~ ~ ~ PHARYNX ~ ~ ~

Dr. Baker

All MOTOR inneveration to pharynx muscles is by

Ann Nguyen -- NYUCD 2008
Pharyngeal Plexus (cranial-XI
with-- X)
D1traveling
Anatomy Notes
Spring '05
EXCEPT: Stylopharyngeus (IX)
Tensor Palatini (V3)
Cricopharyngeus (Recurrent Laryngeal)

- a common passageway for food and air, but structurally belongs to the GI tract
- air proceeds anteriorly down the larynx trachea bronchial tree
- food proceeds posteriorly down the esophagus
- posterior communication w/ nasal cavity (above) & oral cavity (below)

EXCEPT: Nasopharynx above the Eustachian Tube

(Pharyngeal branches of V2 traveling thru
Palatovaginal & Vomerovaginal Canals)

MUSCLES OF THE PHARYNX

Constrictor Muscles
Superior Constrictor
- Pterygopharyngeus
- Buccopharyngeus
- Mylopharyngeus
- Glosspharyngeus

Middle Constrictor
- Ceratopharyngeus
- Chondropharyngeus

Inferior Constrictor
- Thyropharyngeus
- Cricopharyngeus
Longitudinal Muscles

All SENSORY inneveration to pharynx mucosa is by

Pharyngeal Plexus (IX traveling with X)

Origin

Insertion

Pharyngeal Raphe
Greater Hyoid Horn
Lesser Hyoid Horn

Thyroid Cartilage
Cricoid Cartilage

Accessory (XI)
traveling with
Vagus (X)

Styloid Process
(medial aspect)

Constrictor muscles
Thyroid Cartilage (posterior)
Lateral Glossoepiglottic Fold

Palatopharyngeus

Hard Palate
(posterior edge)

Pharyngobasilar Fascia
Thyroid Cartilage (posterior)
pharyngeal wall

Eustachian Tube
(medial cartilaginous part)

pharyngeal wall

Origin

Insertion

Eustachian Tube
(medial cartilaginous part)

Tensor Veli Palatini

Eustachian Tube (lateral)

Scaphoid Fossa (M-Pt Plate base)
Sphenoid Spine

Action

Palatine Crest Aponeurosis

Innervation

Glossopharyngeal
(IX)

elevates
pharynx & larynx
during swallowing
Accessory (XI)
traveling with
Vagus (X)

Action
approximates the soft
palate to the tongue
to seal off
nsaopharynx during
swallowing

Posterior Nasal Spine

Levator Veli Palatini

Recurrent
Laryngeal

this part does NOT meet at Raphe

Stylopharyngeus

Musculus Uvulae

sequential peristaltic
squeezing of the
pharynx during
swallowing to move
food downward

Hamulus
Pterygomandibular Raphe
Mylohyoid Line of Mandible
Tongue

Insertion

Associated Muscles

Innervation

Pharyngeal Tubercle (occipital)

Origin

Salpingopharyngeus

Action

Innervation

Accessory (XI)
traveling with
Vagus (X)

elevate soft palate to

seal off nasopharynx
during swallowing

tenses soft palate to

seal off nasopharynx
during swallowing

root of V3
Compiled for you by:

Ann Nguyen -- NYUCD 2008

D1 Anatomy Notes -- Spring '05

BONY SKULL ATTACHMENTS of some pharyngeal muscles

Ann Nguyen -- NYUCD 2008

D1 Anatomy Notes -- Spring '05

- Pharyngeal Raphe = pharyngeal tubercle (11)

- Stylopharyngeus = medial aspect of the styloid process (22)
- Palatopharyngeus = posterior edge of the hard palate (10)
- Muscular Uvulae = posterior nasal spine (8)
- Levator Palatini = petrous portion by the opening of the carotid canal (4)
- Tensor Palatini = scaphoid fossa (27)
SPECIAL NOTES about some pharyngeal muscles
Tensor Palatini = uses the Hamulus to change its direction of pull
Superior Constrictor = shares a common attachment w/ the
Buccinator to the Pterygomandibular Raphe
Cricopharyngeus (Inferior Constrictor)
- does NOT insert into the Midline Raphe
- is NOT innervated by Pharyngeal Plexus
- innervated possibly by Recurrent Laryngeal Nerve
- is in a constant state of contraction
- to prevent air from going into the esophagus stomach
Stylopharyngeus
- runs b/t the Superior & Middle Constrictors
- is NOT innervated by Pharyngeal Plexus
- innervated by Glossopharyngeal (IX)
Palatopharyngeal Sphincter
- a tiny fiber from the Superior Constrictor
- acts as an accessory swallowing muscle to seal off the nasopharynx from oropharynx
Passavants Ridge
- created by the Palatopharyngeal Sphincter only during swallowing
- moves inferiorly as a stripping wave
Dehiscence of Killian
- the gap between Thyropharyngeus and the Cricopharyngeus portions of the Inferior Constrictor
Area of Lamiar
- the triangular-shaped blending of the Cricopharyngeus muscle to the Esophagus below

both areas have

potential for
herniation

Compiled for you by:

Ann Nguyen -- NYUCD 2008

D1 Anatomy Notes -- Spring '05

LAYERS OF THE PHARYNX

(1) Areolar Coat

- outermost layer that is continuous w/ the buccinators fascia
- therefore AKA: Buccopharyngeal Fascia
- contains plexus of veins & nerves
Retropharyngeal Space is located between the Buccopharyngeal & Prevertebral Fascia, and communicates w/ mediastinum
(2) Muscular Coat
- outer semicircular layer = constrictor muscles: Superior, Middle, Inferior (stacked on top of e/o like cups)
- inner longitudinal layer = longitudinal muscles: Stylopharyngeus, Palatopharyngeus, Salpinogpharyngeus
(3) Submucosa
- a tough fibrous coat that anchors the pharynx to the base of the skull
- U-shaped attachment involves the medial pterygoid plate, carotid canal, pharyngeal tubercle (occipital bone)
- therefore AKA: Basilarpharyngeal Fascia
(4) Mucosa = the internal lining of the pharynx
MUSCULAR GAPS OF THE PHARYNX
GAP 1 = b/t skull base and superior border of the Superior Constrictor muscle
Eustachian Tube
Tensor & Levator Palatini muscles
Ascending Palatine Artery
GAP 2 = b/t Superior & Middle Constrictor muscles
Stylopharyngeus muscle
Glosspharyngeal Nerve (IX)
Lingual Nerve (V3)
GAP 3 = b/t Middle & Inferior Constrictor muscles
Superior Laryngeal Artery

(from the Superior Thyroid artery off the External Carotid artery)

Internal Laryngeal Nerve

(from the Superior Laryngeal nerve off the Vagus)
- supplies sensory to larynx ABOVE VOCAL CORDS
By the way: BELOW vocal cords is innervated by Recurrent Laryngeal Nerve (directly off the Vagus)
GAP 4 = b/t Inferior Constrictor (Cricopharyngeus) & esophagus
Inferior Laryngeal Artery

(from the Inferior Thyroid artery off the Thyrocervical Trunk off the Subclavian)

Recurrent Laryngeal Nerve

(from directly off the Vagus)
- supplies motor to ALL LARYNX MUSCLES EXCEPT CRICOTHYROID
- supplies sensory to larynx BELOW VOCAL CORDS
By the way: Cricothyroid muscle is innervated by External Laryngeal nerve
(from the Superior Laryngeal nerve directly off the Vagus nerve)
SWALLOWING MECHANISM
Step 1 (voluntary)
Tongue = pushes food posteriorly into the oropharynx
Step 2 (involuntary)
Tensor & Levator Palatini muscles
- tenses & elevates the soft palate
- to seal off the oropharynx from the nasopharynx
Muscular Uvulae muscle
- pushes back towards the oropharynxs posterior wall
- oropharynxs posterior wall pushes forward too
Palatopharyngel Sphincter forms the Passavants Ridge (occurs only during swallowing)
Longitudinal pharynx muscles
Suprahyoid muscles

elevates the larynx to prevent food going down the trachea

Step 3 (involuntary)
Constrictor pharynx muscles = sequentially contract in peristaltic waves to continue the food down into the esophagus
Step 4 (involuntary)
Esophagus = peristaltic squeezing to continue the food down into the stomach

Compiled for you by:

NASOPHARYNX

Ann Nguyen -- NYUCD 2008

D1 Anatomy Notes -- Spring '05

- superior portion of the pharynx located above the soft palate, at the level of C1 vertebrae
- anterior communication w/ nasal cavity thru the Choanae
- lined w/ respiratory epithelium (ciliated pseudostratified columnar)
- always remains open and never closes up
Eustachian / Pharyngotympanic Tube
- opening is located on nasopharynxs lateral wall and leads to Middle Ear potential for communicating infections
- opening is located at the level of Inferior Nasal Concha of the nasal cavity potential for communicating infections
Levator Palatini muscle = runs along the MEDIAL side of the Eustachian Tube
Tensor Palatini muscle = runs along the LATERAL side of the Eustachian Tube
Pharyngeal Tonsils (Adenoids)
- located on the nasopharynxs superior posterior wall
- extends laterally into the Pharyngeal Recess
Tubal Tonsils = located near the Torus Tubaris
Torus Tubaris
- caused by the cartilage of the Eustachian Tube projecting into the nasopharynxs lateral wall
- located above the Eustachian Tube
Salpingopharyngeal Fold
- caused by the underlying Salpingopharyngeus muscle covered w/ mucosa
- it is the narrowed continuation of the Torus Tubaris,
- runs posterior to the Eustachian Tube and down to the pharynx
Pharyngeal Recess
- posterior to the Salpingopharyngeal Fold
- Eustachian Tube can be opened thru here and internal carotid artery may be damaged in the process

Compiled for you by:

OROPHARYNX

Ann Nguyen -- NYUCD 2008

D1 Anatomy Notes -- Spring '05

- middle portion of the pharynx located below the soft palate, at the level of C2 C3 vertebrae
- soft palate at rest = anterior communication w/ the oral cavity thru the fauces
- soft palate tensed and raised = Tensor & Levator Palatini muscles seal off nasaopharynx from oropharynx
- boundary begins at the Palatoglossal Arch
anterior to this arch is the oral cavity
posterior to this arch is the oropharynx
Palatoglossal Arch (Anterior Pillar) = a fold created by the Palatoglossal Muscle, running from palate to tongue
Palatopharyngeal Arch (Posterior Pillar) = a fold created by the Palatopharyngeal Muscle, running from palate to pharynx
Fauces = Anterior Pillar + Posterior Pillar
Palatine Tonsils
- located in between the Anterior & Posterior Pillars
- large during childhood, but atrophies during adulthood
- when these get infected, this is what people mean by Tonsilitis
- lie on top of a neurovascular bed comprised of Tonsillar Branches arising off the following vessels
Glosspharyngeal Nerve (IX)
Ascending Pharyngeal Artery
(directly off the External Carotid)
Ascending Palatine Artery
(off the Facial artery from External Carotid)
Lesser Palatine Artery
(off the Maxillary artery from External Carotid)
Dorsal Lingual Artery
(off the Lingual Artery from External Carotid)
Lingual Tonsils
- located in the posterior 1/3 of the tongue
Ring of Waldeyer
- Pharyngeal + Palatine +Lingual + Tubal Tonsils collectively form a circle around the oral opening

Compiled for you by:

LARYNGOPHARYNX

Ann Nguyen -- NYUCD 2008

D1 Anatomy Notes -- Spring '05

- inferior portion of the pharynx located between Epiglottis Esophagus (at the level of C4 C6 vertebrae)
Epiglottis = leaf-shaped elastic cartilage that guards the opening to the larynx
3 Glossoepiglottic Folds
- 1 median fold + 2 lateral folds
- run anteriorly from the epiglottis to the posterior base of the tongue
2 Valleculae
- small depressions created by the glossoepiglottic folds
- located on both sides of the median fold, anterior to the epiglottis
- particles can get trapped here cough reflex
Piriform Recess
- a vertical gutter located in between the laryngopharynxs lateral wall and the lateral glossoepiglottic fold
- continues down the larynx and into the esophagus
- Internal Laryngeal Nerve runs through here
- particles can also get trapped here

Compiled for you by:

Ann Nguyen -- NYUCD 2008

Note what pierces the Superior
Constrictor:
D1 Anatomy
Notes -- Spring '05
Tonsillar Artery (Facial)
Paratonsillar Vein

ARTERIAL SUPPLY
From the Maxillary Artery
Greater Palatine
Lesser Palatine

= supplies hard palate

= supplies soft palate

From the Facial Artery

Tonsillar Artery
Ascending Palatine

= supplies palatine tonsils

= supplies Superior Constrictor

From the External Carotid Artery

Lingual
= supplies upper pharynx
Superior Thyroid
= supplies Inferior Constrictor
Ascending Pharyngeal
- Pharyngeal branch
= supplies pharynx
- Palatine branch
= supplies palate
VENOUS DRAINAGE
Pharyngeal Plexus [Pharyngeal Veins] Pterygoid Plexus
Internal Jugular Vein
External Palatine (Paratonsillar) Vein
- pierces Superior Constrictor
- drains palatine tonsils into Pterygoid Plexus

PHARYNGEAL PLEXUS (9, 10, 11)

Motor (11)

all muscles of the pharynx, larynx, soft palate

EXCEPT Stylopharyngeus (IX)
EXCEPT Tensor Palatini (V3)
EXCEPT Cricopharyngeus (Recurrent Laryngeal)

Sensory (9)

mucosa of the pharynx, soft palate, palatine tonsils

EXCEPT the nasopharynx above the level of Eustachian Tube (V2)

GLOSSOPHARYNGEAL (IX)
Motor

Stylopharyngeus muscle

General Sensory

pressure receptors in Carotid Sinus

mucosa of pharynx, soft palate, palatine tonsils
touch to posterior 1/3 tongue

Special Sensory

taste to posterior 1/3 tongue

taste to circumvallate papillae

Pre-gang. Parasymp.
Post-gang. Parasymp.

Tympanic Plexus = medial side of tympanic membrane

Lesser Petrosal Nerve = parotid gland

Eagle Syndrome

caused by an elongated styloid process or a calcified stylohyoid ligament

may press on the external wall of tonsillar bed pain travels through CN IX.

VAGUS (X)
Motor

muscles of the pharynx, larynx, soft palate

EXCEPT Stylopharyngeus (IX)
EXCEPT Tensor Palatini (V3)

General Sensory

chemoreceptors in Carotid Body

mucosa of pharynx, larynx
skin of posterior external ear & canal

Special Sensory

taste to oropharynx & epiglottis

Parasympathetic

abdominocardiothoracic viscera

MAXILLARY (V2)
General Sensory
AUTONOMIC

nasopharynx above the Eustachian Tube

post-ganglionic sympathetic fibers arise off the Internal Carotid Arterys plexus

Compiled for you by:

SENSORY INNERVATION TO THE PHARYNX

Ann Nguyen -- NYUCD 2008

D1 Anatomy Notes -- Spring '05

Compiled for you by: