Pharynx one of the visceral tubes the common chamber of the respiratory and digestive tracts located behind the nasal and oral cavities funnel-shaped

Transcription

1 Pharynx and soft palate Pharynx one of the visceral tubes the common chamber of the respiratory and digestive tracts located behind the nasal and oral cavities funnel-shaped in form 12 cm in length; its greatest width is about 5 cm and narrowest 1.5 cm 1

2 Pharynx Nasopharynx extends from the base of skull to the level of the soft palate; has a respiratory function Oropharynx extends from the soft palate to the hyoid bone Laryngopharynx extends from the level of the hyoid bone to the lower border of the cricoid cartilage, continuous with the esophagus 2

3 Nasopharynx Pharyngeal orifice of auditory tube Pharyngeal recess Torus of auditory tube Salpingopharyngeal fold Pharyngeal tonsil Torus of auditory tube the elevation behind the orifice, which is produced by underlying cartilage of the auditory tube salpingopharyngeal fold produced by the salpingopharyngeus, which extends from the lower part of the torus to palatopharyngeus pharyngeal recess a slit-like recess behind the salpingopharyngeal fold pharyngeal tonsil a collection of lymphatic tissue lying on the roof of the pharynx 3

4 Nasopharynx Levator veli palatini m. Salpingopharyngeus m. Tensor veli palatini m. Ascending palatini a. 4

5 Oropharynx Palatopharyngeal arch Palatoglossal arch Palatine tonsil Oropharynx extends from the soft palate to the hyoid bone palatine tonsil the mass of lymphatic tissue between the two folds 5

6 Oropharynx Lesser palaine a. Ascending pharyngeal a. Ascending palatine a. Dorsal lingual a. Facial a. 6

7 Oropharynx Sup. constrictor m. Palatoglossal m. Palatopharyngeal l m. Styloglossal m. Glossopharyngeal n. Stylopharyngeal m. Hyoglossal m. Mid. constrictor m. Stylohyoid ligament 7

8 Laryngopharynx Piriform recess Laryngopharynx extends from the level of the hyoid bone to the lower border of the cricoid cartilage, continuous with the esophagus piriform recess lies between the hyoid bone, thyrohyoid membrane and thyroid cartilage laterally, and the aryepiglottic fold and the arytenoid and cricoid cartilages medially 8

9 Wall of pharynx Pharyngobasilar fascia Pharyngobasilar fascia a strong fibrous submucosal layer exposing in the interval between the superior constrictor muscle and the base of the skull Circular coat: sup. constrictor, mid. constrictor, and inf. constrictor 9

10 Longitudinal coat: salpingopharyngeus, palatopharygeus, and stylopharyngeus Wall of pharynx salpingopharyngeus from lower part of auditory tube to joins fibers of palatopharyngeus muscle Palatopharyngeus from posterior border of hard palate and palatine aponeurosis to side of pharynx Stylopharyngeus from styloid process to posterior border of thyroid cartilage and wall of pharynx nerve supply glossopharyngeal n 10

11 Structures of the pharyngeal wall superior constrictor from medial pterygoid plate, pterygoid hamulus, pterygomandibular raphe, mylohyoid line, side of tongue to median raphe of pharynx 11

12 Structures of the pharyngeal wall middle constrictor: from lesser and greater horns of hyoid bone; stylohyoid ligament to median raphe of pharynx inferior constrictor : from the oblique line of thyroid cartilage; side of 12 cricoid cartilage to median raphe of pharynx

13 Structures passing through intervals between Auditory tube Skull and superior constrictor levator veli palatini, ascending palatine a., auditory tube 13

14 Structures passing through intervals between Sup. constrictor Skull and superior constrictor levator veli palatini, ascending palatine a., auditory tube Mid. constrictor Inf. constrictor Superior constrictor and middle constrictor styolpharyngeus y m., glossopharyngeal n.; and stylohyoid lig Middle constrictor and inferior constrictor internal laryngeal n., superior laryngeal l a. Inferior constrictor and esophagus recurrent laryngeal n., inferior laryngeal a. 14

15 Structures passing through intervals between Superior constrictor and middle constrictor styolpharyngeus m., glossopharyngeal n.; and stylohyoid lig 15

16 Soft palate 16

17 Soft palate tensor veli palatini from sphenoid bone, lateral surface of the auditory tube,,pass around the hamulus of the medial pterygoid plate to aponeurosis of the soft palate nerve supply: mandibular n. levator veli palatini from petrous portion of temporal bone, medial surface of the auditory tube to aponeurosis of the soft palate 17

18 Soft palate 18

19 Soft palate Musculus uvular from posterior nasal spine of hard palate to connective tissue of uvula 19

20 Soft palate Palatopharyngeal m. Palatoglossal m. palatopharyngeus from posterior border of hard palate and palatine aponeurosis to side of pharynx palatoglossus from the side of the tongue to inferior surface of the soft palate 20

21 Blood supply of pharynx a) ascending pharyngeal branch of external carotid a. b) ascending palatine branch of facial a. c) tonsil branch of facial a. d) descending palatine a. from maxillary a. 21

22 Nerve supply of pharynx 1) motor: glossopharyngeal n (IX) innervate the stylopharyngeus m ; 1) motor: glossopharyngeal n. (IX) innervate the stylopharyngeus m.; mandibular n. (V3) innervate the tensor veli palatini m; the remaining muscles by the pharyngeal branch of the vagus (or accessory n.) 22

23 Nerve supply of pharynx 2) h b ill h b 2) sensory: nasopharynx by maxillary n.; oropharynx by glossopharyngeal n; larygopharynx by vagus n. 23

24 Borders of the infratemporal fossa Lat. pterygoid m. Med. pterygoid m. 24

25 Borders of the infratemporal fossa 25

26 Borders of the infratemporal fossa 26

27 Removal of head Identify the sympathetic trunk and the large superior cervical sympathetic ti ganglion, cut one side of it just superior to SCG, and leave it to the prevertebral region 27

28 28

29 Removal of head Hold the cervical viscera forward 29

30 Removal of head Cut rectus capitis lateralis, rectus capitis anterior, and longus capitis 30

31 Orientation of the cranial nerves Safeguard cranial nerves IX, X, XI and XII 31

32 Orientation of the cranial nerves A CN IX L E.A CN XII down CN X I.A Int.V SCG CN XI 32

33 Orientation of the cranial nerves 33

34 Orientation of the cranial nerves 34

35 Subdivisons of pharynx: nasopharynx, oropharynx, laryngopharynx Nasopharynx: salpingopharyngeus, pharyngeal tonsil, tensor veli palatini, levator veli palatini. Oropharynx: palatoglossal m., palatopharyngeal m.; palatine tonsil Larygopharynx: piriform recess Blood supply of pharynx: ascending pharyngeal a., facial a., maxillary a., lingual a. Nerve innervation of pharynx Motor: pharyngeal plexus, glossopharyngeal n., mandibular n. Sensory: nasopharynx (maxillary n.), oropharynx (glossopharyngeal g n.), laryngopharynx y (vagus n.) 35

36 Structure of the pharynx wall Mucous membrane Muscular layer Circular coat: superior, middle, inferior constrictor m. Longitudinal coat: stylopharyngeus, tl salpingopharyngeus, palatopharyngeus m. Pharyngobasilar fascia Structure passing through intervals between Skull and superior constrictor: levator veli palatine, ascending palatine a., auditory tube Superior and middle constrictor: stylopharyngeus m., glossopharyngeal n., stylohyoid lig. Middle and inferior constrictor: internal laryngeal n., superior laryngeal a. Inferior constrictor and esophagus: recurrent laryngeal n., inferior laryngeal a Muscules of the soft palate: tensor veli palatini, levator veli palatini, palatoglossus, palatopharyngeus, musculus uvular 36

37 Pharynx and Soft Palate Dr. Lue, Grossanatomy Pharynx one of the visceral tubes the common chamber of the respiratory and digestive tracts located behind the nasal and oral cavities funnel-shaped in form 12 cm in length; its greatest breath is about 5 cm and narrowest 1.5 cm Subdivisions without anterior wall, the pharynx communicates directly with the nasal, oral, and laryngeal cavities; posterior wall lies against the prevertebral layer of deep cervical fascia; it is subdivided accordingly A. Nasopharynx: extends from the base of skull to the level of the soft palate; has a respiratory function Anteriorly, choanae (two posterior nasal apertures), nasal septum Wall of the pharynx Pharyngeal orifice of the auditory tube: Torus of auditory tube: the elevation behind the orifice, which is produced by underlying cartilage of the auditory tube salpingopharyngeal fold: produced by the salpingopharyngeus, which extends from the lower part of the torus to palatopharyngeus pharyngeal recess: a slit-like recess behind the salpingopharyngeal fold pharyngeal tonsil: a collection of lymphatic tissue lying on the roof of the pharynx; enlarged adenoids tensor veli palatini m. levator veli palatini m. B. Oropharynx extends from the soft palate to the hyoid bone palatoglossal arch: produced by the palatoglossal m. palatopharyngeal arch: produced by palatopharyngeal m. palatine tonsil: the mass of lymphatic tissue between the two folds. Five tonsillar arteries to the palatine tonsil: a) descending palatine a. from maxillary a. 1

38 b) ascending pharyngeal branch of external carotid a. c) ascending palatine branch of facial a. d) tonsil branch of facial a. e) dorsal lingual branches of the lingual a. C. Laryngopharynx extends from the level of the hyoid bone to the lower border of the cricoid cartilage, continuous with the esophagus. piriform recess: lies between the hyoid bone, thyrohyoid membrane and thyroid cartilage laterally, and the aryepiglottic fold and the arytenoid and cricoid cartilages medially; Foreign bodies such as fish bones may lodge in this recess. Blood supply of pharynx: arteries a) ascending pharyngeal branch of external carotid a. b) ascending palatine branch of facial a. c) tonsil branch of facial a. d) descending palatine a. from maxillary a. veins: pharyngeal venous plexus via pterygoid plexus internal jugular v. Nerve supply of pharynx: 1) motor: glossopharyngeal n. (IX) innervate the stylopharyngeus m.; mandibular n. (V3) innervate the tensor veli palatini m; the remaining muscles by the pharyngeal branch of the vagus (or accessory n.) 2) sensory: nasopharynx aid by maxillary n.; oropharynx supply from glossopharyngeal n; laryngpharynx supply from vagus n Structure of the pharyngeal wall: Mucous membrane is continuous with the lining of the adjacent chambers Pharyngobasilar fascia a strong fibrous submucosal layer exposing in the interval between the superior constrictor muscle and the base of the skull Muscular layer divided into two groups: Circular coat consists of the three constrictor muscles superior constrictor: from medial pterygoid plate, pterygoid hamulus, pterygomandibular raphe, mylohyoid line, side of tongue to median raphe of pharynx 2

39 middle constrictor: from lesser and greater horns of hyoid bone; stylohyoid ligament to median raphe of pharynx inferior constrictor : from the oblique line of thyroid cartilage; side of cricoid cartilage to median raphe of pharynx each muscle meets its fellow in the posterior median plane at the fibrous pharyngeal raphe which extends up to attach to the pharyngeal tubercle of the occipital bone action participate in act of swallowing nerve supply from pharyngeal plexus the inferior constrictor muscle is also supplied by the external branch of superior laryngeal nerve Longitudinal coat also consists of three muscles which originate separately and blend at their insertions Stylopharyngeus: from styloid process to posterior border of thyroid cartilage and wall of pharynx action elevates larynx and pharynx nerve supply glossopharyngeal n. Palatopharyngeus: from posterior border of hard palate and palatine aponeurosis to side of pharynx action approximates palatopharyngeal folds nerve supply pharyngeal plexus salpingopharyngeus: from lower part of auditory tube to joins fibers of palatopharyngeus muscle action same as that of the palatopharyngeus m. nerve supply - pharyngeal plexus Buccopharyngeal fascia - the areolar coat covers the muscles, is continuous with the buccinator fascia, and contains pharyngeal venous and nerve plexuses Structures passing through intervals between: A. Skull and superior constrictor levator veli palatini, ascending palatine artery, auditory tube B. Superior constrictor and middle constrictor stylopharyngeus m., glossopharyngeal n.; and stylohyoid lig. C. Middle constrictor and inferior constrictor internal laryngeal n., superior laryngeal a. 3

40 D. Inferior constrictor and esophagus recurrent laryngeal n., inferior laryngeal a. Soft Palate Muscles of the soft palate tensor veli palatini: from sphenoid bone, lateral surface of the auditory tube, pass around the hamulus of the medial pterygoid plate to aponeurosis of the soft palate action: tenses the plate, opens the auditory tube nerve supply: mandibular n. levator veli palatini: from petrous portion of temporal bone, medial surface of the ausitory tube to aponeurosis of the soft palate action: lifts the soft plate nerve supply: pharyngeal plexus. palatoglossus: from the side of the tongue to inferior surface of the soft palate action: pulls the tongue superiorly, tenses the plate nerve supply: pharyngeal plexus palatopharyngeus: from posterior border of hard palate and palatine aponeurosis to posterior border of thyroid cartilage and side of pharynx action: lifts the larynx, tense the plate nerve supply: pharyngeal plexus musculus uvular: from posterior nasal spine of hard palate to connective tissue of uvula action: elevate and retract uvula; thickens central region of soft plate nerve supply: pharyngeal plexus 4