good

4. - Musculomembranous tube
- Base of skull to C6 vertebra
- Continuous as Oesophagus
- 3 parts :
(a) Naso pharynx – behind Nasal cavity
(b) Oro pharynx – behind oral cavity
(c) Laryngo pharynx – behind oral larynx
- Pharynx is cephalic part of alimentry tube but nasopharynx is
considered as a post extension of nasal cavity hence lined
by Respiratory epithelium.
- External relation
Above – Basi sphenoid & Basi occiput
Below – Oesophagus
Anterior – Nose, mouth, Larynx

5. Posterior – C1 – C6, intervertebral disc, pre & para vertebral
muscles with pre vertebral layer of DCF. Retroph. Space
with its content
Side – Styloid apparatus, carotid sheath
Nasopharynx / Epipharynx
Anterior wall – Choanal
Roof & Posterior wall – Sphenoid, occiput, Atlas
Floor – Pharyngeal isthmus
Features :
(a) Naso pharyngeal tonsil
- Prominent in children
- adenoid – enlargement of tonsil makes obligatory mouth
breathing
- adenoid facies

6. (b) Pharyngeal bursa / pouch of Luschka
- a diverticulum in tonsil with mucous gland
- develop d/t adhesion of the notochord to the dorsal wall
of pharynx
- tumor, cyst
(c) Pharyngeal hypophysis
Smt – pitutary like tissue is there d/t backward extension
of Rathke’s pouch of stomodum
Pharyngeal isthmus
Front – Post surface & free margin of soft palate
Behind – Passavant’s ridge (palato-pharyngeal sphincter)
Side – Palato-pharyngeal arch (muscle)
During swallowing or blowing air through mouth pharyngal
isthmus is closed d/t contraction of LVP, TVP, PP.

7. Lateral wall
(a) Opening of Auditory tube
1.25 behind & slightly below the posterior end of
Inferior nasal concha
(b) Tubal elevation
at upper & posterior margin of auditory opening
2 folds of mucous membrane :
- Salpingo pharyngeal fold (muscle)
- Salpingo palatine fold
(c) Pharyngeal recess / Foss of rosenmuller
behind the tubal elevation, between LVP & longus capitis

8. ORO PHARYNX
(Meso pharynx)
- Behind the oral cavity, separated by oro pharyngeal isthmus
(soft palate, palato glossal arch, tongue)
- Palatine tonsil in triangular tonsillar fossa
- Posterior – C2 & C3 vertebral with contents of retro
pharyngeal space

10. Laryngo pharynx (Hypopharynx)
Anterior – Epiglottis to cricoid cartilage
Posterior – C4 to C6 vertebra with retropharyngeal space & its
content
Anterior wall have Laryngeal inlet
Boundaries of Laryngeal inlet –
- epiglottis, aryepiglottic fold, inter-arytenoid fold of mucous
membrane
Piriform fossa – present on each side of laryngeal inlet in the
lateral wall of laryngo pharynx
Boundaries – aryepiglottic fold, lateral glosso epiglottic fold or
pharyngo-epiglottic fold, mucuous membrane covering the
medial surface of the lamina of thyroid cartilage & thyrohyoid
membrane.

11. Note – Internal Laryngeal Nerve & Superior Laryngeal Vessels
pierce the thyroid membrane, traverse the outside the
mucous lining from lateral to medial side
- Fossa is a catch point of foreign body
Layer’s of Pharynx
(a) Bucco pharyngeal fascia/Areolar
- not well defined
- epimysium of ph. Muscles
- covers outer surface of constrictors & buccinator
(b) Muscular coat
- outer coat / circular coat all constrictor
- inner coat / longitudinal
stylopharyngeus, palato pharyngeus, salpingo
pharyngeus

12. (c) Submucous coat / pharyngeal aponeurosis
- pharyngio basilar fascia closes the sinus of morgagni
(space between superior constrictor and base of skull)
(d) Mucous membrane
Naso pharyngeal – ciliated columnar
oral & laryngopharynx – non ker. Strati. Squamous
Transitional Zone

14. Structures passing between constrictors
(a) Through sinus of Morgagni
- Auditory tube
- LVP
- Ascending palatine artery
- Palatine branch of ascending pharyngeal artery
(b) Between superior & middle constrictor
- Stylo pharyngeus muscle
- 9th Nerve
(c) Between middle and inferior constrictor
- Internal laryngeal nerve
- Superior laryngal vessels
(d) Below inferior constrictor (in oesophageal groove)
- Recurrent Laryngeal nerve
- Inferior Laryngeal vessels

15. Nerve Supply
(a) Motor – Cranial part of 11th Nerve except stylo pharyngeus
(9th Nerve)
Inferior constrictor also supplied by recurrent & external
laryngeal nerve
Nucleus Amigus is main nucleus
(b) Sensory –
Naso pharynx – Maxillary (PPG)
Ora pharynx – 9th Nerve
Laryngo pharynx – Internal lar. Nerve
Pharyngeal Plexus
- Cranial part of 11th nerve
- Pharyngeal branch of 9th nerve
- Sympathatics of superior cervical ganglion
- Smt. Ext. lar. nerve

16. Plexus lies on bucco pharyngeal fascia which covers the middle
constrictor vagus is motor, 9th nerve-sensory sympathatics
are vasomotor
Blood Supply
(a) Arterial
- Ascending pharyngeal
- Ascending palatine and tonsillar branch of fascial artery
- gretaer palatine, pharyngeal, pterygoid branch of maxillary
- dorsal lingual branch of lingual
(a) Vein
Venous plexus – Pterygoid venous plexus
IJV

23. Applied
(a) Zenker’s Diverticulum
Dehiscence of Killian
Pulsion diverticulum (C/m Left side)

24. Palatine Tonsil
- Almond shaped Lymphoid tissue in Lateral wall of oro-
pharynx in tonsillar sinus
- Boundaries of tonsillar sinus
Front – palato glossal sinus
Behind – Palato glossal arch
Apex – Soft palate
Base – Post 1/3rd of tongue
Lateral wall – Tonsillar bed
Parts : 2 surfaces – Medial & Lateral
2 Ends – Upper & Lower
2 borders – Anterior & Posterior

27. Medial Surface
- Free, bulges into oro pharynx
- Lined by NKSSE
- Tonsillar pits – 12 th 15 in numbers
- Intra tonsillar cleft / crypta megna 40% remanant of IInd pharyngeal
pouch
- Embryonic folds – Plica semilunaris
-- Plica tringularis
Lateral surface
(a) Fibrous capsule
(b) Loose areolar tissue containing para tonsillar vein
(c) Pharyngo-basilar fascia
(d) Superior constrictor muscle
(e) Bucco pharyngeal fascia with pharyngeal plexus of nerve & vessels
(f) Arteris – fascial with ascending palatine and tonsillar br.
- Ascending pharyngeal
- ICA
Base – Suspensory Lig. of tonsil – fibrous band between tongue & tonsil

28. Arterial supply
- Anterior tonsillar artery – branch of lingual
- Post tonsillar artery – ascending palatine (fascial),
ascending pharyngeal
- Superior tonsillar artery – greater palatine (maxillary)
- Inferior tonsillar – (main artery, branch of fascial)
Note – Ligature of these arteries specially inferior tonsillar is
an important step in tonsillectomy.
Venous drainage – Pharyngeal veins plexus via para tonsillar
vein
Lympatic – Juglodigastric LN
NS – 9th Nerve gretaer & lesser palatine nerve, branch of
PPG. These nerve convey both general & taste sensation
Development – Ventral part of IInd pouch.

30. Applied
(a) Tonsil prevent infection but when infected themselves they
act as a septic foci of the body so surgical removal is
indicated.
(b) Excessive venous haemorrhage d/t paratonsillar vein
(c) Loss of taste – 9th nerve injury
(d) Referred pain to middle ear d/t common nerve supply (9th
nerve)
Auditory Tube
- Pharyngo-tympanic or Eustachian tube
- Mucous lined osseo cartilaginous channel between lateral
wall of nasophx and ante wall of tympanic cavity
- Function – equlilize air pressure on both sides of tympanic
membrane
- Direction – donward, forward, medially
- 36 mm long – 12 mm bony, 24 mm fibro cartilagenous

33. - Narrowest part – Junction between 2 parts
- Widest part – opening in nasophx (1.25m beind & slightly
above the post end of inf. Nasal concha)
- Tubal tonsil / elevation – above & behind
- Muscle attached – LVP
- TT
- Salpingo pharyngeus
- TVP
- Opening muscle
(a) Actively – TVP / dilator tubal
- Salping pharyngeus
(b) Passively – LVP
- Epithelium – bony part – non ciliated flat or cartilage part –
ciliated columnar

34. - Auditory tube in children :
(a) 18 mm long
(b) wider, more horizontal
(c) tubal elevation not prominent
- Arterial supply – (a) MMA
(b) A. to pterygoid canal
(c) Ascending pharyngeal
- Venous drainage – Pharyngeal, pterygoid plexus
- Lymphatic – Retropharyngeal, upper deep cervical
- NS – 9th nerve, except pharyngeal opening (PPG-
maxillary)
- Development – Medial part of tubotympanic recess
Applied
(a) Aeroplane traveling
(b) Catheterization in retracted tympanic membrane (RTM)
(c) Channel of infection

35. Larynx
- Organ of Respiration & Phonation
- Extends – epiglottis to cricoid cartilage
- Communicates – above – laryngeal inlet
below – trachea
- C3 to C6 (A), C1 to C4 – Children
- 9 cartilages are there – 3 are unpaired and 3 are paired
Paired – epiglottis, thyroid, cricoid
Unpaired – arytenoid, corniculate, cuneiform
Note – All laryngeal cartilages are hyaline except epiglottis,
corniculate, cuneiform, vocal process & apex of arytenoid
which are elastic cartilage
Hyaline cartilage ossify with age but not elastic cartilage

57. Epiglottis – Ends – Upper and Lower
- Surfaces – Anterior and Posterior
- Border – Lateral
Thyro epiglottic ligament
Median & 2 lateral glossoepiglottic fold vellacula
Hyo epiglottic ligament
Aryepiglottic folds – having aryepiglotticus and thyroepiglotticus
muscle
Thyroid Cartilage
For protection of larynx in front
2 Lamina
Thyroid angle (Adam’s apple)
2 Surface – Outer and Inner
4 Borders – Upper, Lower, Anterior and Posterior

58. 2 horn – Upper and Lower
Upper border – Thyrohyoid membrane, subhyoid bursa
Lower border – Cricothyroid membrane, conus elasticus

60. Cricoid cartilage –
- Foundation sotne of larynx
- Signatring shaped
Parts – Anterior Arch & Posterior Lamina
Border – Upper & Lower
Arytenoid cartilage –
Pyramidal apex base
3 surfaces – Posterior, medial and anterio lateral
2 process – Muscular & Vocal

66. Cavity of Larynx
Vestibule / Supra glottic part
Rima vestibuli
Sinus of Larynx and Saccute
Rima glottidis / glottis
Infra glottic part
Vocal folds / vocal cords
Vestibular folds
Movements of Rima glottidis
- Abduction
- Adduction
- Tension
- Relaxation

69. Nerve Supply of Larynx
(VC) Vocal Cord – cuater shaped line
Sensory – above the VC internal laryngeal
below VC RLN
Motor – All muscles of larynx are supplied by RLN (cranial part
of accessory nerve) except – cricothyroid (laryngeal nerve)
All muscle of larynx are paired except transversus arytenoid
which is having dual nerve supply RLN & Internal laryngeal
nerve
Blood Supply
Above VC – Superior thyroid
Below VC – TTS via inf. Thyroid

70. Lymphatic drainage
Above VC – Prelaryngeal LN
Luglodiagastric LN
Below VC – Pre & Para tracheal LN
Applied
Paralysis of Laryngeal muscles
Nerve involved Position of glottis
(a) One side RLN Fixed Para median
(b) Both RLN Both glottis are in
Para median position
(c) RLN with ext. laryngeal nerve Fixed and abducted
(cadaveric)
Semon’s law – Abductors of larynx are paralyzed first in
chronic involvement of RLN.