Week 10.1 - The pharynx

Question 1

Describe the location of the nasopharynx. State its boudaries

Answer 1

• In line with C1
• From the back of the nose to the soft palate
• Superior = base of skull
• Inferior = level of soft palate
• Anterior = posterior choanae
• Posterior =nasopharyngeal tonsil (adenoid) and C1

Question 2

Describe the location of the oropharynx. State its boundaries

Answer 2

• In line with C2 and C3
• From the soft palate to superior epiglottis
• Superior = level of the soft palate
• Inferior = supeior edge of epiglottis
• Anterior = oral cavity
• Posterior = c2/3

Question 3

Describe the location of the laryngopharynx. State its boundaries

Answer 3

• From the superior border of epiglottis to the opening if the oesophagus/trachea
• In line with C4,5 and 6
• Superior = Superior ridge of epiglottis
• Inferior = level of inferior cricoid cartilage
• Anterior = larynx
• Posterior = c3-c6

Question 4

In which part of the pharynx does the palatine tonsil lie?

Answer 4

-oropharynx

Question 5

What lines the nasopharynx?

Answer 5

-Respiratory ciliated pseudostratified epithelium and stratified squamous

Question 6

What structures lie in the nasopharynx?

Answer 6

• Adenoids

- Eustachian tube orifice

Question 7

What is the palatoglossal arch?

Answer 7

• The anterior arch in the oral cavity

- Marks the boundary between the oral cavity an the oropharynx

Question 8

What is the palatopharyngeal arch?

Answer 8

-Posterior arch in the oral cavity

Question 9

Describe the palatine tonsil

Answer 9

-An encapsulated area of lymphoid tissue covered in squamous epithelium

Question 10

When do the palatine tonsils begin to atrophy?

Answer 10

-After puberty

Question 11

What makes the floor of the tonsillar fossa?

Answer 11

-Superior constrictor muscle

Question 12

Describe the blood supply to the palatine tonsils

Answer 12

• Tonsillar branch of facial artery (aso lingual and ascending pharyngeal/palatine)
• Venous is pharyngeal plexus (and also paratonsilar vein)

Question 13

Describe the lymphatic drainage of the palatine tonsils

Answer 13

-Lymphatics pierce superior constrictor muscle and pass to nodes along the internal jugular vein, specifically jugulodigastric

Question 14

What tonsils create waldeyers ring?

Answer 14

-Palatine, adenoid (nasopharyngeal), lingual, tubal

Question 15

Which nodes do the adenoids drain to?

Answer 15

-deep cervical and retropharyngeal

Question 16

What are the constrictor muscles of the pharynx?

Answer 16

• Superior, middle and inferior muscles which overlap one another. They are open at the front (attach laterally to trachea) and attach posteriorly at the median raphe
• Contract sequentially to move food bolus down the oesophagus

Question 17

Describe the innervation of the pharyngeal constrictors

Answer 17

-Superior laryngeal nerve

Question 18

Describe the process of swallowing

Answer 18

• Oral phase -> Tongue elevates pushing food bolus to back of mouth. Soft palate elevates and seals off nasopharynx. Tongue and suprahyoid muscles pull up larynx
• Pharyngeal phase ->Epiglottis changes shape to block trachea. Piriform fossa funnels food into laryngopharynx and sequential contraction of the constrictors and relaxation of cricopharyngeus
• Oesophageal phase -> peristaltic contration of oesophagus

Question 19

Describe the blood supply to the pharynx

Answer 19

-Tonsillar branch of facial artery
-Ascending pharyngeal
-Ascending palatine
(all from ECA)

Question 20

Describe the venous drainage of the pharynx

Answer 20

-Pharyngeal plexus

IJV

Question 21

Describe the motor supply to the pharynx

Answer 21

• Vagus (constrictors and palatopharyngeus, salpingopharyngeus)
• Glossopharyngeal (stylopharyngeus)

Question 22

Describe the sensory supply to the pharynx

Answer 22

• Nasopharynx -> CNV2
• Oropharynx -> CNIX
• Hypopharynx -> CNX

Question 23

State what bony/cartilage features can be found at the vertebral levels of C1,2,3,4,5,6

Answer 23

• C1 -> hard palate
• C2-> angle of mandible
• C3 -> hyoid bone
• C4/5 -> Thyroid cartilage
• C6 -> Cricoid cartilage

Question 24

Under what do the left and right RLNs pass?

Answer 24

• Left = arch of aorta

- Right = right subclavian

Question 25

What is the most common cause of adenoid enlargement?

Answer 25

-Viral/bacterial infection

Question 26

After what age do the adenoids begin to regress?

Answer 26

-8 years

Question 27

State the common consequencesNasalof adenoid enlargement

Answer 27

- Eustachian tube obstruction (acute otitis media with effusion) - Nasal obstruction - Obstructive sleep apnoea

Question 28

Where does posterior herniation of pharyngeal mucosa most commonly occur? (pharyngeal diverticulum) Why does it occur?

Answer 28

- Killian's dehiscence (inferior constrictor and cricopharyngeus) - Weaker area - Incoordination of swallowing - Cricopharyngeal spasm