ANATOMY AND PHYSIOLOGY OF

PHARYNX

Presented by Amalia Triakumara

Supervisor: Dr. dr. Sinta Sari Ratunanda, Sp.T.H.T.K.L.(K), M.Kes

DEPARTMENT OF OTORHINOLARYNGOLOGY-HEAD & NECK SURGERY

FACULTY OF MEDICINE PADJADJARAN UNIVERSITY-HASAN SADIKIN GENERAL HOSPITAL
BANDUNG
Introduction

◦ Pharynx is a conical fibromuscular tube forming

upper part of aerodigestive tract
◦ 12-14 cm, extends from base of skull to lower
border of cricoid cartilage (C6).
◦ Width is 3.5 cm at base & 1.5 cm at pharyngo-
oesophageal junction, which is the narrowest part
in GIT.

Snell Clinical Anatomy by regions 9th ed 2012

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Introduction

◦ Situated behind the nose, the moth, and the

larynx
◦ Upper part transmits only air
◦ Lower part transmits only food
◦ Middle part transmit both air and food

Snell Clinical Anatomy by regions 9th ed 2012

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Boundaries
Superiorly :
◦ Base of the skull (body of sphenoid
and basiocciput)
Interiorly :
◦ Continuous with the oesophagus (C6 –
cricoid cartilage)
Posteriorly :
◦ Prevertebral facia and C1 – C6

Snell Clinical Anatomy by regions 9th ed 2012

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Boundaries
Anteriorly :
◦ It communicates with nasal cavity
(nasopharynx), oral cavity (oropharynx),
and the larynx (laryngopharynx).
One each side :
◦ Medial pterygoid plate, pterygomandibular
raphe mandible, tongue, hyoid bone,thyroid
and cricoid cartlage.
◦ It communicates with middle ear through
audiotory tube Snell Clinical Anatomy by regions 9th ed 2012

5
Subdivisions
The cavity of the pharynx is divided into :
1. The nasal part – Nasopharynx.
2. The oral part – Oropharynx.
3. The laryngeal part - Laryngopharynx

Snell Clinical Anatomy by regions 9th ed 2012 6

Nasopharynx (epipharynx)
◦ Situated behind the nose
Extent :
◦ From base of skull to lower border
of the soft palate (C1)
◦ Respiratory in function (lined by
ciliated columnar epithelium)
◦ Mucous membrane is supplied by
the pharyngeal branch of
pterygopalatine ganglion
Snell Clinical Anatomy by regions 9th ed 2012

7
Features of Nasopharynx
◦ Anteriorly : communicates with
nasal cavities through posterior
nasal apertures.
◦ Roof and posterior wall : form by
body of sphenoid, basiocciput, and
anterior arch of atlas.
Nasopharyngeal tonsil-lymphoid
tissue collection

Snell Clinical Anatomy by regions 9th ed 2012

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Features of Nasopharynx cont…
Pharyngeal bursa (pouch of
luschka) – mucous diverticulum
extends into nasopharyngeal tonsil
Enlarged pharyngeal tonsil is
named adenoid – which may
obstruct the air in children
Pharyngeal hypophysis – glandular
tissue similar to adenohypophysis
(Rathke’s pouch remnant)
Snell Clinical Anatomy by regions 9th ed 2012
9
 Features of Nasopharynx cont…
Inferiorly :
◦ Communicates with oropharynx at
pharyngeal isthmus.
Boundaries of nasopharyngeal
isthmus :
◦ Anterior : soft palate
◦ Lateral : palatopharyngeal arches
◦ Posterior : pharyngeal wall in which
passavant’s ridge (palatopharyngeal
muscle) appears during deglutition
Snell Clinical Anatomy by regions 9th ed 2012
and speech. 10
 Features of Nasopharynx cont…
Lateral wall :
◦ Pharyngeal opening of the auditory tube
◦ Tubal elevation (torus tubarius) bounds
the tubal opening
◦ Tubal tonsil – lymphatic aggregation
around tubal opening
◦ Salpingopharyngeal fold : fold is raised
by salphyngopharyngeus muscle
◦ Pharyngeal recess or lateral recess or
fossa of Rosenmuler. (Behind the tubal
elevation) Snell Clinical Anatomy by regions 9th ed 2012
11
Oropharynx (mesopharynx)
◦ Middle part of the pharynx
Situation :
◦ Behind the oral cavity
Exten :
◦ From the level of soft palate to epiglottis
(C1 – C3)
Boundaries :
◦ Post : body of axis & C3
◦ Ant : communicates with oral cavity –
oropharyngeal isthmus Snell Clinical Anatomy by regions 9th ed 2012
12
Oropharynx cont…
◦ Superior : continuous with
nasopharynx at nasopharyngeal
isthmus
◦ Inferior : continuous with
laryngopharynx
◦ Lateral : palatine tonsil

Snell Clinical Anatomy by regions 9th ed 2012

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Oropharynx cont…
Oropharyngeal isthmus :
Boundaries :
◦ Above : soft palate
◦ Below : dorsal surface of 1/3 of
tongue
◦ Each side : palatoglossal arch

Snell Clinical Anatomy by regions 9th ed 2012

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 Oropharynx cont…
Palatine tonsil :
Situation :
◦ Lateral wall of oropharynx
◦ Tonsillar fossa
Boundaries of tonsillar fossa :
◦ Anterior : palate – glossal fold
◦ Posterior : palate – pharyngeal fold
◦ Lateral : (tonsilar bed)
◦ Pharyngobasilar fascia, palatoglossus Snell Clinical Anatomy by regions 9th ed 2012

& superior constrictoe muscle 15

 Waldeyer’s ring
Collections of lymphatic tissue at the
entrance into alimentary tract
◦ Dorsal : nasopharyngeal tonsil
◦ Dorsolateral : tubal tonsils
◦ Lateral : palatine tonsil
◦ Ventral : lingual tonsil

Snell Clinical Anatomy by regions 9th ed 2012

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Laryngopharynx (Hypopharynx)
Extent :
◦ From upper border of epiglottis
(C3) to lower border of cricoid
cartilage (C6)
◦ At C6 continuous with oesophagus

Snell Clinical Anatomy by regions 9th ed 2012

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Laryngopharynx cont…
Boundaries :
◦ Posterior : C3 – C6
◦ Anterior : from above downward
inlet of larynx
◦ Posterior surface of arytenoid
cartilage
◦ Posterior surface of lamina of
cricoid cartilage

Snell Clinical Anatomy by regions 9th ed 2012

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Laryngopharynx cont…
Piriform fossa (smuggler’s pouch)
Boundaries :
◦ Medial : aryepiglottic fold
◦ Lateral : thyroid cartilage

Snell Clinical Anatomy by regions 9th ed 2012

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Structure of pharyngeal wall
◦ Inner to outer :
1. Mucous coat – stratified
squamous epithelium.
2. Fibrous coat – pharyngobasilar
fascia
3. Muscle coat – skeletal muscle
(longitudinal & circular)
4. Buccopharyngeal fascia

20
Structure of pharyngeal wall cont…
◦ Muscle coat :
I. Inner longitudinal layer :
1. Stylopharyngeus
2. Salpingopharyngeus
3. Palatopharyngeus
II. Outer circular layer
4. Superior constrictor
5. Middle constrictor
6. Inferior constrictor Dhingra. Diseases of Ear, Nose and Throat & Head and Neck Surgery 7ed. India: Elsevier India;
2017
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Longitudinal muscles
1. Stylopharyngeus
◦ Origin : medial aspect of styloid
processus
◦ Gap between middle and superior
constrictor
◦ Insertion : posterior border of
thyroid cartilage
◦ Action : elevation of pharynx
◦ Nerve supply : glossopharyngeal
nerve (IX) Gray’s Anatomy for Students, 2 Edition 2009
nd

22
Longitudinal muscles cont…
2. Palatopharyngeus : 3. Salpingopharyngeus :
◦ Origin : palatine aponeurosis ◦ Origin : auditory tube cartilage
◦ Insertion : pharyngeal aponeurosis & (near the pharyngeal opening)
posterior border of thyroid cartilage ◦ Insertion : blend with
◦ Action : elevation of pharynx palatopharyngeus
◦ Nerve supply : cranial part of ◦ Action : elevation of pharynx
accessory nerve thro’ pharyngeal ◦ Nerve supply : cranial part of
plexus accessory nerve thro’ pharyngeal
plexus
Dhingra. Diseases of Ear, Nose and Throat & Head and Neck Surgery 7ed. India: Elsevier India;
2017
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 Superior constrictor
Origin :
◦ Pterygoid hamulus of medial
pterygoid plate
◦ Pterygomandibular raphe
◦ Medial surface of mandible
◦ Side of posterior part of tongue
Insertion :
◦ Median fibrous raphe on the posterior
wall of pharynx.
◦ Upper fibers into pharyngeal tubercle
Gray’s Anatomy for Students, 2nd Edition 2009
(occipital bone) 24
 Middle constrictor
Origin :
◦ Lower part of stylohyoid lig.
◦ Lesser cornu of hyoid bone
◦ Upper border of greater cornu of hyoid
bone.
Insertion :
◦ Median raphe
◦ Fan shaped fibers
◦ Upper fibers overlap the lower fibers of
sup. Constrictor Gray’s Anatomy for Students, 2nd Edition
2009
◦ Lower fibers overlapped by inf. 25

constrictor
Inferior constrictor
2 parts :
1. Thyropharyngeus
◦ Origin : oblique line & inferior
cornu of thyroid cartilage
2. Cricopharyngeus
◦ Origin : cricoid cartilage
◦ Insertion : both part inserted into
median raphe

Gray’s Anatomy for Students, 2nd Edition 2009

26
Gap between constrictor muscles
Sinus of morgagni :
◦ Closed by upper strong part of
pharyngobasilar fascia
◦ Structures passing trough the gap :
Auditory tube, tensor veli palatine,
levator veli palatine & ascending
palatine artery.

Gray’s Anatomy for Students, 2nd Edition 2009

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Gap between constrictor muscles cont…

Gap between superior constrictor & middle

constrictor
◦ Stylopharyngeus
◦ Glossopharyngeal nerve

Gray’s Anatomy for Students, 2nd Edition 2009

28
Gap between constrictor muscles cont…
Gap between middle constrictor &
inferior constrictor
◦ Internal laryngeal nerve ( a branch
of superior laryngeal nerve)
◦ Superior laryngeal vessels

Gray’s Anatomy for Students, 2nd Edition 2009

29
Gap between constrictor muscles cont…
Gap between inferior constrictor and
oesophagus
◦ Recurrent laryngeal nerve
◦ Inferior laryngeal vessels

Gray’s Anatomy for Students, 2nd Edition 2009

30
Gap between constrictor muscles cont…
Killian’s dehiscence (pharyngeal
pouch)
◦ Weak area between thyropharyngeus
& cricopharyngeus, thro’ pharyngeal
mucosa herniates
Applied importance :
Zenker’s diverticulum : due to neuro
muscular incoordination between
thyropharyngeus & cricopharyngeus
Snell Clinical Anatomy by regions 9th ed 2012
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Arterial Supply
I. Branches of facial artery
◦ Ascending palatine artery
◦ Tonsilar artery
II. Branch of eksternal carotid artery
◦ Ascending pharyngeal artery
III. Branch of lingual artery
◦ Dorsal lingual artery
IV. Branches of maxillary artery
◦ Greater palatine artery
◦ Pharyngeal artery
◦ Artery of pterygoid canal Snell Clinical Anatomy by regions 9th ed 2012
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Venous drainage
◦ Pharyngeal venous plexus
◦ Drain into internal jugular vein
facial vein

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 Nerve supply
◦ Pharyngeal plexus of nerve :
Formed by
1. Pharyngeal branches of
glossopharyngeal nerve
2. Pharyngeal branches of vagus
nerve
3. Cranial part of accessory nerve
4. Pharyngeal branches of superior
cervical sympathetic ganglion
Snell Clinical Anatomy by regions 9th ed 2012
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Nerve supply cont…
I. Motor supply :
◦ All muscles of pharynx supplied by
– cranial part of accessory nerve
except stylopharyngeus.
◦ Stylopharyngeus –
glossopharyngeal nerve

Snell Clinical Anatomy by regions 9th ed 2012

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Nerve supply cont…
II. Secretomotor (parasympathetic)
◦ Pharyngeal brance of
pterygopalatine ganglion
III. Sensory nerve supply :
A. General sensory – cranial N.IX
& N.X
B. Taste sensation – internal
laryngeal branch of vagus

Gray’s Anatomy for Students, 2nd Edition 2009

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Lymphatic drainage
a. Retropharyngeal lymph nodes
b. Parapharyngeal nodes

◦ Deep cervical lymph nodes

Gray’s Anatomy for Students, 2nd Edition 2009

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Pharyngeal Spaces
◦ Retropharyngeal space- from base of
skull to bifurcation of trachea between
buccopharyngeal fascia & prevertebral
fascia. Divided by median raphe into
two (space of Gillette)
◦ Prevertebral space - between
vertebral bodies & prevertebral fascia,
extends from base of skull to coccyx

Dhingra. Diseases of Ear, Nose and Throat & Head and Neck Surgery 7ed. India: Elsevier India;
2017 38
Parapharyngeal space
Boundaries :
◦ Medial: buccopharyngeal fascia
covering constrictors
◦ Posterior: prevertebral fascia
◦ Lateral: medial pterygoid muscle,
mandible.

Dhingra. Diseases of Ear, Nose and Throat & Head and Neck Surgery 7ed. India: Elsevier India; 2017

39
Physiology of Pharynx
1. Deglutition
2. Protection from aspiration
3. Part of respiratory & food passage
4. Speech adds resonance to the voice
5. Waldeyer’s ring is involved
6. Taste sensation
7. Mucous from respiratory tract is swallowed
8. E.tube ventilates & drains the middle ear cleft

Bailey BJ. Head and Neck Surgery Otolaryngology. 5th Ed. Volume 1. Philadelphia. JB. Lippincott Williams and Wilkins. 2014: 868-878
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Functions of Nasopharynx

◦Airway for passage of air into larynx, trachea and lungs

◦Hearing – middle ear ventilation, maintains air pressure
◦Resonance for voice production
◦Drainage for nasal and nasopharyngeal secrtetions
◦Prevents aspiration (Nasopharyngeal isthmus closes during, swallowing,
vomiting, speech)

Bailey BJ. Head and Neck Surgery Otolaryngology. 5th Ed. Volume 1. Philadelphia. JB. Lippincott Williams and Wilkins. 2014: 868-878
41
 Functions of Oropharynx
◦ Common conduit for air and food
◦ Deglutition
◦ Vocal resonance
◦ Taste sensation (tongue base, soft palate, anterior pillar, posterior pharyngeal
wall)
◦ Local defence and immunity (Waldeyer’s ring)

Bailey BJ. Head and Neck Surgery Otolaryngology. 5th Ed. Volume 1. Philadelphia. JB. Lippincott Williams and Wilkins. 2014: 868-878
42
Functions of tonsils and adenoids
◦ Immunity against bacteria, virus By T Lymphocytes in parafollicular region
◦ Barrier to infection (protective sentinels)
◦ Ig A antibody production by B Lymphocytes in follicles
◦ First 5 years life later atrophy

Bailey BJ. Head and Neck Surgery Otolaryngology. 5th Ed. Volume 1. Philadelphia. JB. Lippincott Williams and Wilkins. 2014: 868-878
43
Functions of Laryngopharynx
◦ Common conduit for air and food
◦ Voice resonance
◦ Deglutition

Bailey BJ. Head and Neck Surgery Otolaryngology. 5th Ed. Volume 1. Philadelphia. JB. Lippincott Williams and Wilkins. 2014: 868-878
44
Deglutition
◦ Process of propulsion of bolus of food from oral cavity into
◦ Stomach through oropharynx controlled by neuromuscular activity
◦ It also disposes dust and bacteria laden mucus Causes pharyngeal opening of
E.T to establish equal pressure on both sides of T.M
Phases
1. Oral (voluntary) – 1 second
2. Pharyngeal (both) – 1 second
3. Oesophageal (involuntary) – 8 to 20 second
Bailey BJ. Head and Neck Surgery Otolaryngology. 5th Ed. Volume 1. Philadelphia. JB. Lippincott Williams and Wilkins. 2014: 868-878
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Oral Phase
◦ Food chewed
◦ Lubricated with saliva
◦ Converted into bolus
◦ Held between tongue and palate
◦ Tongue elevated against palate
(myelohyoid)
◦ Food propelled into oropharynx

Bailey BJ. Head and Neck Surgery Otolaryngology. 5th Ed. Volume 1. Philadelphia. JB. Lippincott Williams and Wilkins. 2014: 868-878
46
Pharyngeal Phase
Reflex actions ◦ Contraction of pharyngeal
1. Closure of Nasopharyngeal constrictors -> bolus pushed to
isthmus (Soft palate raised cricopharyngeal sphincter
against passavants ridge) ◦ Relaxation of cricopharyngeus
2. Closure of Oropharyngeal muscle (Fall in pressure) -> food
isthmus (Palatoglossus muscle) passes into esophagus
3. Closure of Laryngeal inlet
(contraction of aryepiglottic
folds)
Bailey BJ. Head and Neck Surgery Otolaryngology. 5th Ed. Volume 1. Philadelphia. JB. Lippincott Williams and Wilkins. 2014: 868-878
47
Oesophageal Phase
◦ Closure of cricopharyngeal sphincter
◦ Primary peristalsis of oesophagus (contraction of circular muscles)
◦ Food moves down
◦ Relaxation of gastro oesophageal sphincter and opens (X.CN)
◦ Food enter stomach
◦ Sphincter closes
◦ Note –Secondary peristalsis is due to oesophageal
◦ distension (aeurbachs plexus)
Bailey BJ. Head and Neck Surgery Otolaryngology. 5th Ed. Volume 1. Philadelphia. JB. Lippincott Williams and Wilkins. 2014: 868-878
48
Neural control
◦ CN V and XII – Chewing and tongue movement
◦ CN VII – Taste (chorda tympani), Sensory to oral cavity (Nervus Intermedius),
Motor to Orbicuilaris oris
◦ CN IX – Taste, Pharynx
◦ CN X – Taste, Larynx, Laryngopharynx

Bailey BJ. Head and Neck Surgery Otolaryngology. 5th Ed. Volume 1. Philadelphia. JB. Lippincott Williams and Wilkins. 2014: 868-878
49
Speech function
◦ The function of the pharynx is in
the resonance of sound
◦ When speaking, the palate mole
moves upward during sound
production except for the letters M
and N

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Respiration function

◦ Is a part of the respiratory tract

◦ The pharyngeal muscles have a
"tonic dilator activity"
◦ This prevents the oropharynx from
collapsing due to negative pressure
during inspiration
◦ This will keep the pharyngeal
lumen open
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THANK YOU

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