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PHARYNX,
CRANIOVERTEBRAL
JOINTS,
PREVERTEBRAL
REGION
STEVEN J. ZEHREN, PH.D.
SUBDIVISIONS OF PHARYNX
Sphenoid sinus
Pharyngeal tubercle of occipital bone
NASOPHARYNX
Soft palate
OROPHARYNX
Root of tongue
Epiglottis
LARYNGOPHARYNX
Cricoid cartilage
Trachea
Esophagus
Vertebral bodies
C6
PHARYNX IN POSTERIOR VIEW
Base of skull
(5 cm)
CV6
(1.5 cm)
Esophagus
NASOPHARYNX (MUCOSA INTACT)
Pharyngeal tonsil
Orifice of auditory tube
Choana
Pharyngeal recess
Torus tubarius
Torus levatorius
Salpingopharyngeal fold
Uvula
Pharyngeal
isthmus
NASOPHARYNX (MUCOSA REMOVED)
Cartilage of auditory tube
Tensor (veli) palatini
Levator (veli) palatini
Salpingopharyngeus
PHARYNGOTYMPANIC (AUDITORY) TUBE
Nasopharynx
Tympanic cavity
Pharyngotympanic (auditory) tube
OROPHARYNX IN ANTERIOR VIEW
(BOUNDARIES OF OROPHARYNGEAL ISTHMUS)
Soft palate
Palatoglossal arch
Dorsum of tongue
Epiglottis
Median glossoepiglottic fold
Lateral glossoepiglottic fold
Vallecula
Root
Body
Palatopharyngeal arch
Palatine tonsil
Lingual tonsil
Palatoglossal arch
TONSILLAR BED
Tonsillar br. of facial a.
External palatine
(paratonsillar) v.
Glossopharyngeal n. (IX)
Superior constrictor
TONSILLAR BED
Superior constrictor
Styloid process &
Stylohyoid ligament
Lesser horn
of hyoid bone
Peritonsillar Abscess
Choanae
NASOPHARYNX
Soft palate
OROPHARYNX
Root of tongue
Epiglottis
LARYNGOPHARYNX
Aryepiglottic fold
Piriform recess
with fold over internal
laryngeal n.
NERVES DEEP TO MUCOSA OF
PIRIFORM RECESS
Internal laryngeal n.
Recurrent laryngeal n.
WALDEYER’S RING
WALL OF PHARYNX
1. Mucous membrane
2. Pharyngobasilar fascia
3. Muscle layer
4. Buccopharyngeal fascia
MUSCLES OF PHARYNX
THREE PHARYNGEAL CONSTRICTOR MUSCLES
Superior constrictor
Middle constrictor
Inferior constrictor
Esophagus
Pterygomandibular raphe
Pterygomandibular raphe
Superior pharyngeal constrictor m.
Middle pharyngeal constrictor m.
Hyoid bone
Thyroid cartilage
Cricoid cartilage
Inferior pharyngeal constrictor m.
Zone of sparse muscle fibers
Cricopharyngeus m.
(part of inferior constrictor m.)
Styloid process
Cartilaginous part of
pharyngotympanic tube
Stylopharyngeus m.
Salpingopharyngeus m.
Palatopharyngeus m.
Pharyngobasilar fascia
Pharyngeal raphe
Stylopharyngeus m.
Superior constrictor m.
Middle constrictor m.
Longitudinal pharyngeal mm.
Inferior constrictor m.
Cricopharyngeus m.
Posterior border of thyroid cartilage lamina
(Mechanism of Swallowing)
Tensor palati m.
Levator palati m.
Salpingopharyngeus m.
Passavant’s ridge
Superior constrictor m.
Palatopharyngeus m.
Stylopharyngeus m.
Mylohyoid m.
Middle constrictor m.
Inferior constrictor m.
Cricopharyngeus m.
Circular esophageal m.
FOUR GAPS IN THE PHARYNGEAL MUSCULATURE
Levator palati
Superior constrictor
Stylopharyngeus & IX
Middle constrictor
Internal laryngeal n.
& superior laryngeal a.
Inferior constrictor
Recurrent laryngeal n.
& inferior laryngeal a.
NERVES OF PHARYNX
MOTOR INNERVATION OF PHARYNX
Glossopharyngeal n.
(to stylopharyngeus)
Pharyngeal branch of X
(to other pharyngeal mm.)
X
(Medial view)
Trigeminal (V2)
via pharyngeal branch of
pterygopalatine ganglion
Glossopharyngeal (IX)
via pharyngeal plexus
via tonsillar branches
taste plus general
sensation via
lingual branches
Vagus (X)
via internal laryngeal n.
Trigeminal n. (V)
Glossopharyngeal n. (IX)
Vagus n. (X)
Facial n. (VII)
PHARYNGEAL PLEXUS OF NERVES
Pharyngeal br. of IX (GVA)
Pharyngeal br. of X (SVE)
BLOOD SUPPLY & LYMPHATICS
OF PHARYNX
ARTERIAL SUPPLY TO PHARYNX
Ascending pharyngeal a.
Superior constrictor m.
Ascending pharyngeal a.
Superior thyroid a.
Inferior thyroid a.
VENOUS DRAINAGE OF PHARYNX
Retropharyngeal nodes
Jugulodigastric node
Superior deep cervical
nodes
RELATIONSHIPS
OF PHARYNX
NEUROVASCULAR RELATIONSHIPS
XI
IX
XII
Sympathetic trunk
Com. & int. carotid aa.,
IJV, X
CRANIOVERTEBRAL JOINTS
Ant. tubercle
Facet for dens
Ant. arch
Lateral mass
Transverse pr.
Tubercle for
transverse lig.
Transverse foramen
Sup. facet for
occipital condyle
Post. arch
Post. tubercle
Groove for vertebral a.
ATLAS (C1): SUPERIOR VIEW
Dens
Sup. facet for atlas
Interarticular part
Inf. articular pr.
Post. facet for
transverse lig.
Body
Transverse pr.
Spinous pr.
AXIS (C2): POSTEROSUPERIOR VIEW
Atlas and Axis
(superior view)
Dens
Facet for
occipital
condyle
Facet for
transverse
ligament
C1
C2
C3
C4
Atlanto-occipital Joints (Ellipsoid)
Allow flexion/extension of head (nodding “yes”)
Allow lateral flexion of head
Lateral atlanto-axial joints (gliding)
Median atlanto-axial joint (pivot)
ROTATION OF THE HEAD OCCURS AT THE ATLANTO-AXIAL JOINTS
Spinous processes and parts of vertebral
arches removed: posterior view
Basilar part of occipital bone
Tectorial membrane
Capsule of AO
joint
Atlas (C1)
Capsule of lateral
AA joint
Axis (C2)
Deeper (accessory part) of tectorial membrane
Posterior longitudinal ligament
Alar ligaments
Capsule of
zygopophysial joint
(C2-C3)
Atlas (C1)
Superior longitudinal band
CRUCIATE
LIGAMENT
Transverse ligament of atlas
Inferior longitudinal band
Axis(C2)
Deeper (accessory part)
of tectorial membrane
Principal part of tectorial membrane
removed: posterior view
Atlas (C1)
Apical ligament of dens
Alar ligament
Facet of dens
(for transverse lig.)
Alar ligament
Anterior tubercle of atlas
Synovial cavities
Axis (C2)
Dens
Cruciate ligament removed:
posterior view
Transverse ligament
of atlas
Median atlantoaxial joint: superior view
CLINICAL CORRELATIONS
FRACTURE & DISLOCATION OF THE ATLAS
(JEFFERSON OR BURST FRACTURE)
FRACTURE & DISLOCATION OF THE ATLAS
(JEFFERSON OR BURST FRACTURE)
PREVERTEBRAL MUSCLES
Basilar part
of occipital bone
Jugular process
of occipital bone
Longus capitis m. (cut)
Occipital condyle
Rectus capitis anterior m.
Rectus capitis lateralis m.
Transverse process of atlas
Longus capitis m.
Longus colli m.
CERVICAL PART OF
SYMPATHETIC TRUNK
Internal carotid n.
Superior cervical ganglion
External carotid a. & plexus
Gray rami communicantes
Middle cervical ganglion
Vertebral ganglion
Vertebral a. & plexus
Cervicothoracic (stellate) ganglion
Ansa subclavia
HORNER’S SYNDROME
Int. carotid a. & plexus
SYMPTOMS:
1. MIOSIS (PARALYSIS OF
DILATOR PUPILLAE M.)
2. PTOSIS (PARALYSIS OF
SUPERIOR TARSAL M.)
3. REDNESS & INCREASED
TEMPERATURE OF SKIN
(VASODILATION)
4. ANHIDROSIS (SWEAT GLS.
CAN’T SECRETE)
Sup. cervical
ganglion
Sympathetic trunk
Ext. carotid a.
& plexus
Facial a. & plexus
LAB PREVIEW
1. REMOVE ALL MUSCULATURE FROM OCCIPITAL BONE &
POSTERIOR ARCH OF ATLAS.
2. REMOVE WEDGE OF OCCIPITAL BONE
3. REMOVE POST. ARCH OF ATLAS, TRANSECT & REMOVE CERVICAL
SPINAL CORD & ASSOCIATED MENINGES.
4. CUT & REFLECT TECTORIAL MEMBRANE INFERIORLY.
Spinous processes and parts of vertebral
5. CUT ALAR
& posterior
SUP. LONGITUDINAL
BAND.
archesLIGS.
removed:
view
6. DISARTICULATE AO JOINTS W/ HAMMER & CHISEL.
Basilar part of occipital bone
Tectorial membrane
Capsule of AO
joint
Atlas (C1)
Capsule of lateral
AA joint
Axis (C2)
Deeper (accessory part) of tectorial membrane
Posterior longitudinal ligament
Alar ligaments
Capsule of
zygopophysial joint
(C2-C3)
Atlas (C1)
Superior longitudinal band
CRUCIATE
LIGAMENT
Transverse ligament of atlas
Inferior longitudinal band
Axis(C2)
Deeper (accessory part)
of tectorial membrane
Principal part of tectorial membrane
removed: posterior view
7. CUT PREVERTEBRAL MUSCLES THAT INSERT INTO SKULL.
8. WORK YOUR HANDS INTO RETROPHARYNGEAL SPACE,
AND PULL CERVICAL VISCERA AND HEAD FORWARD AWAY FROM
VERTEBRAL COLUMN.
END OF LECTURE