PHARYNX & PALATE

Objectives:
Students should be able to:
1.
define the term pharynx and list its anatomical divisions;
2.
describe the arrangement and functions of the muscles of the pharynx and palate;
3.
outline the nerve and blood supply of the pharynx and palate;
4.
define the term "tonsils" and state their locations and functions;
5.
list the basic mechanisms involved in swallowing.

Clinical considerations:
Swallowing - difficulties
Middle ear - infections in relation to colds
Tonsils - inflammation

Pharynx
The pharynx is a muscular tube, lined by mucous membrane, extending from the base of the skull
to roughly the C6 vertebral level (cricoid cartilage level), where it is continuous with the
oesophagus. A potential space, the retropharyngeal space, lies between the pharynx and the
vertebral column on which it rests. Infections can spread through this space.

PHARYNX GENERAL FEATURES

SAGITTAL SECTION
Cranial cavity

Nasal cavity

Pharyngotympanic tube
Nasopharynx

Hard Palate
Palatoglossal
arch

Soft palate
Oropharynx

Oral cavity

Vertebral column
Laryngopharynx

Tongue
Epiglottis
Larynx

Vertebral canal
Oesophagus

Trachea
The function of the pharynx is to conduct air to the larynx and food to the oesophagus and it is

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divided into three anatomical regions:
i) nasopharynx - posterior to the nasal cavity (above the soft palate). The pharyngotympanic
(auditory, Eustachian) tube opens into it;
ii) oropharynx - posterior to the oral cavity (below the soft palate). It includes the posterior third of
the tongue;
iii) laryngopharynx - posterior to the larynx and its opening. The bulging of the larynx into the
central part of the laryngopharynx, results in a lateral, piriform recess (fossa) on each side.

DIVISIONS OF PHARYNX
POSTERIOR VIEW

Base of skull
Nasal cavity

Nasopharynx

Soft palate

Palatopharyngeal arch (fold)

Oropharynx

Tongue
Epiglottis
Laryngeal inlet

Laryngopharynx

Piriform recess (fossa)

Pharyngeal wall (cut)
Laryngeal cartilage
Oesophagus

PHARYNX - OSTEOLOGY (base of skull)

Nasal cavity

Outline of
pharyngeal
attachment

Medial
pterygoid plate

Styloid
process

Pharyngotympanic
tube - cartilaginous

Pharyngeal
tubercle

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Muscles
i. constrictor muscles (superior, middle and inferior) - three bilateral, overlapping muscles,
passing from the base of the skull, to the junction with the oesophagus. Anteriorly they attach to
skeletal structures, including the skull, mandible, hyoid bone and laryngeal cartilages. Posteriorly
they meet in the midline at the pharyngeal raphe. They are lined internally by pharyngo-basilar
fascia and mucous membrane. The fascia is thickened superiorly where it attaches to the base of
the skull. Here, it helps to keep the nasopharynx patent (open) for the passage of air.
The constrictors contract from above downwards during swallowing, pushing food into the
oesophagus. The lower part of the inferior constrictor (cricopharyngeus) is thickened and
functions as a sphincter, preventing entry of air into the oesophagus during breathing.

CONSTRICTOR MUSCLES
LATERAL VIEW

POSTERIOR VIEW

Superior constrictor

Middle constrictor

Inferior constrictor

ii. stylopharyngeus muscle - originates from the styloid process and enters the pharynx
between the superior and middle constrictors, and attaches to the posterior border the thyroid
cartilage. It aids in raising the larynx during the early part of swallowing.

PHARYNGEAL MUSCLES
POSTERIOR VIEW
Pharyngeal tubercle

Pharyngobasilar fascia
Pharyngotympanic tube
Medial pterygoid plate
Mandible

Hyoid bone

Thyroid cartilage
Cricoid cartilage

Superior constrictor
Stylopharyngeus
Middle constrictor

Inferior constrictor
(cricopharyngeus)
Oesophagus

Palate
The palate forms a partition, separating the oral cavity and oropharynx from the nasal cavity and
nasopharynx. The anterior, hard palate is bony and rigid. It is formed on each side by parts of the
maxilla and palatine bones. The bones of the two sides meet in the mid-line.

HARD PALATE - OSTEOLOGY

Incisive foramen
Greater & lesser
palatine foramina

Maxilla
palatine process
Palatine bone
horizontal plate

Nasal cavity
Hamulus
Medial
pterygoid plate

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The soft palate attaches to the posterior margin of the hard palate. It is muscular and mobile, and
is raised to seal off the nasopharynx from the rest of the pharynx during swallowing. Relaxation
(lowering) of the soft palate allows direct passage of air from the nasopharynx into the oropharynx
during breathing. Its posterior, free edge has a mid-line projection, the uvula (= small grape),
which hangs down into the oropharynx.
The soft palate is elevated (raised) during swallowing to prevent food entering the nasopharynx
and depressed (lowered) at other times to allow air to pass through the nasal cavity and
nasopharynx during breathing. Paired tensor and levator palati muscles, which arise from the
base of the skull, are responsible for its elevation, while paired palatopharyngeus and
palatoglossus muscles depress the soft palate. The tendons of the two tensor palati muscles
form an aponeurosis in the soft palate which acts as a "skeleton" for attachment of the other
muscles of the palate.

MUSCLES OF PALATE
POSTERIOR VIEW
Nasal cavity

Pharyngotympanic tube
Tensor palati

Hamulus
Levator palati
Palatine
aponeurosis

Uvular muscles

Palatopharyngeus
Oral cavity

MUSCLES OF PALATE
SAGITTAL VIEW
Tensor palati
Nasal cavity
Pharyngotympanic
tube
Hard palate
Levator palati
Soft palate
Tongue
Palatine
aponeurosis
Palatoglossus

Palatopharyngeus

Superior &
middle
constrictors

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At the base of the skull the tensor and levator palati muscles also attach to opposite sides of the
cartilaginous part of the pharyngotympanic tube, which opens into the nasopharynx. Posteriorly,
the cartilaginous part of the tube is continuous with a bony part which forms a canal in the
temporal bone. Eventually, it opens into the tympanic (middle ear) cavity. When the muscles
contract, as in swallowing, the tube is opened and the pressure in the tympanic cavity and
nasopharynx can be equalized.

Nerves:
i) motor: Most of the muscles of the pharynx and palate are supplied by the vagus nerve
(cranial nerve X), via its pharyngeal , external laryngeal and recurrent laryngeal branches.
Exceptions are the stylopharyngeus (supplied by the glossopharyngeal nerve) and the tensor
palati (supplied by the mandibular nerve [V3]).

NERVES OF PHARYNX
POSTERIOR VIEW
Pharyngobasilar fascia
Pharyngotympanic
tube
Styloid process
Superior constrictor
Stylopharyngeus
Middle constrictor

Glossopharyngeal n.
Vagus n.
to stylopharyngeus

Pharyngeal n.
Pharyngeal plexus
Superior laryngeal n.
Internal laryngeal n.

Inferior constrictor

External laryngeal n.
Oesophagus

Recurrent laryngeal n.

ii) sensory:
a) nasopharynx and palate - from the maxillary nerve;
b) oropharynx (including the posterior part of the tongue) - glossopharyngeal nerve;
c) laryngopharynx - vagus nerve (via the internal laryngeal nerve [above level of vocal chords]
and the recurrent laryngeal nerve [below level of vocal chords]).
(The most posterior part of the tongue [root], immediately anterior to the epiglottis, receives
innervation from the internal laryngeal branch of the vagus.)
Branches of the glossopharyngeal nerve (sensory), pharyngeal branch of the vagus nerve (motor)
and superior cervical sympathetic ganglion form a pharyngeal plexus over the posterior surface of
the middle constrictor muscle. Branches from the plexus penetrate the pharyngeal wall to reach
their targets.

PHARYNX & PALATE SENSORY NERVES

POSTERIOR VIEW

Base of skull
Nasopharynx

Maxillary
Oropharynx

Glossopharyngeal

Nasal cavity
Soft palate
Tongue
Epiglottis
Laryngeal inlet

Laryngopharynx

Vagus

Internal laryngeal

Level of vocal chord

Recurrent laryngeal

Laryngeal cartilage
Oesophagus

Vessels - arterial supply is from the external carotid artery via the ascending pharyngeal,
maxillary, facial and superior thyroid arteries, as well as from the inferior thyroid arteries
(from the subclavian arteries).
The corresponding veins form a pharyngeal plexus (venous) on the posterior surface of the
pharynx. Veins from the plexus drain into the internal jugular vein. The pharyngeal plexus also
communicates with other venous channels, such as the pterygoid plexus, to be described later.

Tonsils - accumulations of lymphoid nodules within the mucosa lining the pharynx. They act as
a "first line of defence" against organisms entering through the oral or nasal cavities. Tonsils tend
to be much larger in children than in adults. The main ones are as follows:
i) palatine tonsils - found on each side of the entrance to the oropharynx, in depressions
between the palato-glossal and palato-pharyngeal arches. Their lateral surfaces are covered by a
fibrous capsule derived from the pharyngo-basilar fascia. The capsule is penetrated by a tonsillar
branch of the facial artery and a corresponding vein. The vein, in particular, may bleed following a
tonsillectomy;
ii) pharyngeal tonsil - in the posterior wall of the nasopharynx. When enlarged, it is known as
the "adenoids";
iii) lingual tonsil - located in the posterior one-third of the tongue;
iv) tubal tonsil - found around the opening of the auditory tube into the pharynx.
Tonsils have efferent lymphatic vessels leading from them. They drain to deep cervical nodes,
which are associated with the internal jugular vein.

TONSILS
SAGITTAL SECTION THROUGH NASO- & ORO-PHARYNX
Tubal tonsil
Nasal cavity
Pharyngotympanic tube
Palate

Pharyngeal tonsil

Oral cavity
Nasopharynx
Palatoglossal fold
Tongue
Lingual tonsil

Palatine tonsil
Oropharynx
Palatopharyngeal fold

Anatomical Basis of Swallowing

Swallowing involves a number of co-ordinated steps which can be summarized as follow:
1.
After chewing (in the case of solid food), the mouth is closed and the tongue raised against
the hard palate, pushing the food back towards the oropharynx.
2.
The soft palate is elevated, thereby sealing off the nasopharynx from the oropharynx.
3.
The hyoid bone is moved forward, to increase the antero-posterior diameter of the
oropharynx.
4.
The larynx is elevated, together with the laryngopharynx. As a result the epiglottis is
pushed up against the base of the tongue causing the epiglottis to fold back over the
laryngeal inlet.
5.
Food slips into the oropharynx and over the closed laryngeal inlet.
6.
The constrictor muscles contract in sequence, from above, downwards, pushing the bolus
of food through the laryngopharynx and into the oesophagus. The contraction continues
along the wall of the oesophagus, propelling the food towards the stomach.
7.
The larynx and soft palate are lowered, the laryngeal inlet re-opens and the hyoid bone
moves back.