ANATOMY OF

HYPOPHARYNX
LARYNGEOPHARYNX
• Laryngeopharynx or Hypopharynx is the lower part of the
pharynx situated behind the larynx.It extends from the upper
border of the epiglottis to the lower border of the cricoid cartilage.
• The anterior Wall bears:
a.The inlet of the larynx
b. Posterior surfaces of the cricoid and arytenoid
cartilages.
• Posterior wall is supported mainly by the fourth and fifth cervical
vertebrae and partly by the third and sixth vertebrae. The posterior wall is
formed mainly by the Superior, Middle and Inferior constrictors of the
pharynx.
• Lateral wall presents a depression called pyriform fossa,one on each side
PIRIFORM FOSSA
• A deep recess which is broad above and narrow below in
the anterior part of the lateral wall of the laryngeopharynx
,on either side of the laryngeal inlet
• Produced due to the bulging of the larynx into the
laryngeopharynx.
BOUNDARIES
• Medial:Aryepiglottic fold and quadrangular membrane of the larynx.
• Lateral: Mucous membrane covering the medial surface of the lamina of
thyroid cartilage and thyrohyoid membrane.
The internal laryngeal nerve and superior laryngeal vessels pierce the
thyrohyoid membrane and reaches the medial wall through the floor of the
fossa.
• Above: piriform fossa is seperated from epiglottic vallecula by lateral
glossoepiglotic fold.
 CLINICAL ANATOMY

• Sometimes foreign bodies gets lodged in these

recess and hence they’re also known as
Smugglers pouch.
• The internal laryngeal nerve runs on the
lateral wall of the sinus, which makes it
accessible for local anaesthesia.
• The malignant tumors of the hypopharynx
grows in the pyriform fossa without any
symptoms until the patient presents with
lymphadenopathy and referred ear pain
through the internal laryngeal nerve.
POST CRICOID REGION.
• Itis the part of the anterior wall of the
laryngeopharynx between the upper and lower
border of cricoid lamina.
• Itextends from the level of arytenoid
cartilage.
• Commonsite for carcinoma in females
suffering from Plummer-Vinson Syndrome.
POSTERIOR PHARYNGEAL WALL
• It extends from the level of hyoid bone to the level of cricoarytenoid joint.
LYMPHATIC DRAINAGE.
• pyriform sinus is richly supplied by lymphatics which exit through the
thyrohyoid membrane and drain into the upper jugular chain.
• Lymphatics of the posterior wall terminates in the lateral pharyngeal or
parapharyngeal nodes and hence to the deep cervical lymph nodes.
• Lymphatics of the post Cricoid region also drain into the
parapharyngeal nodes.
• They may also drain into nodes of supraclavicular and paratracheal
chain.
BLOOD SUPPLY
• Hypopharynx is supplied by the pharyngeal branches of the
superior and Inferior thyroid arteries.Venous drainage occurs
through the pharyngeal plexus.
NERVE SUPPLY
• Hypopharynx is supplied by the Xth cranial nerve.
• Sensory nerve supply to hypopharynx is by the internal branches of
both superior laryngeal and recurrent laryngeal nerves.
Hypopharyngeal
tumour
 FUNCTIONS
• It is a common pathway for air and
food,provides a vocal tract for
resonance of certain speech sounds
and helps in deglutition.
• There is coordination between
contraction of pharyngeal muscles
and relaxation of cricopharyngeal
sphincter at the upper end of the
oesophagus.
TUMOURS OF HYPOPHARYNX
1. Carcinoma of Pyriform Sinus:
• Exophytic or ulcerative growth which are deeply infiltrative, which are mostly
asymptomatic for a long time.
• Clinically presents as metastatic neck nodes with prickling sensation in the throat.Referred
otalgia,pain on swallowing and dysphagia are also seen in later stages.

2. Carcinoma of Post Cricoid Region:

• Ulcerative type lesion that are seen mostly in females with Paterson-Brown-Kelly
(Plummer-Vinson) syndrome characterized by hypochromic microcytic anemia.

3. Carcinoma of Posterior Pharyngeal Wall:

• Least common, mostly seen in males above 50 yrs of age.
• Exophytic growth but can be ulcerative.Remains localised until late and then spreads to
prevertebral fascia,muscles and vertebrae.
• Dysphagia or spitting of blood may be the presenting symptom.
PHARYNGEAL POUCH
• Also called hypopharyngeal diverticulum or Zenker’s
diverticulum.
• It is a pulsion diverticulum where pharyngeal mucosa
herniates through the Killian’s dehiscence.(a weak area
between two parts of the Inferior constrictor).
• It is at first behind oesophagus and then comes to lie on
its left.Mouth of the sac is wider than the opening of the
oesophagus and food preferentially enters the sac..
REFERENCES
• BD Chaurasia
• Dhingra ENT 7th Edition
• VishramSingh