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Pharynx Flashcards

1
Q

Length of pharynx

A

12-14 cm

From base of skull

To cricoid cartilage (lower border) anteriorly and level C6 posteriorly

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2
Q

Width of pharynx

A

3.5 cm at base
1.5cm at pharyngoesophageal junction

Narrowest part of digestive tract

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3
Q

Layers of pharyngeal wall (inwards to outwards)

A

Mucous membrane
Pharyngeal aponeurosis
Muscular coat
Buccopharyngeal fascia

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4
Q

Mucous membrane

A

Continuos with
Eustachian tube
Nasal cavity
Mouth
Larynx
Esophagus

Nasopharynx has ciliated columnar
Other region has Stratified squamous

Contributes to pharyngobasilar fascia

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5
Q

Pharyngeal aponeurosis

A

Fibrous
Thick near base of skull
Fills gap near sinus of morgagni

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6
Q

Muscular coat

A

2 layers (each 3 muscles)
External layer (inner circular)
Superior constrictor
Middle constrictor
Inferior constrictor
Internal layer (outer longitudinal)
Stylopharyngeus
Salpingopharyngeus
Palatopharyngeus

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7
Q

Buccopharyngeal fascia

A

Covers
Outer surface of constrictors

Upper part covers buccinator muscle

Blends with pharyngeal aponeurosis at upper border of superior constrictor

Inferiorly continues to pretracheal fascia

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8
Q

Killian’s Dehiscence

A

Potential gap between thyropharyngeus and cricopharyngeus
(2 parts of inferior constrictor muscles)

“Gateway of tears”- perforate during esophagoscopy
Site of herniation

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9
Q

Waldeyer’s ring

A

Ring throughout pharynx in subepithelial layer of aggregated lymphoid tissues

Nasopharyngeal tonsil / adenoids
Palatine tonsils
Lingual tonsil
Tubal tonsil (in fossa of rosenmuller)
Lateral pharyngeal bands
Nodules (in post. Pharyngeal wall)

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10
Q

Divisions of pharynx

A

Nasopharynx / Epipharynx
Oropharynx
Hypopharynx / Laryngopharynx

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11
Q

Anatomy of Nasopharynx

A

Roof - basisphenoid
Basiocciput
Post. Wall - arch of atlas
Prevertebral muscles+fascia
Floor - soft palate
Nasopharyngeal isthmus
Ant. Wall - Choanae
Lateral wall - Eustachian tube opening
Torus tubarius
Fossa of rosenmuller
Salpingopharyngeal fold

Lined by pseudostratified ciliated columnar epithelium

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12
Q

Nasopharyngeal Bursa

A

Epithelial lined median recess

From pharyngeal mucosa to periosteum of basiocciput.

Represents attachment of notochord to pharyngeal endoderm in embryonic life.

Abcess can form - Thornwaldt disease

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13
Q

Rathke’s pouch

A

Dimple above adenoids

Cricopharyngioma may arise

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14
Q

Tubal tonsil

A

Subepithelial lymphoid tissue
Form Waldeyers ring
Occludes eustachian tube during infection

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15
Q

Sinus of morgagni

A

Space between base of skull and sup. Constrictor muscle

Structures enter
Eustachian tube
Levator veli palatini
Tensor veli palatini
Ascending palatine artery(facial A)

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16
Q

Passavant’s Ridge

A

Mucosal ridge raised by palatopharyngeus fibres

Encircles post. And lateral walls of nasopharyngeal isthmus

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17
Q

Functions of Nasopharynx

A

Conduit of air
Ventilates middle ear + equalize air pressure +hearing
Elevation of soft palate (swallowing,vomiting,gagging,speech)
Resonating chamber (voice disorders)
Drainage channel of mucus

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18
Q

Anatomy of Oropharynx

A

Post. Wall - retropharyngeal space
Ant. Wall - Base of tongue
Lingual tonsil
Valleculae
Glossoepiglotic fold
Pharyngoepiglottic fold
Lateral wall - palatine / faucial tonsil
Anterior pillar
Posterior pillar
Tonsillar fossa (palatine tonsil)

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19
Q

Functions of Oropharynx

A

Conduit of air and food
Pharyngeal phase of deglutition
Speech sounds
Help in taste (taste buds)
Local defence + immunity

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20
Q

Anatomy of hypopharynx

A

Superiorly From plane of body of hyoid bone to posterior pharyngeal wall
Inferior limit is lower border of cricoid
Opp. To C3,C4,C5,C6 vertebra

Divided in 3 regions:-
Piriform sinus(fossa)
Postcricoid region
Post. Pharyngeal wall

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21
Q

Functions of hypopharynx

A

Pathway for air and food.
Speech sounds
Helps in deglutition

Failure of cricopharyngeal Sphincter causing hypopharyngeal diverticulum.

22
Q

Acute pharyngitis clinical features

A

Mild
Throat discomfort
Malaise
Low grade fever
Pharynx congested
No lymphadenopathy
Moderate + severe
Throat pain
Dysphagia
Headache
Malaise
High fever
Pharynx (edema,exudate,enlarged tonsil,lymphoid follicles)

Very severe
Soft palate edema
Uvula edema
Enlarged cervical nodes

Viral infections
Mild
Rhinorrhoea
Hoarseness

23
Q

Treatment of acute pharyngitis

A

Bed rest
Fluids
Warm saline gargles
Pharyngeal irrigation
Analgesics

Local discomfort relieved by lignocaine viscous before meal (facilitates swallowing)

24
Q

Specific treatment of acute pharyngitis

A

Streptococcal
Penicillin / Benzathine Penicillin G
Erythromycin (to penicillin sensitive)

Diphtheria
Diphtheria antitoxin
Penicillin / Erythromycin

Gonococcal
Penicillin / Tetracyclin

25
Viral infections causing acute pharyngitis
Herpangina ( coxsackie virus) Infectious mononucleosis (Epstein-Barr virus) Cytomegalovirus Pharyngoconjuctival fever (adenovirus) Acute lymphonodular Pharyngitis Measles Chickenpox
26
Fungal pharyngitis
Candida Extension of oral thrush Immunosuppression, Diabetes,High dose steroids Throat pain + Dysphagia Hyphae and spores in microscope Tt of Nystatin / Itraconazole
27
Chronic pharyngitis pathology
Hypertrophy of Mucosa Seromucinous glands Subepithelial lymphoid follicles Muscular coat
28
2 types of chronic pharyngitis
Chronic catarrhal Chronic hypertrophic / granular
29
Factors causing chronic pharyngitis
Persistent infection Mouth breathing (obstruction of nose / nasopharynx) Chronic irritants Pollution Faulty voice production
30
Clinical features of chronic pharyngitis
Throat pain Throat discomfort Foreign body sensation in throat Voice tiredness Cough
31
Signs of chronic catarrhal pharyngitis
Post. Pharyngeal wall congested Vessel engorgement Thickened faucial pillar Mucus secretion increased
32
Signs of chronic Hypertrophic / granular pharyngitis
Thick + edematous pharyngeal wall Congested mucosa Dilated vessels Hypertrophy of lateral pharyngeal bands Uvula elongated + edematous Post. Pharyngeal wall reddish granules (hypertrophy of subepithelial lymphoid follicles
33
Treatment of chronic pharyngitis
Voice rest Speech therapy Avoid hawking and clearing of throat Warm saline gargles Mandl's paint on mucosa Cautery of lymphoid granules (touched with 10%-25% silver nitrate)
34
Atrophic pharyngitis
With atrophic rhinitis Atrophy - pharyngeal mucosa Scanty mucus Crust formation Foul smell (infected crusts)
35
Clinical features of atrophic pharyngitis
Throat dryness Throat discomfort Hawking + Dry cough Crust formation Dry + glazed pharyngeal mucosa
36
Treatment of atrophic Pharyngitis
Spray alkaline solution Pharyngeal irrigation Mandl's paint Potassium iodide 325mg (prevent crust + promote secretion)
37
Features of keratosis pharyngitis
Benign Horny excrescences (on tonsil surface, pharyngeal wall, lingual tonsil) White / yellowish dots Hypertrophy + keratinised epithilium Firmly adherent No inflammation No symptoms May show spontaneous regression
38
Anatomy of Tonsil
Ovoid shaped In lateral wall of Oropharynx 2 surfaces Medial Lateral 2 poles Upper Lower
39
Blood supply of tonsil
Facial artery Tonsillar br Ascending palatine br External carotid Ascending pharyngeal Lingual Dorsal linguae Maxillary Descending palatine
40
Nerve supply of tonsil
Sphenopalatine ganglion Lesser palatine br Glossopharyngeal nerve
41
Functions of tonsil
Local immunity Surveillance mechanism
42
Tonsils consist of
Surface epithelium Crypts Lymphoid tissue
43
Acute tonsillitis classification
Acute catarrhal /superficial Acute follicular Acute Parenchymatous Acute Membranous (exudation from crypts coalesces)
44
Causes of infection in acute tonsillitis
Haemolytic streptococcus Staphylococcus Pneumococci H. Influenza
45
Symptoms of acute tonsillitis
Sore throat Difficult swallowing Fever (chills + rigor) Earache (acute otitis media) Headache Body ache Malaise Constipation
46
Signs of acute tonsillitis
Breath - foetid Tongue - coasted Pillars, soft palate, uvula - Hyperaemia Tonsil Acute follicular Red Swollen Yellowish spots Acute membranous Whitish membrane (medial surface) Acute parenchymatous Enlarged Congested Oedema (uvula + soft palate) Meet in midline Jugulodigastric lymph nodes Enlarged Tender
47
Treatment of acute tonsillitis
Bed rest Fluids Analgesics Antimicrobial (penicillin /erythromycin, ampicillin, amoxicillin)
48
Complication of acute tonsillitis
Chronic tonsillitis Peritonsillar abscess Paraphyrangeal abscess Cervical abscess Acute otitis media (recurrent) Rheumatic fever (grp A beta hemolytic) Acute glomerulonephritis Subacute bacterial endocarditis (viridans)
49
Differential diagnosis in acute tonsillitis
Membranous tonsillitis Diphtheria Vincent angina Infectious mononucleosis Agranulocytosis Leukemia Aphthous ulcers Malignancy tonsil Traumatic ulcer Candida infection of tonsil
50
Clinical features of faucial diphtheria
Oropharynx Greyish white membrane Tonsil Soft palate Posterior pharyngeal wall Bleeding when removed Tenacious Cervical lymph nodes Jugulodigastric Enlarged Tender Bull neck appearance Fever not rise above 38°
51
Complications of faucial tonsillitis
Exotoxin Cardiac Myocarditis Cardiac arrhythmia Acute circulatory failure Neurological Paralysis soft palate Diaphragm Ocular muscles Larynx Membrane cause airway obstruction

ENT (18 decks)

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