Download Parapharyngeal Space

‫‪The pharynx‬‬
‫الدكتور‬
‫سعد يونس سليمان‬
‫كلية طب نينوى‬
Lecture Objectives
Anatomy
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Divisions of the pharynx
The pharyngeal wall .. Killian’s Dehiscence
Nerve supply of the pharynx
Waldeyer’s ring… Palatine tonsils
Retropharyngeal space ( Space of Gillette)
Parapharyngeal Space
Functions of the pharynx
Anatomy of The pharynx
Shape
Irregular conical
Fibromuscular tube
Length: 12-14 cm
Anatomy of The pharynx
Divisions
• Nasopharynx
• Oropharynx
• Laryngopharynx
(Hypopharynx)
•
•
•
•
Form the upper part of
air & food passages
Extends from base of
skull to inferior border of
cricoid cartilage
anteriorly and inferior
border of C6 posteriorly
Widest portion (5cm) at
hyoid
Narrowest portion
(1.5cm) at its caudal
end(Pharyngooesophageal junction)
1
2
3
4
5
6
Nasopharynx
Extends
from base
communicates
anteriorly
with the
of the skull
to the
nasal
through
levelcavity
of hard
the
posterior nares
palate
(choanae) so it has a
respiratory function
Three important structures in
the nasopharynx
Nasopharyngeal tonsil (adenoid)
 Openings of the Eustachian tubes
 Fossa of Rosenmuller

Nasopharynx ( Summary)
•Anteriorly; nasal cavity
•Posterosuperiorly; basisphenoid …adenoid
•Posteriorly; extend down to the junction of the
hard and soft palate in front of C1 (atlas)
•Inferiorly; the superior surface of the soft
palate and opens into the oropharynx.
•Laterally;
openings of the Eustachian tubes
Eustachian cushions,
fossae of Rosenmuller.
Oropharynx
Behind the oral cavity (in front of
2nd&3rd Cervical vertebrae)
from the level of hard palate to
the level of hyoid bone( ant. to
C2& C3 ).
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
Oropharynx (cont.)

The dividing line between the oropharynx and
mouth is:



junction of hard palate and soft palate above
anterior pillar laterally
junction of anterior 2/3 and posterior 1/3 of the tongue
(circumvallate papillae).
Digestive function
Anterior: anterior tonsillar pillar
Posterior: superior constrictor
Superior: soft palate
Inferior: base of tongue, superior
epiglottis
Laterally: palatoglossal and
palatopharyngeal arches
The tonsils lie between the
Two pillars
Hypopharynx
Behind the Larynx (in front of
3rd to 6th Cervical vertebra)
from the level of hyoid to the upper
end of esophagus at the level of
the inferior border of the cricoid
cartilage inferiorly
Communicates:
Anteriorly with the Larynx
Superiorly with the oropharynx
Inferiorly with the oesophagus
Cricoid cartilage
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)
- Two pyriform fossa (on each
side of the larynx)
- Posterior pharyngeal wall
Cross section
The structure of pharyngeal wall
The wall is formed of 4
layers
1-Mucous membrane
2- Pharyngeal aponeurosis
3-Muscle coat
4-Bucco-pharyngeal fascia
a (outer
strong
fibrous
layer
attached
superiorly
the
baseconstrictor
of the it
skull.
A This
Circular
thin iscoat
of connective
layer),
superior,
tissue,
this
middle
fascia
and
isnasopharynx,
inferior
loosely
attached
Stratified
squamous
epithelium
except
theto
is
It is strengthened
posteriorly by strong
fibrous
band called
“median
muscles
posteriorly
to
the
prevertebral
fascia
and
laterally
it
is
pseudostratified
ciliated
columnar
epithelium
withofgoblet
pharyngeal raphe”. This
raphe
attaches above
to the base
the skull,
connected
to
the
styloid
process
and
the
carotid
sheath.
cells
Longitudinal
( internal
Stylopharyngeus
and gives insertion
to the),constrictor
muscles.
Salpingopharyngeus
Palatopharyngeus
Inferior constrictor
muscle has two parts:
1. Thyropharyngeus with
oblique fibers.
2. Cricopharyngeus with
transverse fibers.

Killian’s Dehiscence
This is a potential gap between
fibers of thyropharyngeus and
cricopharyngeus muscles.
Normally cricopharyngeus
muscle relaxes when food bolus
is pushed by the pharynx
towards the esophagus.
If this does not happen,
mucosa will bulge outward
forming a pharyngeal pouch.
Nerve Supply
Motor
---► X Except :
Stylopharyngeus --►IX
Tensor palati --► V
Sensory --►
Nasopharynx: V
- Oropharynx: IX
- Laryngopharynx: X
Autonomic:
- sympathetic: SCG
- Parasympathetic: through VII
-
Waldeyer’s ring:

Definetion:
It is a collection of lymphoid tissue in the
nasopharynx and oropharynx at the entrance to
the airodigestive tract.
It is composed of:
1.
2.
3.
4.
5.
6.
Nasopharyngeal tonsil (adenoid)
Tubal tonsils: lie behind the opening of the
Eustachian tubes.
Palatine tonsils.
Lingual tonsils: embedded in the posterior 1/3 of
the tongue.
Lateral pharyngeal bands: behind the posterior
tonsillar pillars,
Lymphoid nodules: scattered on the posterior
pharyngeal wall.

Hypertrophy of the lymphoid tissue of
Waldeyer’s ring occurs in the earlier years of
childhood, probably in response to URTI.
Maximum hypertrophy occurs between 4-10
years, thereafter some regression in size is to
be expected, and in old age it atrophies.
Waldeyer’s ring is characterized by:
1.
2.
3.
4.
5.
Sub-epithelial lymphoid tissue.
Lack of definite capsule.
They have efferent lymph vessels, but NO afferent vessels.
They function as one unit; when a member of it is removed
the other parts undergo compensatory hypertrophy.
The exact function is unknown but it is thought that it has a
protective function by:


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Formation of lymphocytes.
Secretion of antibodies mainly IgA.
Localization of infection entering the body by initial contact with
the incoming organism.
Palatine tonsils
Two masses of lymphoid tissue situated on each
side of oropharynx
 Its medial surface is pitted by a number
of crypts.
 Laterally the tonsil is enclosed by a dense
fibrous capsule separating the tonsil from
the superior constrictor (tonsillar bed)
plane for dissection of the tonsil during
tonsillectomy.

Blood supply of the tonsil
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)
Venous drainage

To the paratonsillar veins which drains to
the pharyngeal plexus. The plexus drain to
the internal jugular veins.
Retropharyngeal space ( Space of Gillette)
It is a potential space that lies between the pre
vertebral fascia posteriorly and the
buccopharyngeal fascia anteriorly.
 It extend from the base of the skull to the
superior mediastenum.
 It contains retropharyngeal lymph nodes of
Rouviere: few lymph nodes that disappear
spontaneously during the 3rd or 4th year of life.

Prevertebral space
Prevertebral fascia
Bucco-pharyngeal
fascia
Parapharyngeal
space
Retropharyngeal
space
Parapharyngeal Space
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lateral to the pharynx
and connects posteriorly
with the retropharyngeal
space.
It extends from the base
of the skull to the hyoid
bone (i.e. it is lateral to
the nasopharynx and
oropharynx ).
Boundaries of parapharyngeal space
Medially: superior
constrictor muscle
 laterally: medial
ptrygoid muscle,
mandible and deep
lobe of parotid gland.
 Posteriorly: the
prevertebral muscle
and fascia.

Contents of parapharyngeal space
1.
2.
3.
Deep cervical lymph nodes.
Last 4 cranial nerve and cervical sympathetic
trunk.
Great vessels of the neck; common carotid
artery and internal jugular vein.
Functions of the pharynx
1.
2.
3.
4.
Food and air inlet.
Play an important role in speech through vocal
resonance and articulation.
The immunologic function of Waldeyer's ring.
Deglutition; which is divided into three stage;
 Oral
stage ( voluntary )
 Pharyngeal stage ( involuntary )
 Eosophageal stage ( involuntary )
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