Transcript Oropharynx - muhadharaty.com

Dr. Basil M.N. Saeed
Assistant Professor
Department of Surgery
College of Medicine
Mosul University
Is a funnel-shaped fibromuscular tube,
10-12 cm in length in adults.
Extends from the base of the skull to the level
of C6.
The pharynx is divided anatomically into 3
parts;
Nasopharynx
Oropharynx
Laryngopharynx
(( Hypopharynx))
Behind :
The Nose
The Mouth
The larynx
Seen from behind
Nasopharynx
Oropharynx
Laryngopharynx
(Hypopharynx)
This extends from the base of the skull to
the hard palate.
At the junction of the roof and posterior wall
lies a small mass of lymphoid tissue called
adenoids (nasopharyngeal tonsil).
On the lateral wall, there are the openings
of the Eustachian tubes.
Behind which are hollows called the fossa
of Rosenmuller, which is the site of
nasopharyngeal malignancy
-Communicates
inferiorly with the
oropharynx through the
velo-pharyngeal
sphincter
Extends from the level of hard palate to the level of
hyoid bone and opens anteriorly into the oral
cavity. Behind the oral cavity (in front of
2nd&3rd Cervical vertebra)
The palatine tonsils are situated in it's lateral wall
Between the ant. and post tonsillar pillars.
From the soft palate
superiorly to tip of
epiglottis inferiorly
Communicates:
Anteriorly with
the oral cavity
Superiorly with the
nasopharynx
Inferiorly with
the hypopharynx
Behind the Larynx (in front of 3rd to 6th Cervical
vertebra)
From the tip of epiglottis
superiorly to
the lower border
of cricoid cartilage
inferiorly
Communicates:
- Anteriorly with the Larynx
- Superiorly with the oropharynx
- Inferiorly with the esophagus
The hypopharynx does not only
lie behind the larynx BUT also
Projects laterally on each side of the
larynx and is formed of :
- Postcricoid region
( behind the larynx)
- Two pyriform fossae
(on each side of the larynx
The pharyngeal wall consists of 4 layers:
1. Mucous membrane.
2. Pharyngobasilar fascia.
3. Muscle layer.
4. Buccopharyngeal fascia.
1- Mucus Membrane
The lining epithelium is stratified squamous
except in the nasopharynx, where
columnar epithelium is found.
2- Pharyngobasilar fascia
This fascia is strengthened posteriorly by a
strong band called the median raphae.
3- Muscular Layer
I- Circular (outer): which consist of 3
constrictor muscles overlapping one another
from below upwards.
1. Superior constrictor.
2. Middle constrictor.
3. Inferior constrictor.
The inferior constrictor muscle is composed
of 2 parts:
a. Thyropharyngeus (oblique): arises from
the thyroid cartilage.
b. Cricopharyngeus (transverse): arises
from the cricoid cartilage and passes
transversely backwards forming the
upper oesophageal sphincter.
All the constrictor muscles are inserted
posteriorly into the median pharyngeal
raphae.
Functions
The constrictor muscles propel the bolus
of food down into the esophagus
The Cricopharygeus (lower fibers of the
inferior constrictor) act as a sphincter,
preventing the entry of air into the
esophagus between the acts of
swallowing
Killian dehiscence: this is a potential gap
between the fibers of the
thyropharyngeus and cricopharyngeus.
The mucous membrane may bulge
between these two muscles when there
is incoordination of the pharyngeal
peristaltic waves.
Pharyngael Pouch
II- Longitudinal (internal): these
muscles elevate the larynx and shorten
the pharynx during deglutition:
1. Stylopharyngeus.
2. Salpingopharyngeus.
3. Palatopharyngeus
This fascia is loosely attached posteriorly
to the prevertebral fascia and laterally
connected to the styloid process and to
the carotid sheath
Subepithelial lymphoid tissue of the
pharynx (Waldeyer's ring)
Is a collection of sub-epithelial lymphoid
tissue around the entrance of the
respiratory and alimentary tracts.
1. Nasopharyngeal tonsil (adenoid).
2. Tubal tonsils: lie behind the openings of the Eustachian
tubes.
3. Palatine tonsils.
4. Lingual tonsils: which is embedded in the posterior 1/3
of the tongue.
5. Lateral pharyngeal bands behind the posterior
tonsillar pillar.
6. Lymphoid nodules scattered on the posterior
pharyngeal wall
Hypertrophy of the lymphoid tissue of
Waldeyer's ring occurs in the earlier
years of childhood.
Maximum bulk is obtained at the age of
3- 6 years, and in old age it atrophies
Waldeyer's ring is characterized by:
1. Sub-epithelial lymphoid tissue.
2. Lack a definite capsule.
3. They have efferent lymph vessels, but
no afferent vessels.
4. Function as one unit: when a member
of it is removed, the others parts
undergo compensatory hypertrophy.
Two masses of lymphoid tissue situated on each
side of the oropharynx.
The medial surface is exposed in the pharynx
and is pitted by a number of crypts.
The tonsil is related anteriorly and posteriorly to
the palatoglossus and palatopharyngeus
muscles.
Laterally the tonsil is enclosed by a dense fibrous
capsule separating the tonsil from the superior
constrictor muscle (tonsillar bed).
This capsule provide a convenient plane of
separation of the tonsil during tonsillectomy
The main supply is the tonsillar branch of
the facial artery, and decsending palatine
artery.
The venous drainage is to the
paratonsillar vein which drains to the
pharyngeal plexus, and the internal
jugular vein.
Lymphatic Drainage
Deep cervical chain of lymph nodes.
Sensory Nerve Supply
Nasopharynx: Maxillary nerve, trigeminal
Oropharynx: Glossopharyngeal nerve, trigeminal
Laryngopharynx: vagus nerve, and glossopharyngeal.
Motor supply
All the muscles of pharynx, except the
stylopharyngeus, supplied by the pharyngeal
plexus.
Pharyngeal branches of the IX and X nerves, and
sympathetic fibers from the superior cervical
ganglion.
The stylopharyngeus is supplied by the
glossopharyngeal nerve
This space lies behind the pharynx and
extends from the base of the skull to the
superior mediastinum.
The anterior wall is formed by the
posterior pharyngeal wall and it's
covering buccopharyngeal fascia.
The posterior wall is formed by the
cervical vertebrae and their covering
muscles and fascia.
Contents:
Retropharyngeal lymph nodes
of Rouviere.
Usually disappear
spontaneously during the 3rd or
4th year of life.
This potential space lies lateral to the
pharynx and connects posteriorly with
the retropharyngeal space.
It extends from the base of the skull to the
hyoid bone.
It's bounded medially by the superior
constrictor muscle.
Laterally lies the medial pterygoid muscle,
the mandible and the parotid gland.
It's posterior wall is the prevertebral
muscles and fascia.
Contents
1. Deep cervical lymphnodes.
2. The last 4 cranial nerves and the cervical
sympathetic trunk.
3. Great vessels of the neck: carotid and
internal jugular vein.
1. Food and air inlet.
2. Play an important role in speech through
vocal resonance and articulation.
3.The protective function of Waldeyer's
ring.
4. Deglutition: it's divided into 3 stages:
a. Oral stage (voluntary).
b. Pharyngeal stage (involuntary).
c. Oesophageal stage (involuntary).
1- Sore throat (pain)
a. Inflammatory.
b. Neoplastic.
c. Neurological: IX neuralgia.
d. Blood dyscrasia: agranulocytosis and
leukaemia.
2- Dysphagia: is difficulty in swallowing whereas
odynophagia is painful swallowing.
Dysphagia: Intraluminal, Luminal Extraluminal
3- Difficulty in breathing like stridor in Ludwig's
angina.
4- Difficulty in speech: Paralysis of the soft
palate(hypernasalily).
5- Neck mass Cervical lymphadenopathy
Nasopharynx: This can be done with
postnasal mirror and tongue depressor
(posterior rhinoscopy), and it can be
thoroughly examined by rigid and flexible
endoscopes.
Oropharynx: It is simple with
tongue depressor; palpation may be
needed for the tongue.
.
Hypopharynx: It can be done with the use of
laryngeal mirror to examine the larynx too. It
can be done thoroughly with the use of
endoscope.
Neck examination: for cervical
lymphadenopathy.
Other areas : ears are examined for secretory
otitis media in cases of
nasopharyngeal
tumours
Radiography:
Plain films like lateral X-Ray of the skull, is needed in
nasopharyngeal mass like adenoids, and can demonstrate
bone erosion in cases of nasopharyngeal cancer.
Contrast films: barium swallow is needed in the diagnosis of
pharyngeal pouch, esophageal web and hypopharyngeal
mass.
CT scan
MRI scan.
Laboratory investigations:
CBC, ESR, serum iron and iron binding capacity, monospot
test, serology for toxoplasma, brucella, CMV and HIV.
Biopsy for suspected lesions in the pharynx may be
needed.