2. BRIG MIRZA KHIZER HAMEED
ANATOMY OF PHARYNX
BRIG MIRZA KHIZER HAMEED

3. PHARYNX Muscular tube lying behind the nose, oral cavity & larynx
Extends from the base of the skull to level of the 6th cervical vertebra, where it is continuous with the esophagus
The anterior wall is deficient and shows (from above downward):
Posterior nasal apertures
Opening of the oral cavity
Laryngeal inlet

4. PHARYNX Site Midline of the neck From skull base to esophagus Behind :
Seen from behind
Midline of the neck
From skull base to
esophagus
In front of upper 6
Cervical vertebra
Behind :
The Nose
The Mouth
The larynx

5. PHARYNX Shape Irregular Fibromuscular tube lined by mucous membrane
Length: 15 cm

6. PHARYNX Structure The wall is formed of 4 layers 1-Mucous membrane
2- Pharyngeal aponeurosis
3-Muscle layer
4-Bucco-pharyngeal fascia
Formed of 3 muscles, superior middle and inferior constrictor muscles
A thin coat of connective tissue
Loose connective tissue which contains lymphoid tissue that aggregates in some areas forming tonsils (Waldayer’s ring)
Stratified squamous epithelium except the nasopharynx, it is pseudo-stratified with goblet cells

7. PHARYNX Compartments Pharynx is divided into three compartments:
Nasopharynx:
Superior part, communicates with the nasal cavity through posterior nasal apertures
Oropharynx:
Middle part, communicates with the oral cavity through the oropharyngeal isthmus
Hypopharynx:
Inferior part, communicates with the larynx through the laryngeal inlet

8. PHARYNX Compartments Nasopharynx Oropharynx Hypopharynx
Seen from behind
Nasopharynx
Oropharynx
Hypopharynx

9. PHARYNX Compartments Nasopharynx Oropharynx Hypopharynx
Seen from lateral
Nasopharynx
Oropharynx
Hypopharynx

10. Nasopharynx -Behind the nasal cavity
-Extends from skull base superiorly to the soft palate inferiorly
-Communicates inferiorly with the oropharynx through the velo-pharyngeal sphincter
-The nasopharyngeal tonsil lies in the roof
-The pharyngeal opening of ET lies in the lateral wall

11. Oropharynx
Behind the oral cavity (in front of 2nd&3rd Cervical vertebra)
From the soft palate superiorly to tip of epiglottis inferiorly
Communicates:
Anteriorly with the oral cavity
Superiorly with the nasopharynx
Inferiorly with the hypopharynx
The palatine tonsils lie laterally
between the anterior and posterior pillars

12. The posterior pillar formed The tonsils lie between the
The anterior pillar formed
by palatoglossus muscle
The posterior pillar formed
by palatopharyngeus
muscle
The tonsils lie between the
Two pillars

13. PALATINE TONSILS Paired masses of lymphoid tissue
Located in the palatine fossa/sinus, in the lateral wall of the oropharynx
Reaches its maximum size during early childhood, but after puberty diminishes in size

14. PALATINE TONSILS Lateral surface: covered by a fibrous capsule
Medial surface:
Projects into the cavity of oropharynx
Covered by mucous membrane
Shows multiple depressions, the tonsillar crypts and one deep intratonsillar cleft

15. Hypopharynx
Behind the Larynx (in front of 3rd to 6th Cervical vertebra)
From the tip of epiglottis superiorly to the lower border of cricoid cartilage inferiorly
Communicates:
Anteriorly with the Larynx
Superiorly with the oropharynx
Inferiorly with the esophagus

16. Hypopharynx The hypopharynx does not only
Seen from
behind
The hypopharynx does not only
lie behind the larynx BUT also
Projects laterally on each side of the larynx
So it is formed of :
Postcricoid region ( behind the larynx)
Posterior pharyngeal wall
Two pyriform fossae (on each side of the larynx
Cross section

17. Waldeyer’s ring It is a lymphoid tissue ring located in the pharynx
Consists of:
Adenoids (pharyngeal tonsils)
Tubal tonsil
Palatine tonsil
Lingual tonsil
Lateral pharyngeal bands
Lymphoid follicles in post.
wall

18. Waldeyer’s ring The lymphoid tissue in the pharyngeal aponeurosis
aggregates in some areas
forming tonsils:
1-one nasopharyngeal tonsil
2- two palatine tonsils
3- two lingual tonsils

19. Blood supply From the External Carotid Artery & its branches
1- Tonsillar artery (from Facial Artery)
2- Ascending palatine artery (from Facial Artery)
3- Ascending pharyngeal Artery (from external carotid)
4- Descending palatine artery ( from Maxillary artery)
5- Dorsalis lingulae artery (from Lingual artery)

20. Lymph Drainage Nasopharynx ---►Retropharyngeal
---►Upper Deep Cervical L N
Oropharynx ---► Upper Deep Cervical L N
Hypopharynx ---► Upper Deep Cervical L N

21. Nerve Supply Motor X Sensory Autonomic Except : Stylopharyngeus IX
Tensor palati V
Sensory
Nasopharynx V
Oropharynx IX
Laryngopharynx X
Autonomic
Sympathetic: SCG
Parasympathetic: through VII

22. BRIG MIRZA KHIZER HAMEED
ACUTE PHARYNGITIS
BRIG MIRZA KHIZER HAMEED

23. Pharyngitis
Inflammation of the Pharynx secondary to an infectious agent
Most common infectious agents are Group A Streptococcus and various viral agents
Often co-exists with tonsillitis

24. Etiology 30%-65%: idiopathic 30%-60%: viral 5%-10%: bacterial
Group A beta-hemolytic: most common bacterial pathogen
15%-36%: pediatric cases
5%-10% : adult pharyngitis
Disease of children

25. Etiology Bacterial Fungal Others Viral Strep.A
Corynebacterium diphteriae
Gonococcus
Fungal
Candida albicans
Others
Toxoplasmosis
Viral
Rhinovirus
Influenza
Parainfluenza
EBV
Cytomegalovirus
HIV

26. Clinical manifestations
Differ in severity
Fever
Sore throat
Headache
GI symptoms
Erythema
Exudates
Enlarged tonsils
Anterior cervical adenopathy
Prominent lymphoid follicles on Post. Wall
Edema of Uvula

27. Suppurative Complications of Group A Streptococcal Pharyngitis
Otitis media
Sinusitis
Peritonsillar and retropharyngeal abscesses
Suppurative cervical adenitis

28. Nonsuppurative Complications of Group A Streptococcus
Acute rheumatic fever
follows only streptococcal pharyngitis (not group A strep skin infections)
Acute glomerulonephritis
May follow pharyngitis or skin infection (pyoderma)
Nephritogenic strains

29. Course Group A strep pharyngitis naturally self-limiting
Resolve spontaneously in 3-4 days w/ or w/o antibiotics
Rapid test or throat culture: reduces unnecessary antibiotic use by identifying those whom antibiotic therapy is justified

30. Diagnosis
History
Throat culture
Rapid antigen detection test (RADT)

31. Diagnostic tools History: Fever Tonsillar exudates
Swollen or tender lymph nodes
Lack of cough
unreliable

32. Diagnostic tools Throat culture: gold standard for dx
Sensitivity 90%, specificity 99%
For adult patients to confirm clinical diagnosis

33. Diagnostic tools Rapid antigen detection test (RADT)
When throat culture is impractical or inappropriate
Extensive contact with others
Work full-time jobs
Difficult to reach
Sensitivity 80%-90%, specificity 70%-95%
Helps selects true positives thus avoiding unnecessary use of antibiotics
(+) RADT- start antibiotic therapy

34. Treatment Antibiotic Bed rest Plenty of fluids
Analgesics/ Antipyretics
Warm saline gargles
Decongestants

35. Antibiotic therapy Penicillin Ampicillin, amoxicillin Cephalosporins
Macrolides

36. Thank You