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7. Pharynx and Larynx


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What IS the pharynx?
A muscular tube, open anteriorly, situated behind the nasal cavities + oral cavity + larynx; continuous w/ esophagus.
What 2 sytstems use the pharynx?
Digestive and Respiratory
What are the 3 divisions of the pharynx?
1. Nasopharynx
2. Oropharynx
3. Laryngopharynx
What are the boundaries of the nasopharynx?
-Above the soft palate
-Behind the choane
What does the Nasopharynx consist of?
-Posterior wall
-Lateral walls
(open anteriorly)
What opening resides in the lateral walls of the nasopharynx?
Auditory canal
What structure is just superior to the auditory opening?
Torus tubarius - a tubal elevation
What structures is just inferior to the auditory opening?
Salpingopharyngeus muscle - within a mucosal fold.
What other muscle is inferior to the auditory opening?
Levator veli palatini
What is the function of levator veli palatini?
It lifts the soft palate in swallowing to seal off the pharygeal isthmus.
What IS the pharyngeal isthmus?
The open, horizontal plane between the nasopharynx and oropharynx.
How does the pharyngeal isthmus close during swallowing? (2 mechanisms)
1. The soft palate elevates
2. Superior constrictor mm contract
What immune system structures are located in the nasopharynx?
Nasopharyngeal tonsils/Adenoids
What are the adenoids?
MALT - lymphatic tissue in the mucosa of the upper part of the midline nasopharynx.
What 3 structures make up Waldeyer's ring?
1. Nasopharyngeal tonsils
2. Palatine tonsils
3. Lingual tonsil
What are the boundaries of the oropharynx?
-Below the soft palate
-Above the epiglottis
What 2 features are important re: the oropharynx?
-Oropharyngeal isthmus
-Palatine tonsils
What is the oropharyngeal isthmus?
The open coronal plane between the oral cavity and oropharynx.
Where are the palatine tonsils located?
Between palatoglossal and palatopharyngeal arches.
What is teh most common cause of swelling in the neck?
Tonsillitis - when lymphatics from the tonsills drain into jugulodigastric lymph nodes and make them swell.
What are the boundaries of the laryngopharynx?
-Superior border of epiglottis
-Inferior border of cricoid cartilage
What important feature is found within the laryngopharynx?
The Piriform Fossae
Where are the piriform fossae?
on either side of the laryngeal inlet
What are the piriform fossae's
-Medial boundaries?
-Lateral boundaries?
Medial = aryepiglottic folds
Lateral = thyrohyoid membrane and thyroid cartilage
What pierces the thyrohyoid cartilage to enter the piriform fossae?
Internal branch of the superior laryngeal nerve
How many pairs of muscles are in the pharynx? What are they?
-Superior, middle, and inferior pharyngeal constrictors
What are the attachments of the superior pharyngeal constrictor (3)?
1. Pterygoid hamulus (sphenoid)
2. Pterygomandibular raphe
3. Median pharyngeal raphe
What is the pterygomandibular raphe?
The line separating Buccinator muscle from sup. pharyng. constrictor.
What is the median pharyngeal raphe?
Where the paired pharyngeal muscles meet posteriorly in the midline.
What bridges the gap between superior pharyngeal constrictor and the base of the skull?
Pharyngobasilar fascia
What passes through the pharyngobasilar fascia?
The pharyngotympanic tube.
What separates superior ph. constrictor from middle?
-Stylopharyngeus muscle
What lies externally to the superior pharyngeal constrictor? (5 things)
1. Ascending pharyngeal a.
2. Pharyngeal venous plexus
3. CN IX
4. Lingual nerve
5. Medial pterygoid muscle
What innervates the superior pharyngeal constrictor?
Pharyngeal plexus of CN X
What are the 2 functions/actions of superior pharyng. constrictr?
1. Helps close pharyng. isthmus
2. Pushes food bolus/liquid past the epiglottis
The pharyngeal plexus of CN X innervates ALL pharyngeal muscles EXCEPT:
What innervates stylopharyngeus?
CN IX - it's the one exception of all the pharyngeal mm.
What are the attachments of the middle pharyngeal constrictor? (3)
1. Hyoid bone (greater/lesser cornu)
2. Stylohyoid ligament
3. Median pharyngeal raphe
What separates the middle from lower pharyngeal constrictor?
Internal laryngeal nerve and Superior thyroid artery
What innerates middle pharygneal constrictor?
What is the action of middle pharyngeal constrictor?
Pushes a bolus of food or liquid past the epiglottis
The inferior pharyngeal constrictor has 2 parts; what are they?
1. Thyropharyngeus
2. Cricopharyngeus
What are the attachments of the inferior pharyngeal constrictor?
1. Cricoid/thyroid cartilages
2. Median pharyngeal raphe
3. Inferior fibers blend with esophageal fibers.
What pierces the lower part of the inferior pharyng. constrictor?
The external laryngeal n.
What is the overall action of the inferior ph. constrictor?
To expel food from the pharynx into the esophagus.
What are the actions of inferior pharyngeal constrictors individual parts?
1. Thyropharyngeus propels bolus during swallowing
2. Cricopharyngeus acts as a sphincter in swallowing.
What are the 3 attachments of Stylopharyngeus?
1. Styloid process
2. Merges w/ constrictor fibers
3. Thyroid cartilage
Where is stylopharyngeus located in the pharynx?
Between the super and middle constrictors, with CN IX.
What is the action of stylopharyngeus?
It elevates the larynx during speech and swallowing.
What is Salpingopharyngeus attached to?
-Inferior border of eustachian tube cartilage
-Blends w/ palatopharyngeus m.
What is the action of Salpingopharyngeus?
Elevation of the upper pharyngeal wall during swallowing.
What are the attachments of Palatopharyngeus?
1. Posterior border of hard palate
2. Mucosa of soft palate
3. Blends w/ salpingopharyngeus
What is the function of Palatopharyngeus?
-Shortens pharynx in swallowing
-Constricts palatopharyng arch
One motor nerve innervates all pharyngeal muscles except 2:
Cn X
1. Stylopharyngeus - CN IX
2. Tensor veli palatini - CN V3
What nerves compose the pharyngeal plexus?
CN 9, 10, and sympathetic fibers
What gives sensory innervation to the upper pharynx?
CN IX and CN V2
What gives sensory innervation to the lower pharynx?
What 2 pathologies are commonly associated w/ the pharynx?
1. Pharyngitis
2. Dysphagia
What are symptoms of pharyngitis?
-Scratchy/sore throat
-Fever, red throat, edema
What bacteria is responsible for 15% of all pharyngitis cases?
Strep A
What is dysphagia?
Difficulty in swallowing.
What is the function of the larynx?
Voice production
What makes up the skeleton of the larynx?
Cartilages interconnected by ligaments and fibrous membranes
What 6 cartilages make up the larynx? Which are pairs?
1. Thyroid
2. Cricoid
3. Arytenoid (pair)
4. Corniculate (pair)
5. Cuneiform (pair)
6. Epiglottic
What kind of cartilage are the Thyroid/Cricoid/Arytenoids?
What kind are the other 3?
First 3: hyaline

Last 3: elastic
What is the thyroid cartilage structure like?
Two laminae fused anteriorly at laryngeal prominence.
What is a major difference in the thyroid cartilage of males and females?
Males - 90' angle

Females - 120' angle
What are 3 features to remember about the Thyroid cartilage?
1. Superior cornua
2. Inferior cornua
3. Oblique line
What does the inferior cornua of the thyroid cartilage articulate with?
Cricoid cartilage via Synovial joint
What does the oblique line on the Thyroid cartilage exist for?
The attachment of 3 muscles
What 3 muscles attach to oblique line of Thyroid cartilage?
1. Inferior constrictor
2. Sternothyroid
3. Thyrohyoid
What is special about the cricoid cartilage?
It's the only laryngeal cartilage that forms a COMPLETE ring.
What 2 structures articulate with the cricoid cartilage?
1. Inferior cornua of thyroid cartilage - at the junction of arch and lamina
2. Arytenoid cartilages
Are the arytenoids completely hyaline cartilage?
No; partially elastic too.
Where are the arytenoids situated?
Atop the superior border of the cricoid cartilage lamina
What are 4 features on the arytenoids?
1. Base - articulation w/ cricoid cartilage
2. Apex - superior articulates w/ cuneiform cartilages
3. Muscular processes (laterl)
4. Vocal process (anterior)
What 2 muscles attach to the muscular process on arytenoids?
1. Lateral cricoarytenoids
2. Posterior cricoarytenoids
What attaches to the vocal process of the arytenoids?
the vocal ligament
Where are the corniculate cartilages?
Situated atop superior surface of arytenoids
Within what FOLD are both the corniculate and cuneiform cartilages?
How is the epiglottic cartilage attached to the thyroid laminae?
Via the thyroepiglottic ligament which connects the tapered inferior end of epiglottis to the thyroid laminae.
What does the Cricotracheal ligament connect?
Cricoid cartilage to first tracheal ring
What is the thyrohyoid membrane for?
To connect the superior border of thyroid cartilage to the hyoid bone.
What is the thicker median portion of the thyrohyoid membrane called?
The thyrohyoid ligament
Where are the cricothyroid membranes?
Between cricoid cartilages and inferior margin of thyroid cartilage.
How many Cricothyroid Ligaments are there?
-one anterior
-two lateral
What is an alternate term for th 2 lateral cricothyroid ligaments?
Cricovocal membranes
What do the lateral cricothyroid ligaments extend between?
The cricoid cartilage & the vocal ligament.
What are the vocal ligaments?
The thickend superior margins of the cricoval membranes (lateral cricothyroid liagments)
What is conus elasticus?
Cricovocal membrane + vocal ligaments
For the vocal ligaments what is:
-Anterior attachment?
-Posterior attachment?
Ant: junction of thyroid cartilage laminae

Post: vocal processes of the arytenoid cartilages
What covers the vocal ligament?
The vocal fold
What does the vocal fold consist of? (3 things)
Mucous membrane covering:
1. Cricovocal membrane
2. Vocal ligament
3. Vocalis muscle
What is the quadrangular membrane?
Submucosal sheet of connective tissue extending from arytenoid cartilages to epiglottis
What is the inferior free edge of the quadrangular membrane?
The vestibular ligament
What covers the vestibular ligament?
The vestibular fold
What is the rima glottidis?
The space between the vocal folds
What is the vestibule of the larynx?
The space superior to the vestibular folds
What is the ventricle of the larynx?
The space btwn the vestibular folds and the vocal folds
What is the infraglottic cavity?
The space inferior to the vocal folds
What connects the epiglottis to the tongue and pharynx?
Glossoepiglottic folds
What term denotes small depressions between the glossoepiglottic folds between the tongue and epiglottis?
What is the Aditus laryngis?
The laryngeal inlet
What are the folds of mucous membrane extending from the arytenoid cartilages to the epiglottis called?
Aryepiglottic folds
What is the name of the lateral recess in the laryngopharynx wall?
Piriform fossa
How many muscles are in the larynx? Whats the acronym?
7: Crunch 2 times and owe a paperclip to a lucky cider vinegar
What muscles are referred to by the acronym Crunch Two Times And Owe A PaperClip To A Lucky Cider Vinegar?
CrunchTwo = Cricothyroids
TimesAnd = Transverse arytenoid
OweA = Oblique arytenoids
PaperClip = Posterior cricoarytenoids
ToA = thyroarytenoids
LuckyCider = lateral cricoarytenoids
Vinegar = Vocalis
Where are the cricothyroids located?
On the external surface of the larynx between the thyroid cartilage and cricoid cartilage
What innervates the cricothyroids?
The external laryngeal nerve
What is the action of the cricothyroids?
To tilt the thyroid cartilage anteriorly thus elongating and tightening the vocal ligaments
What is unique about the transverse arytenoid?
It is the only unpaired muscle of the larynx.
What is the transverse arytenoid like in structure?
A broad band of muscle; extends horizontally from one arytenoid cartilage to the other.
What is the action of the transverse arytenoid?
Pulls the arytenoid cartilages toward each other (medially) closing the posterior rima glot.
Describe the oblique arytenoids:
-Superficial to transverse arytenoid muscles
-2 muscle bundles, connect to arytenoid cartilages and blend with the aryepiglottic m.
How do the oblique arytenoids relate to each other?
Cross in an X pattern
What is the action of the oblique arytenoids?
They modify the laryngeal inlet to vary the rima glot.
Describe the posterior cricoarytenoids attachments:
-Muscular processes of arytenoid cartilages
-Posterior part of cricoid cartilage
What are the actions of the posterior cricoarytenoids (3)?
1. Pull muscular processes posteriorly
2. Abduct vocal folds
3. OPEN rima glot
Why are the posterior cricoarytenoids special?
Describe the thyroarytenoids in terms of where they arise and insert:
-Arise from posterior surface of the thyroid cartilage
-Insert onto arytenoid cartilages
What is the action of the thyroarytenoids?
They pull the arytenoid cartilages anteriorly
What does pulling the arytenoid cartilages anteriorly accomplish?
It shortens the vocal ligaments and decreases voice pitch.
What muscles do the opposite of the the thyroarytenoids?
Cricothyroids - by tilting the thyroid cartilage anteriorly
How does tilting the thyroid cartilage anteriorly increase the voice pitch?
It elongates and tightens the vocal ligments.
What are the attachment points of the lateral cricoarytenoids?
-Muscular processes of the arytenoid cartilages
-Lateral part of cricoid cartilage
What are the 3 actions of the lateral cricoarytenoids?
1. Pull muscular processes anteriorly
2. Adduct vocal folds
3. Close rima glottidis
What is the vocalis muscle made up of really?
The inferior fibers of the thyroarytenoid muscles
Where does the vocalis muscle
-Arises from the vocal ligament
-Inserts on the vocal processes of the arytenoid cartilages
What is the action of the vocalis muscle?
Minor adjustments in the vocal ligaments
What 2 main nerves provide innervation to the larynx?
What nerve fibers are in these?
1. Superior laryngeal n.
2. Recurrent laryngeal n.
-Both sensory and motor
What type of innervation is carried by internal laryng. n?
Sensory and ANS
What specifically is innervated by internal laryngeal nerve? How does it get there?
-Laryngeal mucosa superior to the vocal folds
-Internal laryngeal nerve pierces thyrohyoid membrane along with superior laryngeal artery.
What type of reflex would be conveyed by the internal laryngeal nerve?
Cough - like if water goes down the wrong pipe.
What does the EXTERNAL laryngeal nerve innervate, with what type of fibers?
Motor innervation; to
-Inferior constrictor muscle
What does the Recurrent laryngeal nerve give motor innervation to?
-All intrinsic laryngeal muscles
Where does the recurrent laryngeal nerve provide sensory innervation?
To the laryngeal mucosa inferior to the vocal folds.
What arteries supply blood to the larynx? (2)
1. Superior thyroid artery -> superior laryngeal a. branch
2. Inferior thyroid artery -> inferior laryngeal a. branch
What are 4 pathologic conditions associated with the larynx?
1. Epiglottitis
2. Laryngitis
3. Croup
4. Phonation problems
What is epiglottitis?
Inflammation of the soft tissues above the vocal folds
Is epiglottitis usually chronic or acute?
Acute - rapid onset of Sx.
What is laryngitis?
Hoarseness - mostly viral induced
What is croup?
An upper resp tract infection that results in subglottic edema.
What is a common symptom of croup?
seal bark cough

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