CHAPTER:ANATOMY OF PHARYNX

INTRODUCTION

Pharynx develops from anterior end of

primitive foregut.

1. Pharynx is a bromuscular tube 12 to

14 cm in length,above it is 3.5 cm and
below 1.5 cm.
2. It extends from base of skull above to
the level of 6th cervical vertebra (lower
border of cricoid cartilage)
where it ends into pharyngoesophagus
junction at cricopharynx, the narrowest
part of digestive tract except the
appendix.
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3. It is lined by squamous strati ed type
of epithelium except in nasopharynx
where the lining membrane is columnar
ciliated epithelium.

Q.WHAT ARE THE PARTS OF

PHARYNX?

Pharynx is divided into three parts they

are
• Nasopharynx, oropharynx and
laryngopharynx or hypopharynx

1. Nasopharynx (Epipharynx):
Nasopharynx extends from the base
of skull above to
the level of soft palate (C2 level).
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Fig:showing parts of pharynx
(Google)

2. Oropharynx: It extends from palatal

sphincter to the level
of tip of epiglottis (C4 level).

3. Hypopharynx: It extends from

epiglottis up to the lower
border of cricoid cartilage (lower border
of C6).

Q.WHAT ARE THE MUSCLES OF

PHARYNX?
Muscles of pharynx is divided into
intrinsic and ectrinsic muscles

EXTRINSIC MUSCLES
1.Superior constrictor :It arises from
pterygoid hamulus, pterygomandibular
ligament and posterior end of mylohyoid
line.
2.Middle constrictor:It is a fan-shaped
muscle, which arises from lesser and
greater cornu of hyoid bone.
3.Inferior constrictor:It is the thickest of
all muscles of pharynx. It has two parts:
 Fig:muscles of pharynx
(Google)

‒ Upper part, i.e. thyropharyngeus with

oblique bers arising from oblique line of
thyroid cartilage
‒ Lower part, i.e. cricopharyngeus arises
from lateral side of cricoid cartilage and
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its transverse bers form
cricopharyngeal sphincter.
Nerve supply
• Constrictor muscles are supplied
through pharyngeal plexus
• Pharyngeal plexus is formed by
pharyngeal branch of vagus and
glossopharyngeal nerve and pharyngeal
branch of superior cervical sympathetic
ganglion
• Inferior constrictor is supplied by
recurrent laryngealnerve.
• Killian s dehiscence is a gap between
oblique and transverse bers of inferior
constrictor muscle.

Intrinsic Muscles

1.Stylopharyngeus
2.Salpingopharyngeus
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3.Palatopharyngeus.

Q.WHAT IS THE BLOOD SUPPLY OF

PHARYNX?
Blood Supply of Pharynx
• Ascending pharyngeal branch of
external carotid
• Ascending palatine branch of facial
(branch of external carotid)
• Greater palatine branch of maxillary.
- Venous drainage through pharyngeal
plexus into internal jugular vein.
Q.WHAT IS THE NERVE SUPPLY OF
PHARYNX?

Nerve supply is by pharyngeal plexus of

nerves, which is formed by:
• Branch of vagus (X nerve): Motor
supply
• Branches of glossopharyngeal (IX
nerve): Sensory supply
• Sympathetic plexus.

Q.WHAT IS THE LYMPHATIC DRINAGE

OF PHARYNX?
Lymphatic drainage is into
retropharyngeal and jugulodigastric
nodes.
Subepithelial collection of lymphoid
tissue in the pharynx forms Waldeyer s
ring. It has no a erents and e erents
drain
into cervical lymph nodes. It consists of
nasopharyngeal tonsil,tubal tonsil,
faucial tonsil and lingual tonsil.

Q.WHAT ARE THE FUNCTIONS OF

PHARYNX?
Functions
• Pharynx helps to provide immunity
and formation of antibodies
• It protects the lower respiratory
tract
• It forms plasma cells and
lymphocytes
• Acts as a warning to the body
against infectious agents in air and food.
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TOPIC:WALDEYER S RING

- It is a group of lymphoid tissue

guarding the oropharynx and
nasopharynx in the form of a ring.It is
formed by
1. Nasopharyngeal tonsil or the adenoids
2. Palatine tonsils or simply the tonsils
3. Lingual tonsil
4. Tubal tonsils (in fossa of Rosenmüller)
5. Lateral pharyngeal bands
6. Nodules (in posterior pharyngeal wall)
FIG:WALDAYERS RING (GOOGLE)

KILLIANS DEHISCENCE

KILLIAN'S DEHISCENCE IS A GAP

BETWEEN OBLIQUE AND
TRANSVERSE FIBERS OF INFERIOR
CONSTRICTOR.

The inferior constrictor consists of two

parts:
a. Upper part i.e. thyropharyngeus with
oblique bers arising from oblique line of
thyroid cartilage.
b. Lower part i.e. cricopharyngeus arises
from lateral side of cricoid cartilage and
transverse bers from cricopharyngeal
sphincter.
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Signi cance:
i. A pharyngeal pouch (or Zenkers
diverticulum) can be formed by
outpouching of pharyngeal mucosa at
this site.
ii. It is a common site for perforation
during esophagoscopy hence called as
Gateway of Tears
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 FIG:KILLIAN S
DEHISCENCE(GOOGLE)

ZENKER'S DIVERTICULUM
(PHARYNGEAL POUCH)

- It is a posterior pharyngeal pulsion

diverticulum through the Killian's
dehiscence (area of weakness also
called gateway of
tears), between the thyropharyngeus
and circopharyngeus parts of inferior
constrictor muscle.
- There is incoordination between the
descending peristaltic wave and
circopharyngeus muscle at the upper
esophageal
sphincter leading to abnormally high
intraluminal pressure and mucosal
herniation through the weak area of
Killian's dehiscence.
- Usually seen in elderly above 60 years.
- M/c symptom is dysphagia; initially
intermittent which becomes progressive
later on.
- It is associated with regurgitations of
food and cough. Patient may experience
halitosis and regurgling sounds in neck-y
The gurgling
sensation palpation of neck is known as
Boyce sign.
- Diagnosis is by Barium swallow +
video uoroscopy.
- Malignancy can develop in 0.5-1%
cases
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 Fig:image showing zenkers
diverticulum(Google)

Q.WHAT IS THE TREATMENT?

- Endoscopic stapling of the diverticulo
esophageal septum (Earlier excision of
 diverticulum with circopharyngeal
myotomy
was considered to be the treatment of
chocie
- In patient not t for major procedures
Dohlman's surgery diverticulotomy may
su ce.
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 Probable questions
1.what are the muscles of pharynx?wite
a short note on it?

2.Explain what is waldayers ring?

3.what is kilian s dehiscence?what is its

signi cance?

4.write a short note on zenkers

diverticulum?
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MCQ

1. Killian s dehiscence is seen in:

a. Oropharynx
b. Nasopharynx
c. Hypopharynx
d. Vocal cords

2. The Eustachian tube opens into

nasopharynx
approximately 1 cm behind the:
a. Tonsil
b. Posterior end of superior turbinate
c. Posterior end of middle turbinate
d. Posterior end of inferior turbinate

3. Nodes of Rouviere:
a. Retropharyngeal node
b. Parapharyngeal node
c. Adenoids
d. None

4. Gillette s space is:

a. Retropharyngeal space
b. Peritonsillar space
c. Parapharyngeal space
d. None

5. Danger space is located between:

a. Buccopharyngeal and alar fascia
b. Alar fascia and prevertebral fascia
c. Buccopharyngeal and mandible
d. Capsule of tonsil and superior
constrictor muscle

6. The Waldeyer s group of lymph nodes

do not
include:
a. Submandibular lymph nodes
b. Tonsils
c. Lingual tonsils
d. Adenoids

7. Parapharyngeal space is also known

as:
a. Retropharyngeal space
b. Pyriform sinus
c. Lateral pharyngeal space
d. None of the above

ANS: 1.C 2.D 3.A 4.A 5.B 6.A 7.C