~ ~ ~ PHARYNX ~ ~ ~ Dr.

Baker

All MOTOR inneveration to pharynx muscles is by Ann Nguyen -- NYUCD 2008 Pharyngeal Plexus (cranial-XI traveling with X) D1 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) MUSCLES OF THE PHARYNX
Constrictor Muscles Superior Constrictor - Pterygopharyngeus - Buccopharyngeus - Mylopharyngeus - Glosspharyngeus Origin Insertion

All SENSORY inneveration to pharynx mucosa is by Pharyngeal Plexus (IX traveling with X) EXCEPT: • Nasopharynx above the Eustachian Tube (Pharyngeal branches of V2 traveling thru Palatovaginal & Vomerovaginal Canals) Action Innervation

Pharyngeal Tubercle (occipital) Hamulus Pterygomandibular Raphe Mylohyoid Line of Mandible Tongue sequential peristaltic squeezing of the pharynx during swallowing to move food downward Accessory (XI) traveling with Vagus (X)

Middle Constrictor - Ceratopharyngeus - Chondropharyngeus

Pharyngeal Raphe Greater Hyoid Horn Lesser Hyoid Horn

Inferior Constrictor - Thyropharyngeus - Cricopharyngeus Longitudinal Muscles

Thyroid Cartilage Cricoid Cartilage Origin

this part does NOT meet at Raphe Insertion Constrictor muscles Thyroid Cartilage (posterior) Lateral Glossoepiglottic Fold Action

Recurrent Laryngeal Innervation

Stylopharyngeus

Styloid Process (medial aspect)

Glossopharyngeal (IX)

Palatopharyngeus

Hard Palate (posterior edge)

Pharyngobasilar Fascia Thyroid Cartilage (posterior) pharyngeal wall

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

Salpingopharyngeus

Eustachian Tube (medial cartilaginous part)

pharyngeal wall

Associated Muscles

Origin

Insertion

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

Innervation

Musculus Uvulae

Posterior Nasal Spine

Accessory (XI) traveling with Vagus (X)

Levator Veli Palatini

Eustachian Tube (medial cartilaginous part)

Palatine Crest Aponeurosis

elevate soft palate to seal off nasopharynx during swallowing

Tensor Veli Palatini

Eustachian Tube (lateral) Scaphoid Fossa (M-Pt Plate base) Sphenoid Spine

tenses soft palate to seal off nasopharynx during swallowing

root of V3
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Ann Nguyen -- NYUCD 2008 D1 Anatomy Notes -- Spring '05

BONY SKULL ATTACHMENTS of some pharyngeal muscles - 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 • Passavant’s Ridge - created by the Palatopharyngeal Sphincter only during swallowing - moves inferiorly as a “stripping wave”

Ann Nguyen -- NYUCD 2008 D1 Anatomy Notes -- Spring '05

• 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

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LAYERS OF THE PHARYNX

Ann Nguyen -- NYUCD 2008 D1 Anatomy Notes -- Spring '05

(1) Areolar Coat - outermost layer that is continuous w/ the buccinator’s 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 oropharynx’s posterior wall - oropharynx’s posterior wall pushes forward too • Palatopharyngel Sphincter forms the Passavant’s Ridge (occurs only during swallowing) • Longitudinal pharynx muscles • Suprahyoid muscles 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
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elevates the larynx to prevent food going down the trachea

NASOPHARYNX - 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

Ann Nguyen -- NYUCD 2008 D1 Anatomy Notes -- Spring '05

• Eustachian / Pharyngotympanic Tube - opening is located on nasopharynx’s 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 nasopharynx’s 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 nasopharynx’s 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

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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

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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 laryngopharynx’s 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

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ARTERIAL SUPPLY From the Maxillary Artery • Greater Palatine • Lesser Palatine From the Facial Artery • Tonsillar Artery • Ascending Palatine 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 = supplies palatine tonsils = supplies Superior Constrictor = supplies hard palate = supplies soft palate

Ann Nguyen -- NYUCD 2008 Note what pierces the Superior Constrictor:Spring '05 D1 Anatomy Notes -• Tonsillar Artery (Facial) • Paratonsillar Vein

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) mucosa of the pharynx, soft palate, palatine tonsils EXCEPT the nasopharynx above the level of Eustachian Tube (V2)

Sensory (9)

GLOSSOPHARYNGEAL (IX) Motor General Sensory Stylopharyngeus muscle pressure receptors in Carotid Sinus mucosa of pharynx, soft palate, palatine tonsils touch to posterior 1/3 tongue taste to posterior 1/3 tongue taste to circumvallate papillae Tympanic Plexus = medial side of tympanic membrane Lesser Petrosal Nerve = parotid gland 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.

Special Sensory Pre-gang. Parasymp. Post-gang. Parasymp.  Eagle Syndrome VAGUS (X) Motor

muscles of the pharynx, larynx, soft palate EXCEPT Stylopharyngeus (IX) EXCEPT Tensor Palatini (V3) chemoreceptors in Carotid Body mucosa of pharynx, larynx skin of posterior external ear & canal taste to oropharynx & epiglottis abdominocardiothoracic viscera

General Sensory

Special Sensory Parasympathetic MAXILLARY (V2) General Sensory AUTONOMIC

nasopharynx above the Eustachian Tube post-ganglionic sympathetic fibers arise off the Internal Carotid Artery’s plexus
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SENSORY INNERVATION TO THE PHARYNX

Ann Nguyen -- NYUCD 2008 D1 Anatomy Notes -- Spring '05

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