pharynx, cranio- vertebral joints, and prevertebral region 2009 dental & optometry students...

PHARYNX, CRANIO- PHARYNX, CRANIO- VERTEBRAL JOINTS, AND VERTEBRAL JOINTS, AND PREVERTEBRAL REGIONPREVERTEBRAL REGION

20092009DENTAL & OPTOMETRY DENTAL & OPTOMETRY

STUDENTSSTUDENTS

-George Salter, Ph.D-George Salter, Ph.D

is a 15 cm. long tube is a 15 cm. long tube connecting inferiorlyconnecting inferiorlywith the oesophagus.with the oesophagus.It is 5 cm. wideIt is 5 cm. widesuperiorly, and superiorly, and it is only 1.5 cmit is only 1.5 cm wide as itwide as itmerges withmerges with the oesophagus.the oesophagus.This point is theThis point is the most narrowmost narrowdiameter of thediameter of the GI tract.GI tract.

PHARYNX

ESOPHAGUS

PHARYNX:

SUBDIVISIONS OF PHARYNX

Nasopharynx

Oropharynx

Laryngopharynx

Nasopharynx

Oropharynx

Laryngo-pharynx or

Hypopharynx

Nasal Cavity

Oral Cavity

Laryngeal Cavity

WALLS OF PHARYNX- in the form of four layers

1. Mucous membrane-including “tonsil”2. Pharyngobasilar fascia = Submucosa3. Muscle layer4. Buccopharyngeal fascia

(1)Mucosa;

(2) Submucosa or Pharyngobasilar Fascia (including

the palatine tonsil);

(3) Muscular; and

(4)Buccopharyngeal Fascia

Cross Section,(Oral Pharynx)

for example:

PHARYNX IN POSTERIOR VIEW

Use scissors in lab

Submucosa extended superiorlyas the pharyngobasilar fascia

Nasal cavity

Oral cavity

Laryngeal cavity

RELATIONSHIPS

ANTERIOR

Choanae

Aditus

Soft Palate & Uvula

CHARACTERISTICSCHARACTERISTICSOF EACH OFOF EACH OF

THE THREE PARTSTHE THREE PARTSOF THE PHARYNXOF THE PHARYNX

(1) NASOPHARYNX (MUCOSA INTACT)

Pharyngeal tonsil

Auditory tube orifice

Pharyngeal recess

Torus tubarius

Salpingopharyngeal fold

Pharyngeal isthmus

Uvula

Choana

NASOPHARYNX – with mucosa removed

Torus Tubarius

Tensor (veli) palatini

Levator (veli) palatini

Salpingopharyngeus

Pharyngo-Tympanic

Tube

MiddleEar

Naso-pharynx

Torus Tubarius

Uvula

SOFT PALATE --comprised of glands &muscle & separates nasopharynx from oral pharynx

(2) OROPHARYNX (MUCOSA INTACT)

Palato-glossalfold

PalatineTonsil Bed

Palato-pharyn-gealfold

Pharyngeal Isthmus

TONSILLAR BED I-with mucosa removed

Palatoglossus

Pharyngobasilar

Fascia

-

Palatopharyngeus

Area between the 2 muscles or folds is the throat or fauces.

TONSILLAR BED

Palatoglossus

Superior Constrictor(forming the bed)

Palatopharyngeus

(WITH MUCOSA & SUBMUCOSA REMOVED)

TONSILLAR BED- II Superior constrictorwith inferior part re-moved

Tonsillar br. of facial a.

External palatine(paratonsillar) v.

Glossopharyngeal n. (IX)

?

Middle constrictor

Styloglossus—lying lateral to superiorconstrictor & joining with hyoglossus

A notable relationship:

Hard palate

Soft palate

Uvula

(3)Laryngopharynx (with mucosa intact)

Aryepiglottic fold-forming part of theaditus

Piriform recess-with mucosal foldindicating the location of the internal laryngeal n.

Bulge indicating location of cricoid cartilage

Indicates aditus or opening to larynx

MUSCLES OF PHARYNX

(1)

(2)

(3)

Outer Layer (circular)- constrictors-3

Inner Layer(longitudinal)-3

(1)

(2)

(3)

Now, let’s blowthese longitudinalmuscles up

Inner, Longitudinal Mm (3):

(1) Salpingopharyngeus

(2) Palatopharyngeus

(3) Stylopharyngeus – in reality only its in-ferior fibers are shown

(1) Superior Constrictor

(2) Middle Constrictor

(3) Inferior Constrictor

Outer, Circular Ms.-3

Salpingo-pharyngeus

Palato-pharyngeusStylo-Pharyngeus(inferiorfibers)

InnerLongitudinalMuscle Layer

Outer CircularMuscular Layer

Superior Constrictor

Middle Constrictor

Inferior Constrictor

(3)(3)

ThreeConstrictorMuscles:

Insertions:

Constrictor Muscles Insertion(s)-all insert posteriorly

Midline Raphe

Pharyngeal tubercle

Origins of constrictors- next:

Pterygomandibular raphe& bone at either end

Superior constrictor

Middle constrictor

Inferior constrictor

Esophagus

Stylohyoid ligament, body & lesser horn of hyoid bone

Origins of the three constrictor muscles (all arise anteriorly):

Thyroid and cricoidcartilages

Superior constrictor

Middle constrictor

Inferior constrictor

Esophagus

GAPS ABOVE, BETWEEN,& BELOW CONSTRICTORS:

Gap betweenSup. & Inf. Const.

Gap between Middle & InferiorConstrictor

Gap inferior toInferior Constrictor

Gap superiorto Sup. Const.

Thyrohyoid Membranepierced by the ____ ?

Recurrent Laryngeal N

Stylopharyngeus, Stylo-hyoid Ligament & IX N.

Region of Killian’s Dehiscence

PharyngobasilarFascia pierced byLevator palati m.& Auditory Tube

Structures relatedto the gaps

NERVES OF PHARYNX

Red (Crimson)= V2- naso-pharyngeal n.

Blue = IX n.—pharyngeal brs.

Auburn = X n.-internal laryngeal brs.

Afferent Fibers From Pharynx:

Motor Innervation of Pharynx

Pharyngeal brs.of X (SVE)--disruption of these fibers leadsto dysphagia

Pharyngeal brs.of sympathetic tr. (GVE)

Br. Of IX toStylopharyn-geus (SVE)

Add these sensoryfibers and the to-

tal equals the pharyngeal plexus

And Pharyngeal Plexus

BLOOD SUPPLY & LYMPHATICS

Pos

S A L F O P S M

A=AscendingPharyngeal A.

Ascending palatine br. of facial artery

DeepCervicalLymph Nodes

RetropharyngealLymph NodesDrain to

PALATINE TONSIL

Jugulodigastricor TonsillarNode

ATLANTO-OCCIPITAL & ATLANTO-OCCIPITAL & ATLANTO-AXIAL JTS.ATLANTO-AXIAL JTS.

Dens

C1

C2

C3

C4

Facet foroccipitalcondyle

Facet fortransverseligament

Atlas and Axis(superior view)

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)- (shaking “No”)

C1-C4 Vertebrae

MUSCLES PRODUCING MOVEMENT OF THE ATLANTO-OCCIPITAL (AO) JOINTS

MUSCLES PRODUCING MOVEMENT OF THE ATLANTO-OCCIPITAL (AO) JOINTS

Tectorial membrane

Posterior longitudinal ligament

Alar ligaments

Superior longitudinal band

Transverse ligament of atlas

Inferior longitudinal band

CRUCIATELIGAMENT

HYPEREXTENSION OF THE HEAD ON THE NECK FRACTURE OF THE AXIS (HANGMAN’S FRACTURE)

Pars inter-articularis

ORIGINALLY, THERE WERE 8 CERVICAL SYMPATHETIC GANGLIA, ONE ASSOCIATED WITH EACH CERVICAL SPINAL NERVE. BUT, THESE GANGLIA COALESCED INTO 3 (4) GANGLIA. THEREFORE, THESE REMAINING CERVICAL SYMPATHETIC GANGLIA WERE LEFT TO SEND POSTSYNAPTIC FIBERS (VIA GRC) TO SEVERAL SPINAL NERVES EACH.

The sympathetic trunk is located posterior to the

carotid sheath on the prevertebral

fascia

K. Kryger

R. Common Carotid A

internal carotid a

I. Carotid npostgang. fibers

Superior Cervical Ganglion

(upper 4 ganglia)

Middle cervical ganglion

(ganglia 5 & 6)

Inferior cervical ganglion

(ganglia 7 & 8)

1st rib (cut)R. subclavian a. (cut)

hyoid

Ext. Carotid N.

Lateral horns of cord levels T1-2

superior cervical ganglion (in neck)

Target tissue

smooth muscle in vessel walls,

dilator pupillae m, & sweat glands.

Preganglionic axons ascendin the sympathetic trunk

Postganglionic axons distributed via Ext. & Int. carotid ns.( carotid plexus)

K. Kryger

Functions:

1) vasoconstriction

2) dilate pupils

3) stimulate sweat glandsPreganglionic fibres enter the

sympathetic trunk

Overview of Sympathetics to HeadOverview of Sympathetics to Head

NOW, LET’S CONSIDER NOW, LET’S CONSIDER SYMPATHETIC FIBERSSYMPATHETIC FIBERS

TO TO THETHE CERVICAL VISCERACERVICAL VISCERA

Sympathetic fibers to the neck viscera, eg. Sympathetic fibers to the neck viscera, eg. the pharynx, would ascend as presynaptic the pharynx, would ascend as presynaptic

fibers to reach the cervical sympathetic fibers to reach the cervical sympathetic ganglia. Synapse would then occur, and ganglia. Synapse would then occur, and

postsynaptic fibers wouldpostsynaptic fibers wouldpass to the viscera via direct branches or pass to the viscera via direct branches or

via the blood vessels.via the blood vessels.

Cervical Viscera

Origin

T1-L2

LABLAB

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

Tectorial membrane

Posterior longitudinal ligament

Alar ligaments

Superior longitudinal band

Transverse ligament of atlas

Inferior longitudinal band

CRUCIATELIGAMENT

TectorialMembrane

4. CUT & REFLECT TECTORIAL MEMBRANE INFERIORLY.

5. CUT ALAR LIGS. & SUP. LONGITUDINAL BAND.

6. DISARTICULATE AO JOINTS (Indicated by the vertebral artery ) W/ HAMMER & CHISEL.

7. WORK YOUR HANDS INTO RETROPHARYNGEAL SPACE, AND PULL CERVICAL VISCERA AND HEAD FORWARD AWAY FROM VERTEBRAL COLUMN.

8. Cut prevertebral muscleattachment into the capitus

Rectus capitis lateralis

???

HAPPY TRAILSTO YOU….

Superficial cervicalNodes of head & face – inthe shape ofa collar (red line) around head and located in relationshipto E.J.V. in Neck

Deep Cervical Nodes – located in relation-ship to the I.J.V.

Division of deep cervicalnodes into superior & inferior groups by omo-hyoid tendon

SuperficialCervical Nodes

Lymph drainage review

Facet for dens

Groove for vertebral a.

Sup. facet foroccipital condyle

Post. facet fortransverse lig.

Spinous pr.Inf. articular pr.

Sup. facet for atlas

Interarticular part

ATLAS (C1): SUPERIOR VIEW

AXIS (C2): POSTEROSUPERIOR VIEW

Tubercle fortransverse lig.

Atlas-Inferior View

Axis-Anterior view

Dens

Post. tuberclePost. arch

Ant. archAnt. tubercle

Lat. Proc.