All MOTOR inneveration to pharynx muscles is by

~ ~ ~ PHARYNX ~ ~ ~ Ann Nguyen -- NYUCD 2008

Pharyngeal Plexus (cranial-XI
D1traveling with-- X)
Anatomy Notes Spring '05
Dr. Baker
EXCEPT: • Stylopharyngeus (IX)
• Tensor Palatini (V3)
• Cricopharyngeus (Recurrent Laryngeal)
- a common passageway for food and air, but structurally belongs to the GI tract
- air proceeds anteriorly down the larynx  trachea  bronchial tree All SENSORY inneveration to pharynx mucosa is by
- food proceeds posteriorly down the esophagus Pharyngeal Plexus (IX traveling with X)
- posterior communication w/ nasal cavity (above) & oral cavity (below)
EXCEPT: • Nasopharynx above the Eustachian Tube
(Pharyngeal branches of V2 traveling thru
MUSCLES OF THE PHARYNX Palatovaginal & Vomerovaginal Canals)

Constrictor Muscles Origin Insertion Action Innervation

Pharyngeal Tubercle (occipital)

Superior Constrictor
- Pterygopharyngeus Hamulus
- Buccopharyngeus Pterygomandibular Raphe
- Mylopharyngeus Mylohyoid Line of Mandible
- Glosspharyngeus Tongue

sequential peristaltic Accessory (XI)

squeezing of the traveling with
Middle Constrictor Pharyngeal Raphe pharynx during Vagus (X)
- Ceratopharyngeus Greater Hyoid Horn swallowing to move
food downward
- Chondropharyngeus Lesser Hyoid Horn

Inferior Constrictor
- Thyropharyngeus Thyroid Cartilage
- Cricopharyngeus Cricoid Cartilage Recurrent
this part does NOT meet at Raphe
Laryngeal
Longitudinal Muscles Origin Insertion Action Innervation

Constrictor muscles
Styloid Process Glossopharyngeal
Stylopharyngeus Thyroid Cartilage (posterior)
(medial aspect) (IX)
Lateral Glossoepiglottic Fold

Pharyngobasilar Fascia elevates

Hard Palate
Palatopharyngeus Thyroid Cartilage (posterior) pharynx & larynx
(posterior edge)
pharyngeal wall during swallowing
Accessory (XI)
traveling with
Vagus (X)
Eustachian Tube
Salpingopharyngeus pharyngeal wall
(medial cartilaginous part)

Associated Muscles Origin Insertion Action Innervation

approximates the soft

palate to the tongue
Musculus Uvulae Posterior Nasal Spine to seal off
nsaopharynx during
swallowing Accessory (XI)
traveling with
Vagus (X)
elevate soft palate to
Eustachian Tube
Levator Veli Palatini Palatine Crest Aponeurosis seal off nasopharynx
(medial cartilaginous part)
during swallowing

Eustachian Tube (lateral) tenses soft palate to

Tensor Veli Palatini Scaphoid Fossa (M-Pt Plate base) seal off nasopharynx root of V3
Sphenoid Spine during swallowing
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 Ann Nguyen -- NYUCD 2008
D1 Anatomy Notes -- Spring '05
BONY SKULL ATTACHMENTS of some pharyngeal muscles Ann Nguyen -- NYUCD 2008
D1 Anatomy Notes -- Spring '05
- Pharyngeal Raphe = pharyngeal tubercle (11)
- Stylopharyngeus = medial aspect of the styloid process (22)
- Palatopharyngeus = posterior edge of the hard palate (10)
- Muscular Uvulae = posterior nasal spine (8)
- Levator Palatini = petrous portion by the opening of the carotid canal (4)
- Tensor Palatini = scaphoid fossa (27)

SPECIAL NOTES about some pharyngeal muscles

• Tensor Palatini = uses the Hamulus to change its direction of pull

• Superior Constrictor = shares a common attachment w/ the

Buccinator to the Pterygomandibular Raphe

• Cricopharyngeus (Inferior Constrictor)

- does NOT insert into the Midline Raphe
- is NOT innervated by Pharyngeal Plexus
- innervated possibly by Recurrent Laryngeal Nerve
- is in a constant state of contraction
- to prevent air from going into the esophagus  stomach

• Stylopharyngeus
- runs b/t the Superior & Middle Constrictors
- is NOT innervated by Pharyngeal Plexus
- innervated by Glossopharyngeal (IX)

• Palatopharyngeal Sphincter
- a tiny fiber from the Superior Constrictor
- acts as an accessory swallowing muscle to seal off the nasopharynx from oropharynx

• Passavant’s Ridge
- created by the Palatopharyngeal Sphincter only during swallowing
- moves inferiorly as a “stripping wave”

• Dehiscence of Killian
- the gap between Thyropharyngeus and the Cricopharyngeus portions of the Inferior Constrictor both areas have
potential for
• Area of Lamiar herniation
- the triangular-shaped blending of the Cricopharyngeus muscle to the Esophagus below

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LAYERS OF THE PHARYNX Ann Nguyen -- NYUCD 2008
D1 Anatomy Notes -- Spring '05
(1) Areolar Coat
- outermost layer that is continuous w/ the buccinator’s fascia
- therefore AKA: “Buccopharyngeal Fascia”
- contains plexus of veins & nerves
 Retropharyngeal Space is located between the Buccopharyngeal & Prevertebral Fascia, and communicates w/ mediastinum

(2) Muscular Coat

- outer semicircular layer = constrictor muscles: Superior, Middle, Inferior (stacked on top of e/o like cups)
- inner longitudinal layer = longitudinal muscles: Stylopharyngeus, Palatopharyngeus, Salpinogpharyngeus

(3) Submucosa
- a tough fibrous coat that anchors the pharynx to the base of the skull
- U-shaped attachment involves the medial pterygoid plate, carotid canal, pharyngeal tubercle (occipital bone)
- therefore AKA: “Basilarpharyngeal Fascia”

(4) Mucosa = the internal lining of the pharynx

MUSCULAR GAPS OF THE PHARYNX

GAP 1 = b/t skull base and superior border of the Superior Constrictor muscle
• Eustachian Tube
• Tensor & Levator Palatini muscles
• Ascending Palatine Artery

GAP 2 = b/t Superior & Middle Constrictor muscles

• Stylopharyngeus muscle
• Glosspharyngeal Nerve (IX)
• Lingual Nerve (V3)

GAP 3 = b/t Middle & Inferior Constrictor muscles

• Superior Laryngeal Artery (from the Superior Thyroid artery off the External Carotid artery)
• Internal Laryngeal Nerve (from the Superior Laryngeal nerve off the Vagus)
- supplies sensory to larynx ABOVE VOCAL CORDS
 By the way: BELOW vocal cords is innervated by Recurrent Laryngeal Nerve (directly off the Vagus)

GAP 4 = b/t Inferior Constrictor (Cricopharyngeus) & esophagus

• Inferior Laryngeal Artery (from the Inferior Thyroid artery off the Thyrocervical Trunk off the Subclavian)
• Recurrent Laryngeal Nerve (from directly off the Vagus)
- supplies motor to ALL LARYNX MUSCLES EXCEPT CRICOTHYROID
- supplies sensory to larynx BELOW VOCAL CORDS
 By the way: Cricothyroid muscle is innervated by External Laryngeal nerve
(from the Superior Laryngeal nerve directly off the Vagus nerve)

SWALLOWING MECHANISM

Step 1 (voluntary)
• Tongue = pushes food posteriorly into the oropharynx

Step 2 (involuntary)
• Tensor & Levator Palatini muscles
- tenses & elevates the soft palate
- to seal off the oropharynx from the nasopharynx

• Muscular Uvulae muscle

- pushes back towards the oropharynx’s posterior wall
- oropharynx’s posterior wall pushes forward too

• Palatopharyngel Sphincter forms the Passavant’s Ridge (occurs only during swallowing)

• Longitudinal pharynx muscles elevates the larynx to prevent food going down the trachea
• Suprahyoid muscles

Step 3 (involuntary)
• Constrictor pharynx muscles = sequentially contract in peristaltic waves to continue the food down into the esophagus

Step 4 (involuntary)
• Esophagus = peristaltic squeezing to continue the food down into the stomach Compiled for you by:
NASOPHARYNX Ann Nguyen -- NYUCD 2008
D1 Anatomy Notes -- Spring '05
- superior portion of the pharynx located above the soft palate, at the level of C1 vertebrae
- anterior communication w/ nasal cavity thru the Choanae
- lined w/ respiratory epithelium (ciliated pseudostratified columnar)
- always remains open and never closes up

• Eustachian / Pharyngotympanic Tube

- opening is located on nasopharynx’s lateral wall and leads to Middle Ear  potential for communicating infections
- opening is located at the level of Inferior Nasal Concha of the nasal cavity  potential for communicating infections

• Levator Palatini muscle = runs along the MEDIAL side of the Eustachian Tube

• Tensor Palatini muscle = runs along the LATERAL side of the Eustachian Tube

• Pharyngeal Tonsils (Adenoids)

- located on the nasopharynx’s superior posterior wall
- extends laterally into the Pharyngeal Recess

• Tubal Tonsils = located near the Torus Tubaris

• Torus Tubaris
- caused by the cartilage of the Eustachian Tube projecting into the nasopharynx’s lateral wall
- located above the Eustachian Tube

• Salpingopharyngeal Fold
- caused by the underlying Salpingopharyngeus muscle covered w/ mucosa
- it is the narrowed continuation of the Torus Tubaris,
- runs posterior to the Eustachian Tube and down to the pharynx

• Pharyngeal Recess
- posterior to the Salpingopharyngeal Fold
- Eustachian Tube can be opened thru here and internal carotid artery may be damaged in the process

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OROPHARYNX Ann Nguyen -- NYUCD 2008
D1 Anatomy Notes -- Spring '05
- middle portion of the pharynx located below the soft palate, at the level of C2 – C3 vertebrae
- soft palate at rest = anterior communication w/ the oral cavity thru the fauces
- soft palate tensed and raised = Tensor & Levator Palatini muscles seal off nasaopharynx from oropharynx
- boundary begins at the Palatoglossal Arch
anterior to this arch is the oral cavity
posterior to this arch is the oropharynx

• Palatoglossal Arch (Anterior Pillar) = a fold created by the Palatoglossal Muscle, running from palate to tongue

• Palatopharyngeal Arch (Posterior Pillar) = a fold created by the Palatopharyngeal Muscle, running from palate to pharynx

• Fauces = Anterior Pillar + Posterior Pillar

• Palatine Tonsils
- located in between the Anterior & Posterior Pillars
- large during childhood, but atrophies during adulthood
- when these get infected, this is what people mean by “Tonsilitis”
- lie on top of a neurovascular bed comprised of Tonsillar Branches arising off the following vessels…
• Glosspharyngeal Nerve (IX)
• Ascending Pharyngeal Artery (directly off the External Carotid)
• Ascending Palatine Artery (off the Facial artery from External Carotid)
• Lesser Palatine Artery (off the Maxillary artery from External Carotid)
• Dorsal Lingual Artery (off the Lingual Artery from External Carotid)

• Lingual Tonsils
- located in the posterior 1/3 of the tongue

• Ring of Waldeyer
- Pharyngeal + Palatine +Lingual + Tubal Tonsils collectively form a circle around the oral opening

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LARYNGOPHARYNX Ann Nguyen -- NYUCD 2008
D1 Anatomy Notes -- Spring '05
- inferior portion of the pharynx located between Epiglottis  Esophagus (at the level of C4 – C6 vertebrae)

• Epiglottis = leaf-shaped elastic cartilage that guards the opening to the larynx

• 3 Glossoepiglottic Folds
- 1 median fold + 2 lateral folds
- run anteriorly from the epiglottis to the posterior base of the tongue

• 2 Valleculae
- small depressions created by the glossoepiglottic folds
- located on both sides of the median fold, anterior to the epiglottis
- particles can get trapped here  cough reflex

• Piriform Recess
- a vertical gutter located in between the laryngopharynx’s lateral wall and the lateral glossoepiglottic fold
- continues down the larynx and into the esophagus
- Internal Laryngeal Nerve runs through here
- particles can also get trapped here

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ARTERIAL SUPPLY Ann Nguyen -- NYUCD 2008
Note what pierces the Superior Constrictor:
D1 Anatomy Notes -- Spring '05
• Tonsillar Artery (Facial)
From the Maxillary Artery
• Paratonsillar Vein
• Greater Palatine = supplies hard palate
• Lesser Palatine = supplies soft palate

From the Facial Artery

• Tonsillar Artery = supplies palatine tonsils
• Ascending Palatine = supplies Superior Constrictor

From the External Carotid Artery

• Lingual = supplies upper pharynx
• Superior Thyroid = supplies Inferior Constrictor
• Ascending Pharyngeal
- Pharyngeal branch = supplies pharynx
- Palatine branch = supplies palate

VENOUS DRAINAGE

• Pharyngeal Plexus  [Pharyngeal Veins]  Pterygoid Plexus

Internal Jugular Vein
• External Palatine (Paratonsillar) Vein
- pierces Superior Constrictor
- drains palatine tonsils into Pterygoid Plexus

PHARYNGEAL PLEXUS (9, 10, 11)

Motor (11) all muscles of the pharynx, larynx, soft palate

EXCEPT Stylopharyngeus (IX)
EXCEPT Tensor Palatini (V3)
EXCEPT Cricopharyngeus (Recurrent Laryngeal)

Sensory (9) mucosa of the pharynx, soft palate, palatine tonsils

EXCEPT the nasopharynx above the level of Eustachian Tube (V2)

GLOSSOPHARYNGEAL (IX)

Motor Stylopharyngeus muscle

General Sensory pressure receptors in Carotid Sinus

mucosa of pharynx, soft palate, palatine tonsils
touch to posterior 1/3 tongue

Special Sensory taste to posterior 1/3 tongue

taste to circumvallate papillae

Pre-gang. Parasymp. Tympanic Plexus = medial side of tympanic membrane

Post-gang. Parasymp. Lesser Petrosal Nerve = parotid gland

 Eagle Syndrome caused by an elongated styloid process or a calcified stylohyoid ligament

may press on the external wall of tonsillar bed  pain travels through CN IX.

VAGUS (X)

Motor muscles of the pharynx, larynx, soft palate

EXCEPT Stylopharyngeus (IX)
EXCEPT Tensor Palatini (V3)

General Sensory chemoreceptors in Carotid Body

mucosa of pharynx, larynx
skin of posterior external ear & canal

Special Sensory taste to oropharynx & epiglottis

Parasympathetic abdominocardiothoracic viscera

MAXILLARY (V2)

General Sensory nasopharynx above the Eustachian Tube

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AUTONOMIC post-ganglionic sympathetic fibers arise off the Internal Carotid Artery’s plexus
SENSORY INNERVATION TO THE PHARYNX Ann Nguyen -- NYUCD 2008
D1 Anatomy Notes -- Spring '05

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