Upload
sumit-prajapati
View
7.306
Download
2
Embed Size (px)
DESCRIPTION
Citation preview
Surgical anatomy and physiology of pharynx
Otorhinolaryngology Department of the First Affiliated Hospital of Sun Yat-Sen University
Otorhinolaryngology Institute of Sun Yat-Sen
University
Rui Xu
2
3
Pharyngeal surgical anatomy
◆ is a musculofascial half-cylinder that links the oral and nasal cavities in the head to the larynx and esophagus in the neck.
◆ the pharyngeal cavity is a common pathway for ‘air ’and ‘food’. (common passages of respiratory systems and digestive systems)
4
Pharyngeal surgical anatomy
Relationship:
◆ It is attached above to the base of skull and
continuous below, approximately at the level of the
sixth cervical vertebra, with the top of esophagus.
Anteriorly attached to the margin of nasal cavities,
oral cavities , and larynx. Posterior wall is adjacent to
the prevertebral fascia, and bilateral is close to the
cervical blood vessels and nerves.
5
Pharyngeal surgical anatomy
♣ nasopharynx ♣ oropharynx ♣ laryngopharynx (hypopharynx)
6
7
Nasopharynx
◆Position: behind the posterior apertures of the nasal cavities and above the level of the soft palate.
◆ Characteristics: the cavity of the nasopharynx is continuous below with the cavity of the oropharynx at the pharyngeal isthmus.
8
Nasopharynx
Relationships of the nasopharynx are as follows: roof---part of sphenoid bone and occipital bone,
adenoids situated at the junction of roof and posterior wall of nasopharynx.
posterior--- first and second cervical vertebra anterior--- posterior naris. lateral---opening of Eustachian (pharyngotympanic)
tube, pharyngeal recesses, the fossae of rosenmuller. Inferior---oral cavity.
9
10
Nasopharynx
There is a large collection of lympoid
tissue (the pharyngeal tonsil) in the
mucosa covering the roof of
nasopharynx.
11
12
13
Oropharynx
● Position: posterior to the oral cavity, inferior to the level of the soft palate, and superior to the upper margin of the epiglottis.
● Posterior---second and third cervical vertebra
● Anterior--- isthmus oropharyngeus.
14
15
Oropharynx
● Isthmus oropharyngeus : uvula, free edge of soft palatine,palatoglossal arch, palatopharyngeal arch and dorsum of tongue*.
● Palatine tonsils: on the lateral wall of the oro-
-pharynx, and between the palatoglossal and palatopharyngeal arches **.
16
17
Hypopharynx(Laryngopharynx)
☆ Position: extends from the supior margin of the epiglottis to the top of the esophagus at the level of cervical vertebral Ⅵ
18
19
Hypopharynx(Laryngopharynx)
☆ Relationships of the hypopharynx are as follows:
superior---upper border of the epiglottis
inferior--- lower border of cricoid cartilage contiunes into
oesophagus.
anterior ---by the laryngeal inlet
posterior---the third to sixth cervical vertebra 。
20
Hypopharynx(Laryngopharynx)
☆ valleculae: a pair of mucosal pouches, anteriorly to the cavity of laryngopharynx, one on each side, and between the base of tongue and epiglottis.
☆ piriform fossae: another pair of mucosal recess, between the central part of the larynx and more lateral lamina of the thyroid cartilage*.
21
22
23
24
Pharyngeal wall*
★ mucosa : pseudostratified ciliated columnar epithelia, stratified squamous epithelia.
★ fibrous layer: anterior by skull base , pharyngeal suture formed at the midline of posterior wall.
★ muscular layer : constrictor pharyngis,longitudinal , levator palati, tensor palati,palato-glossus,etc.**
★ External membrane layer : fascia membrane.
Pharyngeal wall
muscle posterior att
achmentanterior attachment Innervation Function
superior constrictor
pharyngeal raphe
pterygomandibular raphe and adjent bone on the mandibular and pterygoid hamulus
Vagus nerve [ ]Ⅹ Constriction o
f pharynx
★ Constrictor muscles*:
middleconstrictor
pharyngeal raphe
Upper margin of greaterbhorn of hyoid bone and adjent margins of lesser horn and stylohyoid ligament
Vagus nerve [ ]Ⅹ
Constriction of pharynx
inferiorconstrictor
pharyngeal raphe
Cricoid cartilage,oblique line of thyroid crtilage, and a ligament that spans between these attachments and crosses the crocothyroid muscle
Vagus nerve [ ]Ⅹ Constriction
of pharynx
26
Pharyngeal wall★ Longitudinal muscles:Muscle origin Insertion Innervation Function
stylopharyngeus middle side of base of styloid process
pharyngeal wall glossopharyngeal nerve [ ]Ⅸ Elevation of the
pharynx
Salpingppharyngeus inferior aspect of pharyn-geal end of pharyngo-tympanic tube
pharyngeal wall
vegus nerve [ ]ⅩElevation of pharynx
palatopharyngeus upper surface of palatine aponeurosis
pharyngeal wall vegus nerve [ ]Ⅹ Elevation of phary-nx, and closure of the oropharyngeal isthmus
28
29
Fascia
The pharyngeal fascia is seperated into two layers*:
♣ buccopharyngeal fascia: a thin layer, coats the outside
of the muscular part of the wall.
♣ pharyngobasilar fascia: a much thicker layer, lines the i
nner surface
30
Fascial spaces ♦ Retropharyngeal space : ※ Between the buccopharyngeal fascia and prevertebra
l fascia, which extends from skull base to the upper part of
posterior mediastinum (T1,T2).
※ anteriorly by the posterior pharyngeal wall and buccopharyngeal fascia; posteriorly by the cervical vertebra ,their muscles and fascia. One on each side, and seperated from parapharyngeal space. It contains retropharyngeal lymph nodes and connective tissue.
31
32
♦ parapharyngeal space :
From the skull base above to the glossal bone below.
It’s occupied by the carotid vessels, internal jugular
vein, deep cervical lymph nodes, the last four cranial
nerves and cervical sympathetic trunk.
Fascial spaces
33
35
Pharyngeal lymphoid tissue
Tonsil occur mainly in three areas: ▪ the pharyngeal tonsils, known as adenoids when enlarged,
is in the midline on the roof of the nasapharynx.
▪ the palatine tonsils are on each side of the oropharynx between the palatoglossal and palatopharyngeal arches
▪ the lingual tonsil refer collectively to numerous lymphoid nodules on the posterior one-third of the tongue.
36
37
38
Palatine tonsils
♠ tortuous crypts
♠ Capsule: lateral two-third of each tonsil, a well
defined structure composed of fibrous tissue, elastic
tissue and muscle fibres.
♠ Blood supply : A. palatina descendens, A. palatina
ascendens, A. pharyngea ascendens, A. facialis and
A. dorsales linguae
39
40
41
Vessels supply of pharynx
♣ Arteries ◆ upper parts of pharynx: the ascending pharyn-
geal a.,the ascending palatine and tonsillar branches of the facial a.,numerous branches of the maxillary and the lingual a.
◆ lower parts of pharynx: pharyngeal branches from the inferior thyroid a.
42
43
44
Vessels supply of pharynx
♣ Veins ◆ veins of the pharynx form a plexus, which
drains into: superiorly : pterygoid plexus in the infratemporal
fossa.
inferiorly : the facial and internal jugular veins
45
46
Innervation of the pharynx
♣ pharyngeal plexus*: pharyngeal branch of
the vagus nerve[ ], superior laryngeal branch Ⅹof the vagus nerve[ ], and pharyngeal branch Ⅹof the glossopharyngeal nerve [ ]Ⅸ
♣ trigeminal nerve (tensor veli palatini,etc.)
47
Lymphatic vessels from the pharynx
♣ deep cervical nodes and include retropharyngeal, paratracheal , and infrahyoid nodes.
♣ the palatin tonsils drain through jugulodigastric nodes
48
49
50
Physiology of pharynx
1. Respiration
2. Swallowing
3. Language formation
4. Protective function
5. Modulate barometric pressure
6. Tonsil immunologic function (IgA, IgG and small amount of IgD. These are secreted into pharynx and increased when inflammation)
51
Symptomatology of Pharynx
● pharyngeal pain
● pharyngeal abnormal sensation
● dysphagia
● heterophony
● drink back flowing