Pharynx and mechanism of

swallowing

Dr Srinivasa Rao S
Fall 19/09/2023
 Objectives
• Describe the structure of the wall of pharynx
• Describe the muscles of pharynx and soft palate
• Describe the innervation of pharynx and soft palate
• Review the pathways involved in the "gag reflex"
• Describe the mechanism of swallowing and the muscles involved
• Co-relate with relevant clinical anatomy
 Nasopharynx Oropharynx

Pharyngeal tonsil

Tubal elevation &

tubal tonsil

Pharyngeal
opening

Nasopharyngeal
isthmus
Oropharynx

Tonsillar bed

During tonsillectomy external

External palatine vein
palatine vein, tonsillar artery &
IX CN may be damaged
 Woldeyer's lymphatic ring pharyngeal tonsil

• Aggregations of lymphoid tissue in relation to

oropharyngeal isthmus
– Right and left palatine tonsils
– Posteriorly and above-pharyngeal tonsil
– Laterally and above- tubal tonsils
– Inferiorly- lingual tonsil
• Function- prevent invading of pathogens

 Clinical anatomy
• Tonsillitis
• Tonsilloliths: stone formation in tonsils
• Both tonsillitis and tonsilloliths cause
referred pain in ear
(Glossopharyngeal nerve)
• Infection of tubal tonsil obstruct the
auditory tube opening and can cause
otitis media (middle ear infection)
 Laryngopharynx
• Clinical anatomy
• Removal of foreign bodies from piriform
fossa
– May damage internal laryngeal nerve
– Anaesthetia in the supraglottic part of
the larynx
 Structure of
pharyngeal wall

From inside to outside:

a) Mucosa
b) Submucosa
c) Muscular coat
d) Buccopharyngeal fascia
 Mucosa
• Pseudostratified ciliated columnar(in
nasopharynx)
• Stratified squamous epithelium (rest of
pharynx)
Submucosa
• Pharyngobasilar fascia: fibrous layer lining
muscular coat

Muscular coat
• Longitudinal muscles (inner layer)
• Constrictors (outer layer)

Buccopharyngeal fascia
• Covers pharynx externally
 Pharyngeal muscles
LONGITUDINAL MUSCLES

Stylopharyngeus Palatopharyngeus Salpingopharyngeus

• Origin: styloid • Origin: upper • Origin: cartilage of

process of surface of the auditory tube
temporal bone palatine
aponeurosis

• All the 3 are inserted as a conjoint sheet at the post border of lamina of
thyroid cartilage
 Actions
• Elevates the larynx and pharynx during swallowing
Pharyngeal muscles
 Constrictor muscles
 Superior constrictor
• Origin
– Posterior border of medial
pterygoid plate & pterygoid
hamulus
– Pterygomandibular ligament
– Posterior end of mylohyoid line of
mandible
• Inferiorly overlapped by middle
constrictor
 Middle constrictor
• Origin: lower part of stylohyoid
ligament, lesser and greater cornua of
hyoid bone
• Inferiorly overlapped by inferior
constrictor
 Inferior constrictor
• Thyropharyngeus: oblique line of thyroid
cartilage
• Cricopharyngeus: side of cricoid cartilage
• Killian’s dehiscence- weak area b/w two
parts
• Insertion: all three constrictors are
inserted into the median fibrous raphe

 Actions of constrictors:
• All constrictors reflexly contracts during
deglutition and induce wave of peristalsis
• Thyropharyngeus propulsive in function
and cricopharyngeus acts as sphincter
 Pharyngeal/Zenker’s diverticulum

• Incoordination of thryopharyngeus and

cricopharyngeus raises Intrapharyngeal
pressure
• Results in formation of midline pharyngeal
diverticulum at Killian’s dehiscence
• Symptoms: dysphagia
 Structures passing b/w constrictor muscles

 Above superior constrictor (Sinus of

Morgagni)
• Auditory tube
• Levator veli palati
• Ascending palatine artery
 B/W superior and middle constrictors

• Glossopharyngeal nerve
• Stylopharyngeus
 B/W middle and inferior constrictors

• Internal laryngeal nerve

• Superior laryngeal artery
 Nerve supply
• Motor and sensory nerve supply by pharyngeal
plexus
 Pharyngeal plexus formation
• Pharyngeal branch of X CN
• Pharyngeal branch of IX CN
• Branches from superior cervical sympathetic
ganglion

 Sensory nerve supply

• Nasopharynx: pharyngeal branch of maxillary
nerve
• Oropharynx: IX CN
• Laryngopharynx: X CN

 Motor nerve supply

• All muscles are supplied by pharyngeal branch of vagus nerve
• Except stylopharyngeus supplied by glossopharyngeal nerve
 Arterial supply Blood supply
• Ascending pharyngeal artery
• Ascending palatine & tonsillar
branches of facial artery
• Lingual artery
• Maxillary artery
 Venous drainage
• Pharynx is drained by pharyngeal
venous plexus and finally into
internal jugular vein
 Lymphatic drainage

• Retropharyngeal and finally into

deep cervical lymph nodes
 Soft palate
• Mucous covered fibro-musculo-glandular
curtain
• Hangs from posterior margin of hard
palate
• Inferior border presents a conical
projection-uvula

Cleft palate: congenital anomaly of

palate, due to non-fusion of palatal
processes
 Soft palate
Levator veli palatini
 Consist of five pairs of muscles Tensor veli palatini

• Tensor veli palatini: tighten soft

palate and opens mouth of
Palatoglossus Palatopharyngeus
auditory tube
• Levator veli palatini: elevates soft
plate
• Palatopharyngeus: pulls pharynx
upwards Sagittal section showing one
side of soft palate muscles
• Palatoglossus: elevates posterior
part of tongue
• Musculus uvulae: shortens uvula
and pulls it superiorly
 Passavant’s muscle/ passavant’s
ridge
• Formed by fibres of palatopharyngeus
• Lies at posterior and lateral walls of
nasopharyngeal isthmus
• During swallowing soft palate come in
contact with ridge to close isthmus
 Nerve supply

• All muscles are supplied by the pharyngeal plexus

• Except tensor veli palati is supplied by mandibular nerve (nerve to

medial pterygoid)
Vagus nerve lesion- produce paralysis of soft palate which
results in nasal regurgitation of liquids/food
 Mechanism of swallowing

 First stage: voluntary

• Masticated food is formed into bolus on
dorsum of tongue
• Food bolus is pushed upward and backward
against the under surface of hard palate
– Brought by contraction of muscles of
tongue and suprahyoid muscles
• Palatoglossus squeeze the bolus backward
into oropharynx
 Second stage: involuntary
• Food bolus pushed from the
oropharynx to laryngopharynx
• At this stage-
 Nasopharyngeal isthmus is closed
by elevation of soft palate and
forward pulling of posterior wall of
pharynx by contraction of superior
constrictor and passavant’s
muscle

 Inlet of larynx is closed by approximation of aryepiglottic folds

 Larynx and laryngopharynx are pulled upward by longitudinal muscles of pharynx

 Pharynx widens and shortens to receive food bolus

 Third stage: involuntary
• Brought about by sequential contractions of constrictors of pharynx
• Food bolus passes from laryngopharynx to oesophagus
 Fourth stage: involuntary
• Begins when upper
oesophageal sphincter relaxes
• Successive contraction of the
musculature of oeosphagus
pushes the food towards
stomach
• Lower oesophageal sphincter
relaxes – food reaches stomach
 Role of cranial nerves

• Lingual nerve (mandibular nerve)-sensing the food

• Chorda Tympani (Facial nerve)- mucus secretions from salivary glands

• Mandibular nerve- for the movements of TM Joint

• Hypoglossal nerve- for muscles of the tongue

• Glossopharyngeal and vagus, accessory cranial nerves- for muscles of the palate,
pharynx & larynx
 Reflex arc
• Anatomical pathway for a reflex is called
as reflex arc
• It has 5 components :
 Receptor
 Afferent nerve
 Center
 Efferent nerve
 Effector organ
 Gag reflex

• Prevent unwanted entry of any foreign body

to respiratory passage
• Elicited by touching the posterior pharyngeal
wall, tonsillar area or base of tongue
• Reflex involves elevation of soft palate and
bilateral contraction of pharyngeal muscles CN IX
 Afferent limb: glossopharyngeal nerve

 Efferent limb: vagus nerve

Gag reflex is absent in X CN and IX CN

damage
Thank you