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Anatomy Lecture 8 – The Pharynx and Esophagus Pharynx is divided into 3 regions: o Nasopharynx – Nasal cavity above the Soft Palate o Oropharynx – From Soft Palate to Epiglottis o Laryngopharynx (Hypo) – From Epiglottis to Cricoid Cartilage Muscles of the Pharynx o Superior Constrictor Muscle (attached by Pterygo-Mandibular Raphae) to the Buccinator Muscle o Middle Constrictor Muscle – Attaches to Hyoid Bone o Inferior Constrictor – Attaches to Thyroid Cartilage Structures found in the Retropharyngeal Space (behind the Pharynx) o Thyroid Gland o Sympathetic Chain (Superior Cervical Ganglion) o Spinal Accessory Nerve o Glossopharyngeal Nerve o Hypoglossal Nerve o Carotid Sheath Common Carotid Internal Jugular Vagus Nerve o Stylopharyngeus Muscle – CN IX – Elevates Larynx for swallowing o Superior, Middle, Inferior Constrictor Muscles Nasopharynx: o Torus Tubarius: cartilaginous ring around the opening of the Eustachian Tube (auditory tube) o Eustachian Tube: tube that links the Nasopharynx to the Middle Ear – equilibrates pressure (ROOT OF INFECTION, esp. in children) o Salpingopharyngeus Muscle: Acts to raise the Pharynx during swallowing – CN X o Levator Veli Palatini Muscle: Elevates the Soft Palate – CN IX o Tensor Veli Palatini Muscle: Tenses the Soft Palate – CN V3 o Velo-Lingual Seal – When you’re breathing, the Uvula sits on the tongue o Velo-Pharyngeal Seal – When you swallow, the Tensor and Levator open the Eustachian Tube o Adenoids: one of the filters that remove particles from the air before it moves into the trachea (from the nose) o Velum: The Soft Palate Oropharynx: o Muscles: Elevate the tongue to push food up and back Palatoglossus Muscles: CN X Palatopharyngeous Muscles: CN X o Tonsillar Fossa with Palatine Tonsils Severe bleeding can occur via External Palatine Vein (From Facial Vein) o Lingual Tonsils: Posterior 1/3 of the tongue. Enlargement can cause gag reflex and dysphagia o Waldeyer’s Ring: The ring of lymphoid tissues (tonsils) that protext the oro-nasal region from infection Adenoids Tubal Tonsils Palatine Tonsils Lingual Tonsils Laryngopharynx o Piriform Recesses: extend inferior the Lateral Glossopiglottic Folds on either side of the larynx. Food and liquid can be stuck in these recesses upon deglutition Cancers can develop here o Zenker’s Diverticulum: Killian Laimer Triangle: triangle made from the Inferior Constrictor Muscle meets the Cricopharyngeal Muscle (weak spot) – herniations occur here Leads to outpouching of the Posterior Pharyngeal Wall just above the Cricopharyngeal Muscle Causes dysphagia Vagus runs through here – so hoarseness can occur Reflexes: o Carotid Reflex from the Carotid Body (O2-CO2) and Carotid Sinus (Baroreception) -- Glossopharyngeal Afferent: CN IX Efferent CN X o GAG Reflex: Afferent: CN IX Efferent: CN X Enteric Nervous System: o Peristalsis Barrett’s Esophagus: o Persistent GERD (Acid Reflux) can lead to changes the esophageal lining Lower Esophageal Sphincter opens too frequently o The Z-Line was shifted up. o Causes Dysphasia Achalasia o The Lower Esophageal Sphincter (LES) opens less frequently (primary) or is completely paralyzed (secondary). o This leads to reduced or absent peristalsis, which then causes esophageal obstruction o Loss of Enteric Innervation, which normally relaxes the LES o Can use Botox Injections Esophageal Varices o Veins in the esophagus that can swell and occlude the lumen Mallory-Weiss Syndrome: o Tear at the Esophago-Gastric Junction caused by vomiting o Can happen during pregnancy o Patients vomit blood Boerhaave’s Syndrome o Caused by sudden rupture of esophagus allows entry of air into the peritoneal or pericardial cavities o Symptoms: Dyspnea (shortness of breath), Tachypnea (Rapid Breathing), Cyanosis, Shock