2.  Pharynx  Larynx  Esophagus  Trachea  Salivary glands  Thyroid gland  Cervical lymph nodes

3.  Funnel shaped  12 cm long muscular tube  Opening for respiratory and digestive organs  Base of skull  extend inferior to esophagus  3 sections:  Nasopharynx  Oropharynx  laryngopharynx 1.Pharynx3. Larynx 2. Epiglottis 4. Esophagus

4.  Nasopharynx › Superior- nasal cavity › Passage of air from nasal cavity to larynx › Boundary  posterior- clivus/ upper cervical spine  Inferior- soft palate- uvula  Lateral wall- post/inf nasal conchae  Opeining of eustachian tube- middle ear recurrence of nasopharyngeal carcinoma in the right nasopharynx

5.  Oropharynx › Posterior oral cavity › Soft palate  Hyoid › Separated from larynx by epiglottis › Lymphoid tissue- palatine & lingual tonsils › Valleculae- pouch like openings  (foreign objects can lodge) Planning procedure for the two lateral opposing 6 MV asymmetrical fields for the treatment of the oropharyngeal region. The isocenter is positioned between vertebrae C5 and C6

6.  Laryngopharynx › From oropharynx- between hyoid bone and esophagus/lary nx › @ the cricoid cartilage it becomes the esophagus › Piriform sinuses- depressions that divert food from larynx

7. Recap of Anatomy 1. Corpus Callosum 2. Sphenoid sinus 3. 4 th Vent 4. Oropharynx 5. Spinal Cord

8.  Bony skeleton- “voice box”  Surround and protect vocal cords  Laryngopharynx  trachea › Beginning of respiratory pathway  Three of the cartilages that make up the larynx are:  Thyroid  epiglottis  Cricoid- ring @ base of larynx on which other cartilages rest-junction of larynx/trachea and beginning of esophagus.

9.  Thyroid is the longest and most superior  Anterior lamina of the thyroid cartilage= “Adam’s Apple”  Posterior to the Adam’s apple is the epiglottis- during swallowing the epiglottis folds back over the larynx to prevent solids from entering the respiratory tract. acute epiglottitis

10. MR imaging, larynx. T1- weighted axial slice above Image 2 showing the epiglottis Axial CT scan of a T4 laryngeal tumor with extensive cartilage destruction

11.  Laryngopharynx to cardiac orifice of stomach  Posterior to cricoid cartilage and descends though thoracic cavity › between trachea and anterior longitudinal ligament of vertebrae  Opening in diaphragm= esophageal hiatus  2 sphincters › Esophageal- @ entrance- prevents air › Cardiac- @ prevents reflux from stomach

12. What is the condition that happens to the esophagus when Portal Hypertension is present???

13.  Airway  Extend from larynx  lungs  ANTERIOR to esophagus  T5 –trachea bifurcates into the right and left mainstem bronchi…….CARINA

14.  Produce and empty saliva into the oral cavity by ducts  Begin the digestion process  3 large paired glands : › 1. parotid- largest- anterior to auricle › 2. submandibular- border post half of mandible- to hyoid bone › 3. sublingual- smallest, lie under the tongue Adenoid cystic carcinoma of the parotid

15. abscesses. enlarged left submandibular gland CT scan shows a large mucous retention cyst arising from the sublingual gland (ranula)

16. How do we prevent it??? MMR shot…..

17.  Endocrine gland  Located @ level of cricoid cartilage  Two lobes joined together by an isthmus  Excretes hormones  Thyroxine (T4)- body growth/ metabolism  Triiodothyronine (T3)- growth/ metabolism  Calcitonin- < blood calcium to promote bone formation  Controlled by the parathyroid glands- posterior surface of thyroid lobes (4 total) adenocarcinoma

19.  >1/3 of the body’s total nodes  About 75 on each side of the neck  Lymph vessels carry fluid from interstitial spaces to the regional lymph nodes that filter the lymph fluid- before emptying into the venous blood supply

20. central necrosis within a left cervical lymph node metastasis

21. Images of cervical Lymph Nodes Normal adenopathy

22.  The neck is divided by sternocleidomastoid (SCM) into anterior and posterior triangles  Originates on the sternum and clavicle and inserts on the mastoid tip of temporal bone  Turns the head and flexes the neck

23.  Muscles of the throat  Suprahyoid and infrahyoid › Infrahyoid muscles are called Strap muscles › They look like ribbons extending inferiorly on the anterior neck

24.  Trapezius  Splenius capitis  Levator scapulae  Anterior, middle and posterior scalene

25. 4.2 cm left supraclavicular mass posterior to the sternocleidomastoid muscle and lateral to the carotid sheath

26. Vertebral body Is not involved. Brachial plexus. Lesions coming from the cervico-brachial plexus are expected to be found in a more paraspinal location. Vertebral artery and vein Are not involved. Prevertebral and paraspinal musculature. The lesion is clearly arising from the left paraspinal musculature.

27.  Carotid arteries  Rt CCA- arise from brachiocephalic artery posterior to sternoclavicular joint  Lt CCA- arises directly from AO arch  Medial to internal jugular and bifurcate into internal and external carotid at level of thyroid cartilage (C3- C4)

30.  Branch of the subclavian artery and ascend though the transverse formina of C6-C1  Arteries enter foramen magnum and join to form the BASILAR artery

31. (A) Axial computed tomographic (CT) angiogram shows the course of the right vertebral artery. (B) Corresponding coronally reformatted CT angiogram shows the course and morphology of the right vertebral artery. The complexity of the fracture (arrow) is also visible. (C) Axial CT angiogram through C2 shows the course of the left vertebral artery. (D) Corresponding oblique coronally reformatted CT angiogram shows the course and morphology of the left vertebral artery

32.  Internal jugular veins drain blood from brain  Largest vascular structures of the neck  Unite with the subclavian vein to form brachiocephalic vein  Rt is larger than the Lt  Lateral to common carotids