Pharynx - pediagenosis
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Tuesday, June 11, 2019


The pharynx is a musculomembranous tube; much of its anterior wall is absent due to the fact that the right and left nasal cavities, oral cavity, and larynx open into its anterior side. It extends from the base of the skull to the inferior border of the cricoid cartilage at the level of the lower margin of the sixth cervical vertebra, at which time it becomes continuous with the esophagus. In addition to the cavities already listed, the pharynx also communicates with the middle ear on each side by means of the auditory (eustachian) tube; this fact explains how infections spread from the pharynx to the middle ear, making a total of seven cavities with which it has communication. The transverse diameter of the pharynx exceeds the anteroposterior diameter, which is greatest superiorly and is diminished to nothing inferiorly where the anterior and posterior walls are in contact unless separated during the act of swallowing. The transverse diameter does not differ greatly throughout the length of the pharynx, except where it narrows at the lower end.

The posterior wall of the pharynx is attached superiorly to the pharyngeal tubercle on the inferior surface of the basilar part of the occipital bone, its adjacent area, and the undersurface of the petrous portion of the temporal bone medial to the external aperture of the carotid canal. The lateral wall has several attachments. It is attached superiorly to the cartilaginous portion of the auditory tube, which pierces the wall in this area. Anteriorly it connects to the lower, posterior border of the medial pterygoid plate and its hamulus, as well as the pterygomandibular raphe, the inner surface of the mandible (near the posterior end of the mylohyoid line), the side of the root of the tongue, the hyoid bone, and finally the thyroid and cricoid cartilages. Inferiorly, the walls of the pharynx continue as the walls of the esophagus.

The pharyngeal lining is a mucous membrane that is continuous with the lining of the cavities communicating with the pharynx. External to the mucous membrane of the posterior and lateral walls is a sheet of fibrous tissue, more defined superiorly than inferiorly, known as the pharyngeal aponeurosis (pharyngobasilar fascia), and external to this is the muscular layer of the pharynx. On the outer surface of the muscular layer is another fascial covering, the buccopharyngeal fascia.
The posterior pharyngeal wall is separated from the prevertebral fascia overlying the anterior arch of atlas and the bodies of the second to the sixth cervical vertebrae (partially covered by the longus colli and longus capitis muscles) by a minimal amount of loose fibrous connective tissue. This allows the pharynx some degree of freedom of movement and forms a retropharyngeal space. Under anesthesia it is possible to palpate these bony structures as far caudally as the fourth or fifth cervical vertebra.
On the basis of openings in its anterior wall, the pharynx is divided into the nasopharynx, oropharynx, and laryngopharynx. The nasopharynx typically has a purely respiratory function (acting as a passageway for air and not for food) and remains patent because of the bony framework to which its walls are related. The anterior wall is entirely occupied by the choanae (posterior nares), with the posterior border of the nasal septum between them. The posterior wall and roof form a con- tinuous arched wall, with the roof extending from the superior margin of the choanae (where it is continuous with the roof of the nasal cavities) to about the midpoint of the basilar portion of the occipital bone; the posterior wall extends from this point caudally to about the lower border of the anterior arch of the atlas. In the region where the roof and posterior wall meet, the mucous membrane is thrown into many variable folds, with an accumulation of nodular and diffuse lymphoid tissue (extensively developed in children, atrophied in adults) forming the pharyngeal tonsil (adenoids). In the midline, near the anterior margin of the pharyngeal tonsil, is a minute flask-shaped depression of mucous membrane, known as the pharyngeal bursa. Also in the midline, near the anterior limit of the roof, and submerged in the mucosa or lying in the periosteum, a microscopic remnant of the Rathke pouch (pharyngeal hypophysis) can be found, which is grossly visible only when it has become cystic or has formed a tumor.

The incomplete floor of the nasopharynx is formed by the posterosuperior surface of the soft palate with an opening from the nasal to the oral pharynx between the soft palate and the posterior wall of the pharynx. This opening is closed by bringing these two structures in contact.
On the lateral wall of the nasopharynx at the level of the inferior concha is the pharyngeal opening of the auditory tube, with the pharyngeal recess (fossa of Rosenm├╝ller) posterior to it. The levator cushion (produced by the levator veli palatini muscle) bulges into the inferior margin of the triangular opening, and coursing inferiorly from the posterior lip is the salpingopharyngeal fold produced by the muscle of the same name. In child-hood, a considerable mass of lymphoid tissue (tubal tonsil) may be present around the opening of the auditory tube and may enlarge, blocking drainage from the middle ear.
The oropharynx extends from the inferior border of the nasopharynx to the level of the pharyngoepiglottic folds, with the epiglottis protruding into it. This part of the pharynx carries both air and food. The posterior wall remains in relation to the bodies of the second to fourth cervical vertebrae, whereas the anterior wall is deficient superiorly where the oropharynx and oral cavity communicate by means of the isthmus of the fauces. Inferior to the isthmus, the anterior wall is formed by the posterior third of the tongue. Between the  tongue  and  epiglottis  are  the valleculae,  spaces where foreign bodies may lodge.
The laryngopharynx lies posterior to the larynx and anterior to the fifth and sixth cervical vertebrae. The superior part of the anterior wall contains the roughly triangular laryngeal inlet (aditus), the borders of which are formed by the margins of the epiglottis, the aryepiglottic folds, and the interarytenoid incisure. Inferior to the laryngeal opening, the laryngopharynx only transmits food and is purely alimentary in function. The mucous membrane of the anterior wall overlies the posterior surfaces of the arytenoid cartilages and the lamina of the cricoid cartilage (mostly covered by laryngeal muscles). Inferior to the laryngoepiglottic fold on each side is the piriform recess, located between the cricoid and arytenoid cartilages medially and the lamina of the thyroid cartilage laterally. This is another location where foreign bodies may lodge.

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