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ANATOMY OF PHARYNX BRIG MIRZA KHIZER HAMEED PHARYNX • Muscular tube lying behind • • the nose, oral cavity & larynx Extends from the base of the skull to level of the 6th cervical vertebra, where it is continuous with the esophagus The anterior wall is deficient and shows (from above downward): Posterior nasal apertures Opening of the oral cavity Laryngeal inlet PHARYNX Site Seen from behind Midline of the neck Behind : to From skull base The Nose esophagus The of Mouth In front upper 6 The vertebra larynx Cervical PHARYNX Shape Irregular Fibromuscular tube lined by mucous membrane Length: 15 cm PHARYNX Structure The wall is formed of 4 layers 1-Mucous membrane 2- Pharyngeal aponeurosis 3-Muscle layer 4-Bucco-pharyngeal fascia Formed ofsquamous 3of muscles, superior inferior constrictor A thin coat connective tissuemiddle Loose connective tissue which contains lymphoid tissue that aggregates Stratified epithelium except and the nasopharynx, it is muscles in some areas forming tonsils (Waldayer’s pseudo-stratified with goblet cellsring) PHARYNX Compartments • Pharynx is divided into three compartments: Nasopharynx: Superior part, communicates with the nasal cavity through posterior nasal apertures Oropharynx: Middle part, communicates with the oral cavity through the oropharyngeal isthmus Hypopharynx: Inferior part, communicates with the larynx through the laryngeal inlet PHARYNX Compartments Seen from behind • Nasopharynx • Oropharynx • Hypopharynx PHARYNX Compartments Seen from lateral • Nasopharynx • Oropharynx • Hypopharynx Nasopharynx -Behind the nasal cavity -Extends from skull base superiorly to the soft palate inferiorly -Communicates inferiorly with the oropharynx through the velopharyngeal sphincter -The nasopharyngeal tonsil lies in the roof -The pharyngeal opening of ET lies in the lateral wall Oropharynx Behind the oral cavity (in front of 2nd&3rd Cervical vertebra) From the soft palate superiorly to tip of epiglottis inferiorly Communicates: Anteriorly with the oral cavity Superiorly with the nasopharynx Inferiorly with the hypopharynx The palatine tonsils lie laterally between the anterior and posterior pillars The tonsils lie between the Two pillars PALATINE TONSILS • Paired masses of lymphoid tissue • Located in the palatine fossa/sinus, in the lateral wall of the oropharynx • Reaches its maximum size during early childhood, but after puberty diminishes in size PALATINE TONSILS • Lateral surface: covered by a • fibrous capsule Medial surface: • Projects into the cavity of oropharynx • Covered by mucous membrane • Shows multiple depressions, the tonsillar crypts and one deep intratonsillar cleft 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 Hypopharynx Seen from behind The hypopharynx does not only lie behind the larynx BUT also Projects laterally on each side of the larynx So it is formed of : - Postcricoid region ( behind the larynx) - Posterior pharyngeal wall - Two pyriform fossae (on each side of the larynx Cross section Waldeyer’s ring • It is a lymphoid tissue ring located • in the pharynx Consists of: Adenoids (pharyngeal tonsils) Tubal tonsil Palatine tonsil Lingual tonsil Lateral pharyngeal bands Lymphoid follicles in post. wall Waldeyer’s ring The lymphoid tissue in the pharyngeal aponeurosis aggregates in some areas forming tonsils: 1-one nasopharyngeal tonsil 2- two palatine tonsils 3- two lingual tonsils Blood supply From the External Carotid Artery & its branches 1- Tonsillar artery (from Facial Artery) 2- Ascending palatine artery (from Facial Artery) 3- Ascending pharyngeal Artery (from external carotid) 4- Descending palatine artery ( from Maxillary artery) 5- Dorsalis lingulae artery (from Lingual artery) Lymph Drainage • Nasopharynx ---►Retropharyngeal ---►Upper Deep Cervical L N • Oropharynx ---► Upper Deep Cervical L N • Hypopharynx ---► Upper Deep Cervical L N Nerve Supply Motor X Except : Stylopharyngeus Tensor palati IX V Nasopharynx Oropharynx Laryngopharynx V IX X Sympathetic: SCG Parasympathetic: through VII Sensory Autonomic ACUTE PHARYNGITIS BRIG MIRZA KHIZER HAMEED Pharyngitis – Inflammation of the Pharynx secondary to an infectious agent – Most common infectious agents are Group A Streptococcus and various viral agents – Often co-exists with tonsillitis Etiology • 30%-65%: idiopathic • 30%-60%: viral • 5%-10%: bacterial • Group A beta-hemolytic: most common bacterial pathogen – 15%-36%: pediatric cases – 5%-10% : adult pharyngitis – Disease of children Etiology Bacterial • Strep.A • Corynebacterium diphteriae Gonococcus • Fungal • Candida albicans Others • Toxoplasmosis Viral • Rhinovirus • Influenza • Parainfluenza • EBV • Cytomegalovirus • HIV Clinical manifestations • • • • • Differ in severity Fever Sore throat Headache GI symptoms • • • • • • Erythema Exudates Enlarged tonsils Anterior cervical adenopathy Prominent lymphoid follicles on Post. Wall Edema of Uvula Suppurative Complications of Group A Streptococcal Pharyngitis • Otitis media • Sinusitis • Peritonsillar and retropharyngeal abscesses • Suppurative cervical adenitis Nonsuppurative Complications of Group A Streptococcus • Acute rheumatic fever – follows only streptococcal pharyngitis (not group A strep skin infections) • Acute glomerulonephritis – May follow pharyngitis or skin infection (pyoderma) – Nephritogenic strains Course • Group A strep pharyngitis naturally self- limiting • Resolve spontaneously in 3-4 days w/ or w/o antibiotics • Rapid test or throat culture: reduces unnecessary antibiotic use by identifying those whom antibiotic therapy is justified Diagnosis • History • Throat culture • Rapid antigen detection test (RADT) Diagnostic tools • History: – Fever – Tonsillar exudates – Swollen or tender lymph nodes – Lack of cough – unreliable Diagnostic tools • Throat culture: gold standard for dx – Sensitivity 90%, specificity 99% – For adult patients to confirm clinical diagnosis Diagnostic tools • Rapid antigen detection test (RADT) – When throat culture is impractical or inappropriate • Extensive contact with others • Work full-time jobs • Difficult to reach – Sensitivity 80%-90%, specificity 70%-95% – Helps selects true positives thus avoiding unnecessary use of antibiotics – (+) RADT- start antibiotic therapy Treatment • Antibiotic • Bed rest • Plenty of fluids • Analgesics/ Antipyretics • Warm saline gargles • Decongestants Antibiotic therapy • Penicillin • Ampicillin, amoxicillin • Cephalosporins • Macrolides Thank You