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Anterior part of the alimentary canal 1. Isthmus of the fauces 2. Tonsils 3. Salivary glands – minor and major salivary glands 4. Pharynx 5. Esophagus SPLANCHNOLOGY Oropharyngeal isthmus Isthmus of the fauces, isthmus faucium (Lat. a vestibule of an ancient Roman house): palatine velum, velum palatinum palatine uvula, uvula palatina palatoglossal arch palatopharyngeal arch Prof. Dr. Nikolai Lazarov 2 SPLANCHNOLOGY Waldeyer’s ring NALT – Nasal-Associated Lymphoid Tissue Anulus lymphoides Waldeyeri: von Waldeyer (1836-1921) lingual tonsil pharyngeal tonsil (tonsilla adenoidea) tubal tonsils palatine tonsils Prof. Dr. Nikolai Lazarov 3 SPLANCHNOLOGY Lymphoid tissue – “lymphoepithelial organs” MALT – Mucosa Associated Lymphatic Tissue Prof. Dr. Nikolai Lazarov 4 SPLANCHNOLOGY Palatine tonsils, tonsillae palatinae Macroscopic anatomy: paired structures egg-like shape – 25х15х20 mm placed in triangular recess (tonsillar sinus) supratonsillar fossa plica semilunaris, plica triangularis capsule, capsula tonsillae Prof. Dr. Nikolai Lazarov 5 SPLANCHNOLOGY Palatine tonsils, tonsillae palatinae Microscopic anatomy: lamina epithelialis stratified squamous epithelium tonsillar crypts lamina propria desquamated epithelial cells – loose connective tissue lymphoid nodules tela submucosa – capsule trabeculae lobules Prof. Dr. Nikolai Lazarov 6 SPLANCHNOLOGY Blood vessels of palatine tonsils Blood supply: tonsillar branches of facial artery ascending palatine artery ascending pharyngeal artery Venous drainage: palatine vein, pharyngeal veins facial vein internal jugular vein Lymphatic drainage: submandibular nodes lateral cervical nodes Prof. Dr. Nikolai Lazarov 7 SPLANCHNOLOGY Salivary glands Minor salivary glands, glandulae salivariae minores: 700-1000 minor glands mixed (seromucous) glands labial glands buccal glands molar glands anterior linglual (Nuhn’s) glands serous glands gustatory (von Ebner’s) glands mucous glands palatine glands posterior lingual (Weber’s) glands produce only 5-8% of the total output Prof. Dr. Nikolai Lazarov 8 SPLANCHNOLOGY Salivary glands Major salivary glands, glandulae salivariae majores: parotid gland, glandula parotidea (parotis) submanibular gland, glandula submandibularis sublingual gland, glandula submandibularis Prof. Dr. Nikolai Lazarov 9 SPLANCHNOLOGY Parotid gland, gl. parotidea Macroscopic anatomy: located subcutaneously in the parotideomasseteric region the largest salivary gland – 25-30 g has own fascia, fascia parotidea roughly wedge shaped and lobulated superficial and deep lobes internally: Nicolas Steno (Niels Stensen) (1638-1686) end branches of the external carotid artery retromandibular vein deep parotid lymphoid nodes parotid plexus of facial nerve auriculotemporal nerve (V3) parotid duct (Stensen’s duct) accessory parotid gland Prof. Dr. Nikolai Lazarov 10 SPLANCHNOLOGY Parotid gland, gl. parotidea Microscopic anatomy: enclosed within a capsule irregular, lobulated mass a purely serous gland (watery secretion) salivary ducts – mostly intercalated ducts adipose tissue – fat cells Prof. Dr. Nikolai Lazarov 11 SPLANCHNOLOGY Submandibular gland, gl. submandibularis Macroscopic anatomy: under the oral floor in the submandibular trigone weight – 15 g d=1.5-2 cm (the size of a walnut); U-shaped; smaller deep process covered by fascia cervicalis superficialis lobulated structure – 8-10 lobes three surfaces submandibular (Wharton’s) duct – 5-6 cm caruncula sublingualis blood supply – facial and lingual arteries lymphatic drainage – submandibular nodes innervation – intermediate nerve, superior cervical ganglion Prof. Dr. Nikolai Lazarov 12 SPLANCHNOLOGY Submandibular gland, gl. submandibularis Microscopic anatomy: enclosed within a capsule, lobulated mixed (seromucous) gland with predominant serous acini – Giannuzzi’s demilunes or Heidenhain crescents duct system – mostly striated ducts Prof. Dr. Nikolai Lazarov 13 SPLANCHNOLOGY Sublingual gland, gl. sublingualis Macroscopic anatomy: along the sublingual fold, plica sublingualis the smallest one weight – 3-5 g flattened, almond-shaped covered by a thin capsule lobulated mass – 4-16 lobules a group of 30-50 single glands: anterior 10-20 – major sublingual gland major sublingual duct caruncula sublingualis smaller sublingual ducts sublingual fold blood supply – sublingual artery venous drainage – internal jugular vein lymphatic drainage – submandibular nodes innervation – intermediate nerve, superior cervical ganglion Prof. Dr. Nikolai Lazarov 14 SPLANCHNOLOGY Sublingual gland, gl. sublingualis Microscopic anatomy: surrounded by a dense capsule, lobulated predominantly tubulo-alveolar (acinar) gland mixed (seromucous) gland consisting mostly of mucous (60%) acini – minor sublingual glands; serous caps, demilunes (30% of total gland volume) excretory ducts – 8-20 in number Prof. Dr. Nikolai Lazarov 15 SPLANCHNOLOGY Throat, pharynx part of the digestive and the respiratory systems the common channel for deglutition (swallowing) and respiration important also in vocalization musculomembranous cone-shaped tube: height – 12-15 cm diameter – upper part: 3.5 cm lower part: 1.5 cm Prof. Dr. Nikolai Lazarov 16 SPLANCHNOLOGY Topography base of skull 6th cervical vertebra nasal cavity oral cavity larynx cervical fascia (prevetrebral layer) retropharyngeal space posterior mediastinum lateral: cervical lymph nodes neurovascular bundle Prof. Dr. Nikolai Lazarov 17 SPLANCHNOLOGY Topography base of skull 6th cervical vertebra nasal cavity oral cavity larynx cervical fascia (prevetrebral layer) retropharyngeal space posterior mediastinum lateral: cervical lymph nodes neurovascular bundle Prof. Dr. Nikolai Lazarov 18 SPLANCHNOLOGY Macroscopic anatomy upper (nasal) part middle (oral) part lower (laryngeal) part Prof. Dr. Nikolai Lazarov 19 SPLANCHNOLOGY Nasal part of the pharynx synonyms: nasopharynx, epipharynx anterior boundary: nasal conchae lateral wall: pharyngeal opening of the auditory tube cranial boundary: pharyngeal fornix – pharyngeal tonsil (adenoides) Prof. Dr. Nikolai Lazarov 20 SPLANCHNOLOGY Oral part of the pharynx synonyms: oropharynx, mesopharynx anterior boundary: palatopharyngeal arch palatoglossal arch cranial boundary: velum palatinum caudal boundary: upper part of the epiglottis – epiglottic vallecula Prof. Dr. Nikolai Lazarov 21 SPLANCHNOLOGY Laryngeal part of the pharynx synonyms : laryngopharynx, hypopharynx cranial boundary: ventral boundary: epiglottis aditus laryngis dorsal boundary: constrictio pharyngoesophagealis Prof. Dr. Nikolai Lazarov 22 SPLANCHNOLOGY Histological structure Lamina epithelialis: stratified squamous non-keratinizing epithelium, excl. the nasal part – pseudostratified ciliated columnar epithelium with goblet cells Lamina propria: a high density of fibrillar elements fibrous membrane rich in elastic fibers elastic membrane contains glands: nasal part – seromucous glands oral and laryngeal parts – mucous (pharyngeal) glands Tela submucosa: in the lateral walls of the nasal part close to the esophagus Prof. Dr. Nikolai Lazarov 23 SPLANCHNOLOGY Pharyngeal musculature striated muscles: origin – pharyngeal arches tunica muscularis pharyngis: internal longitudinal layer external circular layer two functional groups: three pharyngeal constrictors two longitudinal elevators Prof. Dr. Nikolai Lazarov 24 SPLANCHNOLOGY Vessels of the pharynx Arterial blood supply: a. a. a. a. a. a. thyroidea superior palatina descendens palatina ascendens facialis – ramus tonsillaris thyroidea inferior pharyngea ascendens Venous drainage: plexus venosus pharyngeus vv. pharyngeales into the v. jugularis interna Lymphatic drainage: retropharyngeal lymph nodes deep cervical lymph nodes Prof. Dr. Nikolai Lazarov 25 SPLANCHNOLOGY Innervation of the pharynx Somatosensory innervation: trigeminal nerve Pharyngeal plexus: motor, sensory and parasympathetic innervation: vagus nerve glossopharyngeal nerve sympathetic innervation: superior cervical ganglion of the trunk sympathetic Prof. Dr. Nikolai Lazarov 26 SPLANCHNOLOGY The gullet, oesophagus Straight muscular tube about 25-30 cm long – to carry food, liquids, and saliva from the mouth to the stomach: begins in the neck at the level of C6 passes through the thoracic cavity and pierces the diaphragm at the Th10 level ends at the cardiac orifice of the stomach at the Th11 level Prof. Dr. Nikolai Lazarov 27 SPLANCHNOLOGY Macroscopic anatomy Three anatomical parts: cervical part – 5-6 cm thoracic part – 16-19 cm abdominal part – 1-4 cm Prof. Dr. Nikolai Lazarov 28 SPLANCHNOLOGY Anatomical constrictions Three anatomical constrictions: pharyngeal – 15 cm from the incisor teeth bronchial – 24 cm from the incisors diaphragmatic – 40 cm from the incisors NB:The sites of these constrictions are clinically important in connection with the passage of instruments along the esophagus – gastroscopy! Prof. Dr. Nikolai Lazarov 29 SPLANCHNOLOGY Physiological constrictions Two physiological constrictions – formed by contraction of its musculature 1. Aortal constriction – where esophagus is crossed by the aortic arch 2. Cardiac sphincter – just before entering the stomach cardia Prof. Dr. Nikolai Lazarov 30 SPLANCHNOLOGY The closing mechanism between the stomach and esophagus 2. 1. submucosal venous plexus contraction of the spiral musculature esophagitis 3. elastic nature of the phrenoesophageal ligament esophagitis 4. a pressure difference between the abdominal and thoracic cavities Clinical significance: insufficient closing mechanism – gastroesophageal (acid) reflux disease → heartburn Prof. Dr. Nikolai Lazarov 31 SPLANCHNOLOGY Histological structure Lamina epithelialis mucosae: multilayered (20-24 cell layers) nonkeratinizing squamous epithelium no distinct border at the transition into the stomach – intestinal metaplasia (columnar epithelium) Barrett oesophagus Lamina propria mucosae: collagen and elastic fibers esophageal cardiac glands venous plexus lymphatic nodules Lamina muscularis mucosae: longitudinally organized smooth muscle Prof. Dr. Nikolai Lazarov 32 SPLANCHNOLOGY Histological structure Tela submucosa: wide layer with longitudinal folds contains esophageal glands proper submucosal (Meissner’s) plexus Tunica muscularis – transition zone: inner circular layer (stratum circulare) outer longitudinal layer (stratum longitudinale) between them myenteric (Auerbach’s) plexus Tunica adventitia: loose, fibrous connective tissue Clinical significance: muscular weakness esophageal diverticula! Prof. Dr. Nikolai Lazarov 33 SPLANCHNOLOGY Vessels of the esophagus Blood supply – esophageal branches: cervical part: inferior thyroid artery thoracic part: aorta, intercostal arteries abdominal part: left gastric artery Venous drainage: brachiocephalic vein azygos vein hemiazygos vein hepatic portal vein drain into the: superior vena cava inferior vena cava portal vein Clinical significance: portal hypertension esophageal varices! Prof. Dr. Nikolai Lazarov 34 SPLANCHNOLOGY Innervation of the esophagus motor, sensory and parasympathetic innervation: vagus nerve vagal trunks sympathetic innervation: sympathetic trunk Prof. Dr. Nikolai Lazarov 35 SPLANCHNOLOGY Thank you ... Prof. Dr. Nikolai Lazarov 36