Station 1- Pharynx

Observe in Plastic Models

1 • Skeletal Support
The bases of skull, hard palate, medial pterygoid plate, hyoid bone with thyroid and cricoid cartilages
provide support of the Pharynx and soft palate.

2 ▪ Muscles: (Discuss origin, insertion and innervation)

• Circular group:
o Superior pharyngeal constrictor
o Middle pharyngeal constrictor
o Inferior pharyngeal constrictor
• Longitudinal group:
o Stylopharyngeus
o Palatopharyngeus
o Salpingopharyngeus

3 • Nasopharynx: Identify and observe

- Found between the base of the skull and the soft palate, situated behind the nasal cavity.
- The soft palate separates the nasopharynx from the oropharynx.
- Contains the following structures:
The adenoid tonsils, salpingopharyngeal fold, tubal elevation and the openings to the Eustachian tubes.

Head and Neck: Pharynx, Larynx, and Thyroid Gland

Prepared by: Dr. Altayeb Abdalla Ahmed, Dr. Elhady Kheir, and Dr. Ibrahim Hoja
Reviewed and Approved by: Dr. Altayeb Abdalla Ahmed Page 1
 • Oropharynx
- The middle part of the pharynx, located between the soft palate and the superior border of the epiglottis.
- Identify :
o Median and lateral glossoepiglottic folds
o Vallecula
o Piriform fossa
- contains the following structures
Lingual tonsils, Palatine tonsils, palatoglossal and palatopharyngeal folds.

• Laryngopharynx
- The most inferior part of the pharynx, located between the superior border of the epiglottis and inferior
border of the cricoid cartilage.
- It has the piriform fossa on both sides of the laryngeal inlet.

• Discuss Blood supply& lymphatic drainage?

• Identify and discuss PHARYNGEAL SPACES which are potential spaces in relation to the pharynx:
- Retropharyngeal space
- Parapharyngeal space or infratemporal fossa

Head and Neck: Pharynx, Larynx, and Thyroid Gland

Prepared by: Dr. Altayeb Abdalla Ahmed, Dr. Elhady Kheir, and Dr. Ibrahim Hoja
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 Station 2 Larynx
Observe & Identify in Plastic and Plastinated Models
1 Larynx:
• Location and relation:
Extends from hyoid bone above to cricoid cartilage below opposite to C3 and C6 vertebra, covered
anteriorly by the infrahyoid muscles, and laterally by the lobes of the thyroid gland.
• Is formed by
cartilages, muscles, ligaments & membranes.

2 • Cartilages: (Single: Thyroid, Cricoid and Epiglottis) (Paired: Arytenoid, Cuneiform and Corniculate)
- Thyroid cartilage (lamina, laryngeal prominence, superior thyroid notch, oblique line, superior horn
and inferior horn)
- Cricoid cartilage (lamina and arch)
- Epiglottis (lamina, stalk and upper edge)
- Arytenoid cartilage (Base, apex, vocal process and muscular process)
• Membranes and ligaments
Thyrohyoid membrane and “ligaments”, Hyo-epiglottic ligament, aryepiglottic fold, cricothyroid
membrane(ligament) and cricotracheal ligament)

3 • Inlet of the larynx: discuss Borders and Direction

Head and Neck: Pharynx, Larynx, and Thyroid Gland

Prepared by: Dr. Altayeb Abdalla Ahmed, Dr. Elhady Kheir, and Dr. Ibrahim Hoja
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 4 • Cavity of the larynx:
- Vestibule – between the laryngeal inlet and the vestibular folds.
- Middle part – between the vestibular folds and the vocal folds below.
- Subglottis – between the vocal folds and the inferior opening of the larynx.
• The opening between the two adjacent vocal folds is known as rima glottidis.
• The opening between the two adjacent vestibular folds is known as rima vestibuli.

5 Muscles of larynx:
• Extrinsic muscles: identify and discuss Elevators and Depressors
• Intrinsic muscles:
- Posterior cricoarytenoid r
F n arytenoid
- E Lateral cricoarytenoid (may not see in this specimen) - Transverse
- Thyroarytenoid
D
- Cricothyroid
- Oblique arytenoid
c
- Vocalis
G
Discuss action & innervation of each individual muscle

6 • Identify when possible and discuss: Blood supply & Sensory innervation

Head and Neck: Pharynx, Larynx, and Thyroid Gland

Prepared by: Dr. Altayeb Abdalla Ahmed, Dr. Elhady Kheir, and Dr. Ibrahim Hoja
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 Station 3 Thyroid Gland
Observe in Plastic and Plastinated Models
1 • The thyroid gland is located in the anterior neck, spanning between the C5 and T1 vertebrae.
• Two lobes connected by an isthmus.
• Pyramidal lobe may be present

2 Identify and Discuss: Blood supply & relations to the laryngeal nerves

Head and Neck: Pharynx, Larynx, and Thyroid Gland

Prepared by: Dr. Altayeb Abdalla Ahmed, Dr. Elhady Kheir, and Dr. Ibrahim Hoja
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 Station 4- Wet Specimen Station 5- Clinical Anatomy
1 Enlarged Adenoid Tonsils
The pharyngeal tonsils can become
pathologically enlarged due to

• Viral infections of the upper

respiratory tract.
• Bacterial infection
When enlarged, the adenoids can obstruct
the opening of the eustachian and
posterior nasal apertures.

2 Inflammed Palatine Tonsils (Tonsillitis)

Complication of Acute tonsillitis Local:
• Peritonsillar abscess.
• Para pharyngeal abscess.
• Retropharyngeal abscess.
• Chronic tonsillitis.
Spread of infection.
Systemic complications:
• Acute glomerulonephritis.
• Acute rheumatic fever

3 Pharyngeal Diverticulum (Pouch)

• Etiology not entirely clear:
• Increased pressures while swallowing,
leading to outpouching through naturally
weak area of esophagus (Killian’s
triangle)
• Resistance to swallowing due to
abnormalities of the UES
• High association with dysphagia
(even after repair)
• Acid induced esophageal dysmotility
• Associated with Barrett’s esophagus in 15-
20%
• Associated with increased rate of Hiatal
Hernia

Head and Neck: Pharynx, Larynx, and Thyroid Gland

Prepared by: Dr. Altayeb Abdalla Ahmed, Dr. Elhady Kheir, and Dr. Ibrahim Hoja
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 4 Laryngitis

• inflammation of the larynx

• caused by a respiratory infection or
irritants such as cigarette smoke.
• Inflammation of the vocal folds causes
hoarseness or loss of voice by interfering
with contraction of the folds, or by causing
them to swell to point where they cannot
vibrate freely.
• Many long-term smokers acquire a
permanent hoarseness from damage done
by chronic inflammation.

5 Cancer of the larynx

• Is found almost exclusively in individuals

who smoke.
• The condition is characterized by
hoarseness, pain on swallowing, or pain
radiating to an ear.

6 Cricothyroidotomy

• emergency procedure to provide a

temporary airway.
• used in situations in obstruction at or above
the larynx (e.g foreign body, angioedema
or facial trauma), and intubation has been
unsuccessful.
• To perform the technique, the thyroid
cartilage is palpated in the neck – below
which there is a depression representing
the cricothyroid ligament. A small incision
is made in the midline of this ligament, and
an endotracheal tube is inserted to secure
the airway.

Head and Neck: Pharynx, Larynx, and Thyroid Gland

Prepared by: Dr. Altayeb Abdalla Ahmed, Dr. Elhady Kheir, and Dr. Ibrahim Hoja
Reviewed and Approved by: Dr. Altayeb Abdalla Ahmed Page 7
 7 Discuss sequence of damage to Damage to recurrent Laryngeal Nerves
• The recurrent laryngeal nerves provide sensory innervation to the infraglottis, and motor innervation to all the
internal muscles of larynx (except the cricothyroid).
• Depending on the cause, the nerve damage can be bilateral or unilateral.
• In unilateral palsy, one vocal cord is paralysed. The other vocal cord tends to compensate, and speech is not
affected to a great degree, although the patient may experience hoarseness of voice.
• In cases of bilateral palsy, both vocal cords are paralysed in a position between adduction and abduction
(cadaveric postion). Breathing is impaired, and phonation cannot occur.
• If this occurs partial bilaterally, the rima glottidis (space between the vocal cords) is completely closed, and
emergency surgical intervention is required to restore the airway.

Hoarseness:

Hoarseness can be due to any condition that results in improper

vibration of the vocal folds.

CONDITION DESCRIPTION
Acute laryngitis Inflammation and edema caused
by Smoking,
Geastroesophageal Reflux
Disease,
Chronic Rhinosinusitis, Cough,
Voice Overuse, Myxedema,
Infection
Stiffness Caused by surgical scarring
or inflammation
Mass lesion Caused By Nodule, Cyst,
Granuloma, Neoplasm, Fungal
Infection
Paralysis or Occurs After Viral Infection,
paresis Recurrent Laryngeal Nerve
Lesion,
Or Stroke; Can Have Congenital
Causes Or Be Iatrogenic

Head and Neck: Pharynx, Larynx, and Thyroid Gland

Prepared by: Dr. Altayeb Abdalla Ahmed, Dr. Elhady Kheir, and Dr. Ibrahim Hoja
Reviewed and Approved by: Dr. Altayeb Abdalla Ahmed Page 8