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ORGANUM AUDITORIUM

et VESTIBULOCOCHLEARE

The auditory system is exteroceptive


concerned with perception of sound
The vestibular system is proprioceptive
maintenance of equilibrium and
orientation of the body in space
involved in motor activities
The receptors (mechanoreceptors) are
hair cells

Converting mechanical energy in the form


of displacement of their surface elements
caused by sound waves (for hearing) and
head movements (for balance) into
electrochemical energy to be transmitted
to the auditory (cochlear) or vestibular
root of the vestibulocochlear nerve
(cranial n.VIII)
The auditory hair cells are in the spiral
organ of Corti in the cochlea

The vestibular hair cells are located in the


macula of the utricle, the macula of the
saccule, and the cristae ampullares of the
three semicircular canals.
The cochlear and vestibular nerves merge
to form the vestibulocochlear nerve or
eighth cranial nerve, which enters the
brainstem at the cerebellopontine angle
(junction between the cerebellum, pons
and medulla

Organon
Vestibulocochleare

Auris
externa
Auris
media
Auris
interna

EXTERNAL EAR
Auricle and external auditory meatus
in the petrous part of the temporal
bone
Separated from the middle ear by
the tympanic membrane (ear drum)
Auricle capturing the sound

External Ear (Auris externa)


Auricle cartilage, except lobulus
Meatus acusticus externus:
Ends at sulcus tympanicus membrana
tympani
Pars ossea & Pars cartilaginea
The external auditory meatus functions
as a sound resonator, increasing the
sound pressure level (usually measured
in decibels) at the tympanic membrane.

Auris externa

Auricle (Innervation)
Sensory innervation
The outer more superficial surfaces of the auricle
are supplied by the great auricular nerve
(anterior and posterior inferior portions) and the
lesser occipital nerve (posterior superior portion)
from the cervical plexus and the auriculotemporal
branch of the mandibular nerve [V3](anterior
superior portion);
the deeper parts of the auricle are supplied by the
vagus nerve [X] (the auricular branch) and
the facial nerve [VII] (which sends a branch to the
auricular branch of the vagus nerve [X]).

Auricle (Muscles)
Intrinsic and extrinsic muscles are
associated with the auricle:
Intrinsic muscles pass between the
cartilaginous parts of the auricle change
the shape of the auricle;
Extrinsic muscles, the anterior, superior,
and posterior auricular muscles from the
scalp or skull to the auricle positioning of
the auricle.
Innervation: the facial nerve [VII].

Auricle (Innervation)

Auricle (Vessels)
The external carotid artery supplies
the posterior auricular artery, the
superficial temporal artery supplies
anterior auricular branches, and the
occipital artery supplies a branch.
Venous drainage is through vessels
following the arteries. Pic

External acoustic meatus


The lateral one-third : cartilaginous
The medial two-thirds: a bony tunnel
in the temporal bone.
Covered with skin, contains hair and
modified sweat glands producing
cerumen (earwax).
Diameter varies wider laterally
and narrow medially

External acoustic meatus


Course: passes upward in an anterior direction
then slightly posteriorly a slight descent in
anterior direction
Observation : pull the ear superiorly,
posteriorly, and slightly laterally
Innervation: branches of the
auriculotemporal nerve of the mandibular
nerve [V3], the auricular branch of the
vagus nerve [X] (major); branches of he
facial nerve [VII] to the auricular branch of the
vagus nerve [X] (minor)

Tympanic membrane
Core: connective tissue lined with skin on
the outside and mucous membrane on the
inside
Attached to the tympanic part of the
temporal bone by a fibrocartilaginous ring
(annulus fibrokartilagenosa)
Umbo concavity caused by malleus
attachment
Anteroinferior to the umbo cone of light
(5 oclock)

Tympanic membrane
Superior to the umbo small bulge
in the membrane marks the position
of the lateral process of the malleus
Internal surface: anterior and
posterior malleolar folds. Superior to
these folds is thin and slack (the pars
flaccida), whereas the rest of the
membrane is thick and taut (the pars
tensa).

Otoscopic View

Although perforation of the tympanic membrane


(eardrum) has many causes, trauma infection is still
one of the commonest causes today.Most ruptures of
the tympanic membrane tend to heal spontaneously,
but surgical intervention may be necessary if the
rupture is large.
It is necessary to enter the middle ear through the
tympanic membrane. As the chorda tympani runs in the
upper one-third of the tympanic membrane, incisions
are always below this level. The richer blood supply to
the posterior aspect of the tympanic membrane
determines the standard surgical approach in the
posterior-inferior asp

Tympanic membrane
(innervation)
Outer skin: auriculotemporalis
branch of N. mandibularis (V3),
auricular branch of vagus nerve.
Inner mucosa: glosopharyngeal
nerve (n. IX)

Middle Ear
An air-filled space bounded laterally
Three ear ossicles :
Malleus attached to the tympanic membrane;
Incus in an intermediate position;
Stapes foot-plate is inserted into the oval
window.

Skeletal muscles:
the tensor tympani inserted into the malleus
the stapedius, attached to the stapes
stapedial or acoustic reflex

Middle Ear
Arterial supply : tympanic branch of the
maxillary artery and the mastoid branch of
the occipital or posterior auricular arteries;

Middle Ear
Branches of the middle meningeal
artery, the ascending pharyngeal
artery, the artery of the pterygoid
canal, and tympanic branches from
the internal carotid artery.
Venous drainage : the pterygoid
plexus of veins and the superior
petrosal sinus.
Innervation: tympanic plexus
(tympanic branch of n.IX and
caroticotympanic nerves)

Middle Ear
Consist of :
tympanic cavity
epitympanic recess
superiorly

Communication:
Mastoid area
posteriorly
Nasopharynx (via
the
pharyngotympanic
tube) anteriorly

Middle Ear (Functions)


To transmit vibrations of the tympanic
membrane to the internal ear through
three interconnected but movable bones
Mismatch transformer increases the
sound pressure level at the oval window
(Impedance of the cochlear fluids
(perilymph) is >> than the air in the
external auditory canal)
Higher pressure is necessary to vibrate the
higher-impedance fluid.

Middle ear (Boundaries)


A roof and a floor; anterior, posterior,
medial, and lateral walls
Tegmental wall (roof) tegmen tympani;
separates from middle cranial fossa
Jugular wall (floor) separates from
internal jugular vein;
a small aperture in the medial border the
tympanic branch from the glossopharyngeal
nerve [IX] enters the middle ear

Middle ear (Boundaries)


Membranous wall (lateral) tympanic
membrane & the bony lateral wall of the
epitympanic recess
Mastoid wall (posterior) partly covered
Inferior: bony partition between the tympanic
cavity and mastoid air cells.
Superior: epitympanic recess is continuous
with the aditus to the mastoid antrum

Anterior wall (catocid part)


Labyrinthine wall

Middle ear (Boundaries)

Mastoid area
Posterior to the epitympanic recess: aditus
to mastoid antrum (opening to the mastoid
antrum)
The mastoid antrum air-filled spaces
(the mastoid cells); separated from the
middle cranial fossa above by only the thin
tegmen tympani.
The mucous membrane of mastoid air cells
is continuous with those of the middle ear
spread of infection

Pharyngotympanic tube
Connects the middle ear with the
nasopharynx
Consist of : bony part (1/3 nearest the
middle ear) & cartilaginous part (the
remaining two-thirds)
Vessels: Branches of a. pharyngea
ascendens and a. maxillary
Innervation: the tympanic plexus of the
tympanic nerve, a branch of the
glossopharyngeal nerve [IX]

Tube:
equalizing air
pressure on
the two sides
of the
eardrum

Auditory ossicles (Malleus)


The largest; attached to the tympanic
membrane.
Parts :
head : rounded part in the epitympanic recess
neck :
anterior processes: attached to the anterior wall
of the middle ear by a ligament
lateral processes : attached to the anterior and
posterior malleolar folds of the tympanic
membrane
handle : attached to the tympanic membrane

Auditory ossicles (Incus)


Body of incus articulates with the
head of malleus and is in the
epitympanic recess;
The long limb: articulate with the
stapes;
The short limb: attached to the upper
posterior wall of the middle ear.

Auditory ossicles

Auditory ossicles (Stapes)


Head : articulates with the long
process of the incus;
Two limbs: attach to the oval base;
Base: fits into the oval window on the
labyrinthine wall of the middle ear.

M. tensor tympani
M. tensor tympani ends at the upper
part of the handle of the malleus.
Innervation: a branch from the
mandibular nerve [V3].
Contraction of the tensor tympani
tenses the tympanic membrane by
pulling the handle of the malleus
medially reduces the force of
vibrations in response to loud noises.

M. Stapedius
A very small muscle
Origin: the pyramidal eminence on the
mastoid wall of the middle ear
Insertion : neck of stapes.
Innervation: a branch from the facial
nerve [VII].
Contraction in response to loud noises
pulls the stapes posteriorly and
prevents excessive oscillation

Internal Ear
Bony cavities (the bony labyrinth)
vestibule, three semicircular canals, and
the cochlea
lined with periosteum & contain perilymph

Membranous labyrinth within these


cavities
semicircular ducts, cochlear duct, utricle &
saccule
filled with endolymph.

Auris Interna
Convey information to
the brain about balance
and hearing:
the cochlear duct is the
organ of hearing;
the semicircular ducts,
utricle, and saccule are the
organs of balance.

Responsible nerve :
vestibulocochlear
nerve [VIII]
vestibular (balance)
and cochlear (hearing)

The inner ear is the cochlea (spiral shell).


Traveling waves within the perilymph, generated by
movement of the stapes in the oval window,
displace the basilar membrane together with the
organ of Corti containing the specialized auditory
receptorsthe hair cells
The internal ear converts the mechanical signals
received from the middle ear, which start as sound
captured by the external ear, into electrical signals
to transfer information to the brain. The internal ear
also contains receptors that detect motion and
position

Auris Interna

Bony labyrinth
The vestibule
oval window (lateral wall) the central part of the
bony labyrinth
communicates anteriorly with the cochlea and
posterosuperiorly with the semicircular canals.

Semicircular canals: anterior, posterior, and


lateral; end dilation ampulla
Cochlea : ductus cochlearis scala tympani &
scala vestibuli (continous with vestibulum)
both continue at the apex as helicotrema
Cochlear canaliculus connects with
subarachnoid space in the posterior cranial
fossa

Membranous labyrinth
Filled with endolymph; separated from the
periosteum of the bony labyrinth by
perilymph
Consists of :
two sacs (the utricle and the saccule) and the
three semicircular ducts vestibular
apparatus (balance)
the cochlear duct hearing organ

The three semicircular ducts empty into


the utricle
The cochlear duct empties into the saccule

The utriculosaccular duct connects the


utricle and saccule. Its branch is the
endolymphatic duct, which enters the
vestibular aqueduct to emerge in the
posterior surface of the petrous part of the
temporal bone in the posterior cranial fossa.
Here the endolymphatic duct expands into
the endolymphatic sac, which is an
extradural pouch that functions in
resorption of endolymph.

Sensory Receptor
The utricle and saccule contain sensory
organ the macula
The ampulla of semicircular ducts contain
crista as the receptor
The utricle responds to centrifugal and
vertical acceleration while the saccule
responds to linear acceleration.
The receptors in the three semicircular
ducts respond to movement in any
direction

Sensory receptor
Six specialized areas contain sensory
epithelial receptors (hair cells)
three cristae ampullares, two maculas
the spiral organ of Corti in the cochlea

The organ of Corti is located within


the cochlear duct (scala media) of
the membranous labyrinth.

The cochlear ducts


(blue ) divide bony
labyr. into two
canals (the scala
vestibuli and the
scala tympani).
The spiral organ is
the organ of
hearing, rests on the
basilar membrane

Sel-sel rambut organon spirale


Gln spirale N. cochlearis
Nuc. Cochlearis dorsalis

Nuc. Cochlearis ventralis


Nuc. Olivarius superior
Lemniscus lateralis
Coliculus inferior
Colliculus inferior
Corpus geniculatum mediale
Radiatio acustica
Cortex gyrus temporalis transversus

CAVITAS NASI
Apertura anterior
nares
Apertura posterior
choana,berhub dg
nasopharynx
Cavitas nasalis:
Vestibulum nasi: nares
limen nasi
Regio respiratoria
membrana mucosa
bersilia, vaskularisasi >>
Regio olfactoria:
Concha nasalis superior
2/3 bagian atas septum nasi

Sinuses

Maxillary
Ethmoid
Frontal
Sphenoid

M&M, Fig. 7.11

Human Anatomy, Frolich, Head II:


Throat/Larynx

All connected to
nasal cavity
All lined with
mucous
membranes
Cold/allergiesfill
with mucous=sinus
headache

Conchae of Ethmoid Bone

Scroll-like bones
Covered in mucous membran
Smell
Filter air
Warm air

ORGANUM OLFACTORIUM

The conchae divide each nasal cavity into four air


channels :
an inferior nasal meatus between the inferior concha and
the nasal floor;
a middle nasal meatus between the inferior and middle
concha;
a superior nasal meatus between the middle and superior
concha; and
a spheno-ethmoidal recess between the superior concha
and the nasal roof.

These conchae increase the surface area of contact


between tissues of the lateral wall and the respired
air

Frontal sinus
Each frontal sinus drains onto the lateral wall
of the middle meatus via the frontonasal duct,
which penetrates the ethmoidal labyrinth and
continues as the ethmoidal infundibulum at
the front end of the semilunar hiatus.
The frontal sinuses are innervated by
branches of the supra-orbital nerve from the
ophthalmic nerve [V1]. Their blood supply is
from branches of the anterior ethmoidal
arteries

The opening of the maxillary sinus is


near the top of the base, in the
center of the semilunar hiatus, which
grooves the lateral wall of the middle
nasal meatus

Nasal Cavity
Innervation :
Olfaction: olfactory nerve [I];
general sensation: trigeminal nerve [V], ophthalmic
nerve [V1] (anterior), maxillary nerve [V2] (posterior);
all glands are innervated by parasympathetic fibers in
the facial nerve [VII] (greater petrosal nerve)

Blood supply :
terminal branches of the maxillary and facial (from)
external carotid artery;
ethmoidal branches of the ophthalmic artery
(originates from the internal carotid artery).

Pharynx
Musculomembranous tube
lying behind the nose,
oral cavity & larynx
From the base of the skull
to level of the 6th cervical
vertebras
The anterior wall is
deficient and shows (from
above downward):
Posterior nasal apertures
(choanae)
Opening of the oral cavity
Laryngeal inlet

N
OC

Pharyngeal Wall
It is a musculomembranous wall,
composed of:
Mucosa & submucosa
Pharyngobasilar fascia
Muscles: circular &
longitudinal
Buccopharyngeal fascia
The buccopharyngeal
fascia is separated from
the prevertebral fascia by
the retropharyngeal space.

Throat/Pharynx
Food and air mix and cross
Air
PHARYNX
Esopha
gus
Trache
a

STRUCTURES
Entrypharyngeal arches
Exitglottis (epiglottis is lid)
Pharyngeal constrictors squeeze food
through

When it goes wrongchoking!!


Human Anatomy, Frolich, Head II:
Throat/Larynx

Food

Muscles of the Pharynx


Circular muscles:
The three constrictor muscles extend
around the pharyngeal wall to be inserted
into a fibrous band or raphe
The raphe extends from the pharyngeal
tubercle on the basilar part of the occipital
bone of the skull down to the esophagus
The three constrictor muscles overlap
each other

Longitudinal muscle

Circular (Constrictor) Muscles

S
M
I

Superior, Middle & Inferior


The gap between the
superior border of the
superior constrictor and
the occipital bone is filled
by thickened

Superior constrictor
Origin: medial pterygoid
plate, pterygoid hamulus,
pterygomandibular
ligament, mylohyoid line
Insertion: pharyngeal
tubercle, pharyngeal
raphe

Middle constrictor
Origin: lower part of
stylohyoid ligament,
greater & lesser cornu of
hyoid bone
Insertion: pharyngeal
raphe

Inferior constrictor
Origin: lamina of
thyroid cartilage,
cricoid cartilage
Insertion: pharyngeal
raphe

Functions:
The constrictor muscles
propel the bolus of food
down into the esophagus
Cricopharygeus (lower
fibers of the inferior
constrictor) act as a
sphincter, preventing the
entry of air into the
esophagus between the

Longitudinal Muscles
Three in number:
Stylopharyngeus
Salpingopharynge
us
Palatpharyngeous
Function:
Elevate the larynx
& pharynx during
swallowing

Stylopharyngeus
Origin: styloid process
Insertion: posterior border
of thyroid cartilage

Salpingopharyngeus
Origin: auditory tube
Insertion: blends with
palatoglossus

Palatopharyngeus
Origin: palatine
aponeurosis
Insertion: posterior border
of thyroid cartilage

Division
Pharynx is divided into
three parts:
Nasopharynx:
Superior part,
communicates with the
nasal cavity through
posterior nasal
apertures
Oropharynx:
Middle part,
communicates with the
oral cavity through the
oropharyngeal isthmus
Laryngopharynx:
Inferior part,
communicates with the
larynx through the

Nasopharynx

Boundaries:
Roof: body of sphenoid
& basal part of the
occipital bone.
Pharyngeal tonsils
(adenoides) present in
the submucosa
Floor: upper surface of
soft palate & the
pharyngeal isthmus
(opening between the
free margin of soft
palate and posterior
pharyngeal wall)

Anterior wall: shows


posterior nasal
apertures
Posterior wall:
supported by anterior
arch of atlas (C1)
Lateral wall shows:
Opening of auditory
tube
Tubal elevation
(produced by
posterior margin of
tube)
Pharyngeal recess
Tubal tonsil
Salpingopharyngeal
fold (raised by

Oropharynx
Lies behind the mouth
Extends from soft palate
to upper border of
epiglottis
Boundaries:
Roof: soft palate and
pharyngeal isthmus
Floor: posterior one third
of tongue, median &
lateral glossoepiglottic
folds, and the valleculae

Anterior wall:
opening of the oral
cavity
Posterior wall:
supported by body
of C2 and upper part
of body of C3
vertebra
Lateral wall shows:
Palatopharyngeal
folds posterior to
the palatoglossal
folds.
Palatine tonsil
located between
them in the
Tonsillar fossa

Palatine Tonsil

Paired masses of
lymphoid tissue
Located in the
palatine fossa/sinus,
in the lateral wall of
the oropharynx
Reaches its
maximum size
during early
childhood, but after
puberty diminishes
in size

Lateral surface:
covered by a fibrous
capsule
Medial surface:
Projects into the
cavity of
oropharynx
Covered by
mucous membrane
Shows multiple
depressions, the
tonsillar crypts and
one deep
intratonsillar cleft

Relations

Anteriorly: Palatoglossal
fold (palatoglossus
muscle covered by
mucous membrane)
Posteriorly:
Palatopharyngeal fold
(palatopharyngeus
muscle covered by
mucous membrane)
Superiorly: Soft palate
Inferiorly: Posterior third
of the tongue
Medially: Cavity of the
oropharynx

Laterally:
The capsule separates
it from the structures
forming the tonsillar
bed:
Loose areolar tissue
External palatine vein
Tonsillar branch of facial
artery accompanied by
branches of the
glossopharyngeal nerve
Superior constrictor
muscle of the pharynx
Styloglossus muscle

More laterally are the


facial artery & internal

Palatine Tonsil contd


Arterial supply: Tonsillar branch of
facial artery (and twigs from
ascending pharyngeal, palatine &
lingual arteries)
Venous drainage: Veins pierce the
superior constrictor muscle and join
the external palatine, the pharyngeal
or the facial veins
Lymphatics join the upper deep
cervical lymph nodes (jugulodigastric
node)

Laryngopharynx
Lies behind the laryngeal
inlet & the posterior
surface of larynx
Extends from upper
border of epiglottis to
lower border of cricoid
cartilage
Boundaries:
Anterior wall: has
opening of the larynx in
the upper part and below
that is the mucosa
covering the posterior

Posterior wall:
supported by
bodies of C3, 4, 5, 6
vertebrae
Lateral wall:
Supported by
thyroid cartilage
and thyrohoid
membrane.
On each side of
laryngeal inlet,
lies the piriform
fossa

Piriform Fossa

A small depression situated on


either side of the laryngeal inlet
Leads obliquely backward and
downwrd from the region of the
back of the tongue to the
esophagus
It is a common site for the
lodging of foreign bodies
Bounded:
Medially by the aryepiglottic
fold
Laterally by the lamina of
thyroid cartilage & the
thyrohyoid membrane.
Branches of internal laryngeal (&
recurrent laryngeal) nerve lie
deep to the mucous membrane
of the fossa and are vulnerable to
injury during removal of a foreign

Nerve Supply
Sensory Nerve Supply:
Nasopharynx: Maxillary nerve
Oropharynx: Glossopharyngeal nerve
Laryngopharynx: Internal laryngeal
branch of the vagus nerve
Motor Nerve Supply:
All the muscles of pharynx, except the
stylopharyngeus, supplied by the
pharyngeal plexus
The stylopharyngeus is supplied by a
direct branch of glossopharyngeal nerve

Each subdivision of the pharynx has a different


sensory innervation:
the nasopharynx is innervated by a pharyngeal
branch of the maxillary nerve [V2] that originates
in the pterygopalatine fossa and passes through
the palatovaginal canal in the sphenoid bone to
reach the roof of the pharynx;
the oropharynx is innervated by the
glossopharyngeal nerve [IX] via the pharyngeal
plexus;
the laryngopharynx is innervated by the vagus
nerve [X] via the pharyngeal plexus.

Blood Supply & Lymphatics


Arterial supply is derived from branches of:
Ascending pharyngeal artery
Ascending palatine artery
Facial artery
Maxillary artery
Lingual artery
The Veins drain into pharyngeal venous plexus, which
drains into the internal jugular vein
The lymphatics drain into the deep cervical lymph nodes
either directly, or indirectly via the retropharyngeal or
paratracheal lymph nodes

Waldeyer's Tonsillar Ring

It is a lymphoid tissue
ring located in the
pharynx
Function as a barrier to
infection especially in the
first few years of life
Consists of (from
superior to inferior):
Adenoids (pharyngeal
tonsils)
Tubal tonsil
Palatine tonsil
Lingual tonsil

Clinical Notes
Adenoides (enlarged
pharyngeal tonsils) &
adenoidectomy. Adenoids
results in obstruction to
nasal breathing and make
mouth breathing necessary.
The patient develops a
typical facial expression
called the adenoid facies.
May also cause impaired
hearing
Otitis media (middle ear
infection), secondary to
infection of nasopharynx

Adenoid
facies

Peritonsillar abcess (quinsy), is


a complication of tonsillitis and
consists of a collection of pus
beside the tonsil (peritonsillar
space).
Piriform fossa: a common site
for the lodging of foreign
bodies
Pharyngeal pouch,
posteromedial herniation of
mucosal diverticulum between
thyropharyngeal and
cricopharyngeal parts of the
inferior constrictor muscle
leading to dysphagia (difficulty
in swallowing) . It occurs
mainly in older people

Nasal Pharynx
This lies above the soft palate and behind the
nasal cavities
In the submucosa of the roof is a collection of
lymphoid tissue called the pharyngeal tonsil
The pharyngeal isthmus is the opening in the
floor between the soft palate and the posterior
pharyngeal wall
On the lateral wall is the opening of the auditory
tube, the elevated ridge of which is called the
tubal elevation

Nasal Pharynx
The pharyngeal recess is a
depression in the pharyngeal wall
behind the tubal elevation
The salpingopharyngeal fold is a
vertical fold of mucous membrane
covering the salpingopharyngeus
muscle

Oral Pharynx
This lies behind the oral cavity
The floor is formed by the posterior one
third of the tongue and the interval
between the tongue and epiglottis
In the midline is the median
glossoepiglottic fold on each side the
lateral glossoepiglottic fold
The depression on each side of the
median glossoepiglottic fold is called
the vallecula

Oral Pharynx
On the lateral wall on each side are the
palatoglossal and the palatopharyngeal arches
or folds and the palatine tonsils between them
The palatoglossal arch is a fold of mucous
membrane covering the palatoglossus muscle
The interval between the two palatoglossal
arches is called the oropharyngeal isthmus
It marks the boundary between the mouth and
pharynx

Oral Pharynx
The palatopharyngeal arch is a fold
of mucous membrane covering the
palatopharyngeus muscle
The recess between the palatoglossal
and palatopharyngeal arches is
occupied by the palatine tonsil

Lymphoid Tissue of Pharynx


At the junction of the mouth with the oral
part of the pharynx, and the nose with the
nasal part of the pharynx, are collections of
lymphoid tissue
They are of considerable clinical importance
The palatine tonsils and the nasopharyngeal
tonsils are the most important

Tonsils and Tonsilitis


The palatine tonsils reach their maximum
normal size in early childhood
After puberty, together with other
lymphoid tissues in the body, they
gradually atrophy
The palatine tonsils are a common site of
infection, producing the characteristic
sore throat and pyrexia.

Tonsils and Tonsilitis


The deep cervical lymph node situated below
and behind the angle of the mandible, which
drains lymph from this organ, is usually
enlarged and tender
Recurrent attacks of tonsillitis are best treated
by tonsillectomy
After tonsillectomy, the external palatine vein,
which lies lateral to the tonsil, may be the
source of troublesome postoperative bleeding

Quinsy
A peritonsillar abscess (quinsy) is caused by
spread of infection from the palatine tonsil to
the loose connective tissue outside the
capsule
The nasopharyngeal tonsil or pharyngeal
tonsil consists of a collection of lymphoid
tissue beneath the epithelium of the roof of
the nasal part of the pharynx
Like the palatine tonsil, it is largest in early
childhood and starts to atrophy after puberty

Adenoids
Excessive hypertrophy of the lymphoid
tissue, usually associated with infection,
causes the pharyngeal tonsils to become
enlarged
They are then commonly referred to as
adenoids
Marked hypertrophy blocks the posterior
nasal openings and causes the patient to
snore loudly at night and to breathe through
the open mouth

Adenoids
The close relationship of the infected lymphoid
tissue to the auditory tube may be the cause
of deafness and recurrent otitis media
Adenoidectomy is the treatment of choice for
hypertrophied adenoids with infection
The nasal part of the pharynx may be viewed
clinically by a mirror passed through the mouth

Laryngeal Pharynx
This lies behind the opening into the
larynx
The lateral wall is formed by the
thyroid cartilage and the thyrohyoid
membrane
The piriform fossa is a depression in
the mucous membrane on each side

Sensory Nerve Supply of the


Pharyngeal Mucous Membrane
Nasal pharynx: The maxillary nerve
Oral pharynx: The glossopharyngeal
nerve
Laryngeal pharynx: The internal
laryngeal branch of the vagus nerve

Blood Supply
Ascending pharyngeal, tonsillar
branches of facial arteries, and
branches of maxillary and lingual
arteries

Lymph Drainage
Directly into the deep cervical lymph
nodes or indirectly via the
retropharyngeal or paratracheal
nodes into the deep cervical nodes

Swallowing or Deglutition
Masticated food is formed into a ball or bolus on the
dorsum of the tongue and voluntarily pushed upward
and backward against the undersurface of the hard
palate
This is brought about by the contraction of the
styloglossus muscles on both sides, which pull the
root of the tongue upward and backward
The palatoglossus muscles then squeeze the bolus
backward into the pharynx
From this point onward the process of swallowing
becomes an involuntary act

Swallowing or Deglutition
The nasal part of the pharynx is now shut off
from the oral part of the pharynx by the
elevation of the soft palate
By the pulling forward of the posterior wall of the
pharynx by the upper fibers of the superior
constrictor muscle
And by the contraction of the palatopharyngeus
muscles
This prevents the passage of food and drink into
the nasal cavities

Swallowing or Deglutition
The larynx and the laryngeal part of the pharynx are
pulled upward by the contraction of the
stylopharyngeus, salpingopharyngeus, thyrohyoid, and
palatopharyngeus muscles
The main part of the larynx is thus elevated to the
posterior surface of the epiglottis, and the entrance
into the larynx is closed
The laryngeal entrance is made smaller by the
approximation of the aryepiglottic folds, and the
arytenoid cartilages are pulled forward by the
contraction of the aryepiglottic, oblique arytenoid, and
thyroarytenoid muscles

Swallowing or Deglutition
The bolus moves downward over the epiglottis,
the closed entrance into the larynx, and reaches
the lower part of the pharynx as the result of
the successive contraction of the superior,
middle, and inferior constrictor muscles
Some of the food slides down the groove on
either side of the entrance into the larynx, that
is, down through the piriform fossae
Finally, the lower part of the pharyngeal wall
(the cricopharyngeus muscle) relaxes and the
bolus enters the esophagus

Palatine Tonsils
The palatine tonsils are two masses of
lymphoid tissue, each located in the
depression on the lateral wall of the oral
part of the pharynx between the
palatoglossal and palatopharyngeal
arches
Each tonsil is covered by mucous
membrane, and its free medial surface
projects into the pharynx
The surface is pitted by numerous small
openings that lead into the tonsillar crypts

Palatine Tonsils
The tonsil is covered on its lateral surface by a
fibrous capsule
The capsule is separated from the superior
constrictor muscle by loose areolar tissue
The external palatine vein descends from the
soft palate in this tissue to join the pharyngeal
venous plexus
Lateral to the superior constrictor muscle lie the
styloglossus muscle, the loop of the facial artery,
and the internal carotid artery

Blood Supply
The tonsillar branch of the facial artery
The veins pierce the superior constrictor
muscle and join the external palatine,
the pharyngeal, or the facial veins
Lymph drains into the upper deep
cervical lymph nodes, just below and
behind the angle of the mandible

Waldeyer's Ring of Lymphoid Tissue


The lymphoid tissue that surrounds the
opening into the respiratory and digestive
systems forms a ring
The lateral part of the ring is formed by
the palatine tonsils and tubal tonsils
The pharyngeal tonsil in the roof of the
nasopharynx forms the upper part, and
the lingual tonsil on the posterior third of
the tongue forms the lower part

Retropharyngeal Space
A potential space between the
buccopharyngeal fascial lining of the
pharynx and the prevertebral fascia
Contains loose areolar tissue
Closed:
Superiorly (by the base of the skull) and
Laterally (by the carotid sheath)
Open inferiorly into the superior
mediastinum
Allows movement of pharynx, larynx,
trachea and esophagus during swallowing