PHARYNX

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ANATOMY OF PHARYNX
 The pharynx is the fibro-muscular tube
forming the upper part of the air and food
passages.
 Shape: Conical
 Length: It is 12 to 14 cm long.
 Width: It is 3.5 cm wide at its roof and 1.5
cm wide at its lower end.

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Extent
The pharynx extends from
the base of skull to the
lower border of cricoid
cartilage (vertebral level
C6), where it becomes
continuous with
esophagus.
 Its upper, wider end lying
under the skull

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Deficiencies in Anterior Wall
 The anterior wall of
pharynx has three
deficiencies through
which it opens into
 The nasal cavity,
 Oral cavity and
 Larynx, from the
above downwards.

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 By means of the auditory tube, the mucous membrane is also
continuous with that of the tympanic cavity

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 Subdivisions
1. The nasopharynx or epipharynx performs
respiratory function and communicates with
nasal cavity.
2. The oropharynx is common to both respiratory
and digestive tracts, which cross each other
here.
3. The laryngopharynx or hypopharynx acts as
a conduit of food from oropharynx to the
esophagus. It also conducts air in the larynx via
the laryngeal inlet.
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 Layers of Pharyngeal Wall
 The wall of the pharynx consists of four
layers from within outward as follows:
1. Mucous membrane
a. Submucosa
2. Pharyngeal aponeurosis or pharyngobasilar
fascia
3. Muscular coat
4. Buccopharyngeal fascia.

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 Mucous Membrane
 The mucous membrane lining the nasopharynx is
continuous with that of pharyngotympanic tubes and
nasal cavity. The nasopharynx is lined with respiratory
epithelium (pseudostratified ciliated columnar in type).
 The mucous membrane of oropharynx is stratified
squamous non-keratinizing and is continuous with that
of oral cavity.
 The mucous membrane of laryngopharynx is stratified
squamous non-keratinizing and is continuous with
mucosa of larynx and that of esophagus.

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Submucosa
 The submucosa of
the nasopharynx and
oropharynx contains
lymphatic
aggregations, which
are the constituent of
a lymphatic ring
called Waldeyer’s
ring.

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Pharyngeal Aponeurosis
(Pharyngobasilar Fascia)
 This fascial layer lies outer to submucosa but
inner to the muscular coat.
 The thick part of this fascia fills the gap (sinus
of Morgagni) between the upper margin of
superior constrictor and base of the cranium.
 Here, it is pierced by auditory tube, ascending
palatine branch of facial artery, ascending
pharyngeal artery and levator palati muscle

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Pharyngeal Muscles
 The pharyngeal muscles consist of two
groups, circularly disposed and longitudinally
disposed muscles.
 Constrictor Muscles
 Superior constrictor
 Middle constrictor
 Inferior constrictor
 Longitudinal Muscles
 Salpingopharyngeus
 Palatopharyngeus
 Stylopharyngeus
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 Constrictor Muscles
 They overlap each
other from below
upwards in such a way
that inferior constrictor
lies outer to the lower
part of middle
constrictor and the
middle constrictor lies
outer to the lower part
of superior constrictor.
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Muscles of the Pharynx
 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

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Constrictor Muscles
 The longitudinal
muscles are located
inner to the
constrictors.
 The constrictor
muscles are located
in the posterior wall
and sides of the
pharynx.

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Longitudinal
 Longitudinal – Three paired muscles
 Stylopharyngeus
 Palatopharyngeus
 Salpingopharyngeus

 Common Action
 Elevate larynx & shorten pharynx during
swallowing

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Superior pharyngeal
constrictor
 Origin: Pterygoid hamulus, pterygomandibular
raphe; posterior end of mylohyoid line of
mandible and side of tongue
 Insertion: Pharyngeal tubercle on basilar part
of occipital bone
 Nerve supply: Pharyngeal branch of vagus
(CN X) and pharyngeal plexus
 Main Action(s): Constrict walls of pharynx during
swallowing
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 Middle pharyngeal
constrictor
 Origin: Stylohyoid ligament and greater and
lesser horns of hyoid
 Insertion: (Median) pharyngeal raphe
 Nerve supply: Pharyngeal branch of vagus
(CN X) and pharyngeal plexus, plus branches
of external and recurrent laryngeal nerves
of vagus
 Main Action(s): Constrict walls of pharynx
during swallowing
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 Inferior pharyngeal
constrictor
 Origin: Oblique line of thyroid cartilage and side of
cricoid cartilage
 Insertion: Cricopharyngeal part encircles
pharyngoesophageal junction without forming a
raphe.
 Nerve supply: Pharyngeal branch of vagus (CN X)
and pharyngeal plexus, plus branches of external and
recurrent laryngeal nerves of vagus
 Main Action(s): Constrict walls of pharynx during
swallowing
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Inferior pharyngeal
constrictor
 According to the origin, the inferior constrictor is
divisible into two parts.
 1. Thyropharyngeus
 2. Cricopharyngeus
 The lower part of the inferior constrictor, which
arises from the cricoid cartilage, is called the
cricopharyngeus muscle
 The fibers of the cricopharyngeus pass
horizontally around the lowest and narrowest
part of the pharynx and act as a sphincter
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Cricopharyngeus muscle
 The muscles of the two sides form an upper
esophageal sphincter (UES) at the pharyngo-
esophageal junction. It is a true sphincter
composed of striated muscle.
 It prevents the entry of air into the esophagus
and reflux of food into the pharynx in the interval
between acts of swallowing.
 It relaxes during swallowing but contracts in
between the acts of swallowing (this action is
exactly opposite to that of thyropharyngeus) .
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 Inferior constrictor muscle
 Thyropharyngeus
 Arise from thyroid cartilage
 –oblique line and inferior
tubercle of thyroid cartilage
 A tendinous band that crossed
the cricothyroid muscle & is
attached above to the inferior
tubercle of thyroid cartilage
 Cricopharyngeus
 Cricoid cartilage behind the
origin of cricothyroid muscle

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Stylopharyngeus
 Origin: Styloid process of temporal bone
 Insertion: Posterior and superior borders
of thyroid cartilage with Palatopharyngeus
 Nerve supply: Glossopharyngeal nerve
(CN IX)
 Main Action(s): Elevate (shorten and
widen) pharynx and larynx during
swallowing and speaking
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Palatopharyngeus
 Origin: Hard palate and palatine aponeurosis
 Insertion: Posterior border of lamina of thyroid
cartilage and side of pharynx and esophagus.
 Nerve supply: Pharyngeal branch of vagus (CN
X) and pharyngeal plexus
 Main Action(s): Elevate (shorten and widen)
pharynx and larynx during swallowing and
speaking

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Salpingopharyngeus
 Origin: Cartilaginous part of
pharyngotympanic tube
 Insertion: Blends with Palatopharyngeus
 Nerve supply: Pharyngeal branch of
vagus (CN X) and pharyngeal plexus
 Main Action(s): Elevate (shorten and
widen) pharynx and larynx during
swallowing and speaking
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 Important Relations of
Constrictor Muscles
 The interval between
the free superior border
of superior constrictor
and the cranium (sinus
of Morgagni) is closed
by the pharyngobasilar
fascia and
buccopharyngeal
fascia.

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 The superior border of superior constrictor muscle is related
to auditory tube, tensor veli palatini and levator veli palatini
muscles. The levator veli palatini pierces the fasciae to enter
the wall oropharynx while the tensor palate hooks round the
pterygoid hamulus to enter the wall of oropharynx to reach
the palate.
Auditory tube

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 Gaps & Structures Passing
 Base of Skull & upper
border (Sup. Cons.)
I. Auditory tube
II. Levator palatini muscle
III. Ascending palatine Artery
IV. Palatine br. of Ascending.
Pharyngeal Artery

(A) Palatine branch of ascending pharyngeal artery; (B) Ascending palatine

branch of facial artery; (C) Pterygomandibular raphe; 40
Gaps & Structures Passing
 Superior & Middle
constrictor
 Stylopharyngeus
muscle
 Glossopharyngeal
nerve

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Superior & Middle constrictor
 The stylopharyngeus
muscle and
glossopharyngeal nerve
enter the pharynx
through the gap between
the upper margin of
middle constrictor and
the lower margin of
superior constrictor
muscles.

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 Gaps & Structures Passing
 Middle & Inferior
Constrictor (pierce
thyrohyoid memb.)
 Internallaryngeal nerve
 Superior laryngeal
vessels

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Middle & Inferior Constrictor
 Between the lower
margin of middle
constrictor and the upper
margin of inferior
constrictor muscles.
 The internal laryngeal
nerve and superior
laryngeal artery pierce
the thyrohyoid membrane
to enter the
laryngopharynx
(D) Internal laryngeal nerve; (E) Superior laryngeal artery
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 Gaps & Structures Passing
 Inferior constrictor &
esophagus (T-O
Groove)
 Recurrent laryngeal
nerve
 Inferior laryngeal
vessels

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Inferior constrictor &
tracheoesophageal Groove
 The recurrent laryngeal
nerve and inferior
laryngeal artery pass
deep to the lower margin
of the inferior constrictor
in the tracheo-
esophageal groove.
 The external laryngeal
nerve pierces the inferior
constrictor on way to the
cricothyroid.
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 Buccopharyngeal Fascia
 This fascia covers the
pharynx externally.
 It covers pharyngeal muscles
as well as the buccinator
muscle.
 Posteriorly, it is in contact
with prevertebral muscles
and cervical vertebral
column.
 The pharyngeal plexus of
nerves lies in the fascia,
where it covers the middle
constrictor.
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PARTS OF THE PHARYNX
 The human pharynx
is divided into three
sections:
 The nasopharynx,
 The oropharynx and
 The laryngopharynx.

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PARTS OF THE PHARYNX
 Nasopharynx
 Base of skull nasopharyngeal isthmus
 Oropharynx
 Nasopharyngeal isthmus plane of hyoid bone
 Laryngopharynx
 Plane of hyoid bone lower border of cricoid
cartilage

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Nasopharynx (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
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Communications
1. Anteriorly, it communicates with nasal
cavities through choanae.
2. Inferiorly, it communicates with
oropharynx through nasopharyngeal
isthmus.
3. It is in communication with middle ear via
the auditory tubes.

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Features of Lateral Wall
 The tubal orifice, which is the medial opening of the
pharyngotympanic (auditory) tube.
 The salpingopharyngeal fold is a mucous fold
passing vertically downward from the tubal
elevation.
 The tubal tonsil is the collection of submucous
lymphoid tissue (MALT) lying on the tubal elevation.
 The pharyngeal recess or Rosenmuller’s fossa is
a depression behind the tubal elevation. This is the
commonest site of carcinoma of nasopharynx
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 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

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Features of Floor
 Anterior part of the floor is formed by the soft
palate.
 Posterior to the soft palate the floor shows the
deficiency (nasopharyngeal or pharyngeal
isthmus).
 The boundaries of this isthmus are, the
 posterior surface and free margin of soft palate anteriorly,
 the Passavant’s ridge posteriorly and
 the palatopharyngeal arch on each side

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Inspection of Nasopharynx
 The nasopharynx is inspected by a
procedure called posterior rhinoscopy.
 The tongue of the patient is depressed
with a tongue depressor and then the
rhinoscopic mirror is introduced till it
reaches the posterior one-third of the
tongue.

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 Functions
1. Acts as a conduit for air; nose and larynx.
2. Ventilates middle ear through Eustachian tube
and equalizes air pressure on both sides of TM.
3. Cuts off nasopharynx from oropharynx with the
help of Passavant’s ridge.
4. Acts as a resonating chamber for voice
production
5. Acts as a drainage channel for mucus secreted
by nasal and nasopharyngeal glands
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Oropharynx
 The oropharynx is located behind the oral cavity,
below the nasopharynx and above the
laryngopharynx.
 It communicates with the oral cavity through the
oropharyngeal isthmus and with the
nasopharynx through the nasopharyngeal
isthmus.
 At its lower end, it continues as laryngopharynx
at the level of upper border of epiglottis.
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 Oral Pharynx
 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

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The anterior wall
 The anterior wall is
deficient due to presence
of oropharyngeal isthmus.
 The boundaries of the
oropharyngeal isthmus are
the soft palate superiorly,
dorsal surface of posterior
third of tongue inferiorly
and the palatoglossal arch
on each side.

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 Oral Pharynx (The lateral walls)
 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
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Oral Pharynx
 The interval between
the two
palatoglossal arches
is called the
oropharyngeal
isthmus
 It marks the
boundary between
the mouth and
pharynx

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 Oral Pharynx
 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

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The posterior wall
 The posterior wall
is supported by
the body of
second cervical
vertebra (axis)
C2
and upper part of
body of third C3
cervical vertebra.

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Vallecullae 73
 Lingual tonsils
 Lingual tonsils are
situated near the
rear end of the
tongue, usually
between vallecula
layer and
circumvallate
papillae .
The lingual tonsils are two small mounds of lymphatic tissue located at
the back of the base of the tongue, one on either side. They function to
assist the immune system in the production of antibodies in response to
invading pathogenic bacteria or viruses.
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Inspection of Oropharynx
 The oropharynx (including
the tonsils) is directly
visible when the patient
opens the mouth wide.
 For movements of the soft
palate the patient is asked
to say Aah.
 The posterior one-third of
the tongue is examined by
digital palpation and by
indirect laryngoscopy.
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Functions
1. Conduit passage for air and food
2. Helps in pharyngeal phase of deglutition
3. Forms part of vocal tract for speech
sounds
4. Helps in appreciation of taste (taste buds)
5. Provide local immunity and defense
against harmful intruders

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Lymphoid Tissues 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

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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.

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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
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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
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A peritonsillar abscess

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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
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Adenoids

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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
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Waldeyer’s Ring
 Waldeyer's tonsillar
ring is a ringed
arrangement of lymphoid
tissue in the pharynx.
Waldeyer's ring
surrounds the naso-
and oropharynx, with
some of its tonsillar tissue
located above and some
below the soft palate (and
to the back of the mouth
cavity
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Laryngopharynx
 The laryngeal part of the pharynx is also
known as hypopharynx.
 It extends from the upper border of
epiglottis to the lower border of cricoid
cartilage.
 It communicates above with the
oropharynx, anteriorly with the laryngeal
cavity and below with the esophagus.
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Laryngeal Pharynx
 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 of the
laryngeal inlet

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 Lateral wall [Piriform fossa]
 On each side of laryngeal
inlet between
Pharyngoepiglottic fold to
upper end of esophagus
 Boundaries:
 Medially: aryepiglottic fold,
posterolateral surfaces of
arytenoid & circoid cartilages
 Laterally: thyroid cartilage &
thyrohyoid membrane
Covered by mucous
membrane.

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Lateral wall [Piriform fossa]
 Beneath the membrane is
internal laryngeal nerve
 Smuggler’s fossa -
Foreign bodies may get
lodged here
 Removal of foreign body
from the piriform fossa
may damage the nerve
 Results in anesthesia to
the supraglottic part

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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

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Blood Supply
 Ascending pharyngeal (Ext, carotid art.),
tonsillar branches of facial arteries, and
branches of maxillary and lingual arteries

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

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