixth cervical vertebrae

AT REST

laryngopharynx: what occurs during swallowing

the laryngopharynx is elevated considerably by the hyoid elevators i.e. suprahyoid muscles during swallowing

what is another term for swallowing

deglutition

name the pharyngeal constrictor muscles

three pairs of pharyngeal constrictor muscles

1. superior constrictor

2. middle constrictor

3. inferior constrictor incl. cricopharyngeus (part of inferior constrictor)

function of pharyngeal constrictor muscles

• sequentially constrict the pharynx to propel the bolus of food down towards the oesophagus

pharyngeal constrictor muscles: structure

• pharyngeal constrictor muscles are circular but not fully closed anteriorly

• posteriorly the muscles are joined at the midline via the fibrous pharyngeal raphe

name the pharyngeal longitudinal muscles

three pairs of pharyngeal longitudinal muscles

1. stylopharyngeus

2. salpingopharyngeus

3. palatopharyngeus

function of the pharyngeal longitudinal muscles

• elevate the larynx

• shorten and widen the pharynx during swallowing

which structure is the pharynx innervated by

the pharynx is innervated by the pharyngeal plexus (branches of CN IX and CN X)

where is the pharyngeal plexus located

the pharyngeal plexus of fine nerves spread under the lining (sensory innervation) and muscles (motor innervation) of the pharynx

which nerves form the pharyngeal plexus

• pharyngeal branches of the glossopharyngeal nerves (CN IX)

• pharyngeal branches of the vagus nerves (CN X)

• branches from the external laryngeal nerve (branch of the superior laryngeal nerve which is a branch of the vagus)

• sympathetic fibres from the superior cervical ganglion

pharyngeal sensory innervation: which nerve supplies sensory innervation to the pharynx

the pharynx receives sensory innervation from the glossopharyngeal nerve (CN IX)

pharyngeal sensory innervation: the maxillary nerve

the maxillary nerve (CN V2)

• supplies sensory innervation to the anterior and superior aspect of the nasopharynx

pharyngeal sensory innervation: the internal branch of the superior laryngeal nerve

the internal branch of the superior laryngeal nerve (CN X)

• supplies sensory innervation to the inferior aspect of the laryngopharynx (surrounding the beginning of the larynx)

pharyngeal motor innervation: which nerve innervates the pharyngeal muscles

all of the muscles of the pharynx are innervated by the vagus nerve (CN X)

pharyngeal motor innervation: which pharyngeal muscle is the exception to being innervated by the vagus nerve

the stylopharyngeus muscle (longitudinal) receives motor innervation from the glossopharyngeal nerve (CN IX)

clinical applications: general consequence of damage to pharyngeal innervation

damage to the nerve supply of the pharynx causes swallowing problems i.e. dysphagia

clinical applications: consequences of damage to glossopharyngeal nerve

damage to glossopharyngeal nerve (CN IX) - SENSORY SUPPLY

• difficulty initiating swallowing

clinical applications: consequences of damage to vagus nerve

damage to vagus nerve (CN X) - MOTOR SUPPLY

• difficulty in smooth transit of material from mouth to oesophagus

which structure contains the auditory/ Eustachian tube

the auditory/ Eustachian tube opens into the nasopharynx

which structures do the auditory/ Eustachian tube connect

the auditory/ Eustachian tube connects the middle ear to the nasopharynx

functions of the auditory/ Eustachian tube

the auditory/ Eustachian tube connects the middle ear to the nasopharynx to:

• equalise pressure on either side of the tympanic membrane

• drain fluid from the middle ear

tonsils: describe their structure

tonsils structure

• accumulation of lymphoid tissue (lymphocytes)

tonsils: describe their location

tonsils location

• tonsils lie under the mucosa lining the pharynx

tonsils: function of the lymphoid tissue

lymphoid tissue function

• protective to gastrointestinal tract and respiratory tracts

• lymphocytes produce antibodies in response to bacteria and their toxins

tonsils: what physical changes occur during infection

during infection (viral/ bacterial) the tonsils enlarge

tonsils: state the groups of tonsillar tissue

4 groups of tonsillar tissue

• palatine tonsils - paired

• pharyngeal tonsils/ adenoids - unpaired

• lingual tonsils - paired

• tubal tonsils - paired

tonsils: palatine tonsils location

palatine tonsils location

• between the palatoglossal (anterior) and palatopharyngeal (posterior) arches

• oropharynx

tonsils: pharyngeal tonsils/ adenoids location

pharyngeal tonsils/ adenoids location

• the posterior wall of the nasopharynx

tonsils: lingual tonsils location

lingual tonsils location

• underneath the mucosa of the posterior 1/3 of tongue

tonsils: tubal tonsils location

tubal tonsils location

• around the entrance to the auditory/ Eustachian tube

• MAY OR MAY NOT BE PRESENT

tonsils: which two types are variable in size

• pharyngeal tonsils/ adenoids

• tubal tonsils

what is this diagram showing

Waldeyer’s tonsillar ring

what does this image show

palatine tonsil infection

• bacterial infection

• very enlarged

• cream coloured streaks on top is pus

outline chronic tonsillar enlargement

chronic tonsillar enlargement

• interferes with oral and nasal function (difficulty in articulation)

• affects children especially

• tonsils in children are larger than adult tonsils so if enlarged it can cause considerable blockage

outline pharyngeal tonsil/ adenoid enlargement

pharyngeal tonsils/ adenoids enlargement

• interferes with soft palate elevation

• can cause sinusitis

• can cause auditory tube dysfunction » middle ear infections

• can cause sleep apnea

• patients experience open mouth breathing

• hyponasality - distorted and congested sounding speech

outline palatine tonsil enlargement

palatine tonsil enlargement

• interferes with soft palate elevation

• hypernasality - nasally sounding speech

common consequences of pharyngeal/ adenoid and tubal tonsillar enlargement

pharyngeal/ adenoid and tubal tonsillar enlargement

• prevent auditory tube opening » middle ear infections/ otitis media/ glue ear

outline tonsillectomy

tonsillectomy

• surgical procedure to completely remove the (palatine) tonsils - can sometimes be lingual

• decreasing in frequency

which conditions are tonsillectomies used for

• chronic tonsillitis and complications

• sleep apnea