{"id":"3349","type":{"id":"25","name":"Gross Anatomic \u0026 Microscopic Structures","urlId":"gross-anatomic-microscopic-structure","subtypes":[],"schema":"http:\/\/schema.org\/Article","numTerms":0},"subtype":{"id":"123","name":"Musculoskeletal - Head \u0026 Neck","urlId":"musculoskeletal---head-neck"},"urlId":"pharyngeal-muscles","role":"term","course":{"id":"2","urlId":"gross-anatomy","name":"Gross Anatomy"},"children":[{"id":"3350","type":{"id":"25","name":"Gross Anatomic \u0026 Microscopic Structures","urlId":"gross-anatomic-microscopic-structure","subtypes":[],"numTerms":0},"urlId":"pharyngeal-mucosa","role":"term","course":{"id":"2","urlId":"gross-anatomy","name":"Gross Anatomy"},"name":"Pharyngeal Mucosa","demo":0,"description":"Here we\u2019ll learn about the mucosa of the pharynx, which is a common pathway for foods, liquids, and air. \n\n\u003E ### **Lateral View**\n\n## Set up the diagram.\n\nFirst, draw some key bony and cartilaginous features: the base of the skull, hyoid, and vertebral column. \n\nShow the maxilla, which gives rise to the alveolar process with the upper teeth, and the palatine process, which forms the hard palate.\n\nShow the soft palate extending posteriorly from the hard palate; the soft palate comprises the palatine aponeurosis and muscles. Indicate the skin over the anterior face.\n\nNow, show that the hard and soft palates separate the nasal and oral cavities.\n\nShow additional boundaries of the oral cavity: the mandible and lower teeth and the muscles of the floor of the mouth, the tongue, geniohyoid, and mylohyoid. \n\n![Neck - Suprahyoid Muscles, mylohyoid, diagastric, stylohyoid, ](\/media\/5565\/5fc2ea7a30be33fee7477b819e8d26ad7c03e0c49888b25d5c277d383c7a78f5.png)\n\nNow, show the thyroid cartilage, epiglottis, and the internal surface of the larynx; highlight the laryngeal inlet. Show the connective tissues between the hyoid bone and the thyroid cartilage and epiglottis.\n\nIndicate the **pharyngeal constrictors**, which form the half-cylinder muscular tube of the pharynx: label them as superior, middle, and inferior pharyngeal constrictors. \n\n\n![Pharyngeal muscles, pharyngeal constrictors](\/media\/9529\/afb3f74318b422d8a7f01fb569d10469f28b3485f1cc37d2bc9f803d9efbbf88.png)\n\n\nShow that the internal surface of the constrictors is covered and supported by the **pharyngobasilar fascia**; the external surface of the constrictors is covered by the thinner **buccopharyngeal fascia**.\n\n\n## Three regions of the pharynx: \nThe nasopharynx opens to the nasal cavity.\nThe oropharynx opens to the oral cavity,\nAnd, the laryngopharynx opens to the larynx. \n\n![Pharyngeal muscles lateral view, pharyngeal constrictors, pharyngeal longitudinal muscles](\/media\/9530\/8ab7629abcec26b56488e70f324e1a5a8acb67c00bea04207f8d69262b1e7c64.png)\n\n## Mucosal Features\n\n**Palatoglossal fold** which covers the palatoglossus muscle, and the palatine tonsil. The palatoglossus muscle elevates the tongue and pulls the soft palate inferiorly, narrowing the oropharyngeal isthmus. Located in the oropharynx.\n\n**Pharyngeal tonsil** in the roof of the nasopharynx.\n\n**Pharyngotympanic tube opening** near the pharyngeal tonsil. The opening produces an elevation called the **torus tubularis**.\n\n**Torus levatorius** is the mucosal fold over levator veli palatini.\n\n**Salpingopharyngeal fold** is the mucosa over the salpingopharyngeus. \n\n**Palatopharyngeal arch** is the mucosal fold that overlies the palatopharyngeal muscle. \n\n\u003E ### **Posterior View**\n\nNow let\u2019s learn the pharyngeal mucosa from posterior view, as if we\u2019ve dissected down the midline of the throat. \n\n## Set up the diagram.\n\nFirst, draw the base of the skull, the hyoid bone, larynx, and trachea.\nNow draw the splayed-open mucosa.\n\n## Mucosal Features\n\nOpenings to anterior structures:\n\nThe **choanae** is where the nasopharynx opens to the nasal cavity\n\nThe **oropharyngeal isthmus** is where the oropharynx opens to the oral cavity \u2013 show that we can see the pharyngeal portion of the tongue,\n\nThe **laryngeal inlet** the laryngopharynx opens to the larynx.\nShow that the pharynx is continuous with the esophagus.\n\nIn the nasopharynx, indicate the following:\n\nThe **pharyngeal recess**, which is a deep depression posterior to the opening of the pharyngotympanic tube.\n\n**Pharyngeal tonsil** at the roof of the nasopharynx.\n\nOn the sides of the choanae, show the **torus tubularis** (again, this is the elevation where the pharyngotympanic tube opens to the pharynx); show that the **salpingopharyngeal fold** extends vertically from the tubularis.\n\n**Torus levatorius** (the mucosal fold over levator veli palatini).\n\n**Area of the soft palate** (comprises the palatine aponeurosis and muscles). \n\nIn the oropharynx, indicate the **palatopharyngeal arch** (the mucosal fold that overlies the palatopharyngeal muscle). \n\nShow the **palatine tonsil** and, in the pharyngeal portion of the **tongue**, show the **lingual tonsil**.\n\nLastly, in the laryngopharynx, show the **piriform fossa** (aka sinus; also spelled pyrifirom) lies to the side of the larynx; this is a common site of hypopharyngeal cancer. \n","keywords":[],"favorite":0,"numAnnotations":0},{"id":"3436","type":{"id":"25","name":"Gross Anatomic \u0026 Microscopic Structures","urlId":"gross-anatomic-microscopic-structure","subtypes":[],"numTerms":0},"urlId":"pharyngeal-innervation","role":"term","course":{"id":"2","urlId":"gross-anatomy","name":"Gross Anatomy"},"name":"Pharyngeal Innervation","demo":0,"description":"\u003E ### **Motor \u0026 Sensory Innervation** \n\nThe pharyngeal plexus provides most of the motor and sensory innervation to the pharynx. \nIt is a collection of nerves found in the outer fascia of the pharyngeal wall. \n\nThe pharyngeal plexus comprises fibers from the glossopharyngeal nerve (CN IX), vagus nerve (CN X) and fibers from the sympathetic cervical ganglion. \n\n![Cranial Nerves](\/media\/6387\/831abeded139e223b8cfba6959ea7b327989e872825102c57e0d19fb730b203d.png)\n\n## Nerves\n\n**Maxillary nerve (V2 of CN V)**  \u2013 gives rise to a **pharyngeal branch** deep within the pterygopalatine fossa. This branch passes through the palatovaginal canal in the sphenoid bone to provide sensory innervation to the nasopharynx. \n\n**Glossopharyngeal nerve** exits the skull through the jugular foramen and travels along the posterior aspect of stylopharyngeus; it passes through the gap between the superior and middle pharyngeal constrictors on its way to the tongue.  \n\n**Vagus nerve** exits the skull through the jugular foramen and forms the inferior ganglion. \n\nThe **pharyngeal branch of the vagus nerve** provides motor control to many muscles of the soft palate and pharynx; the pharyngeal branch also carries sensory and parasympathetic information to the plexus.\n\nThe **superior laryngeal nerve** arises from the vagus nerve Inferior to the pharyngeal branch; it gives rise to an **internal branch**, which passes through the thyrohyoid membrane, and an **external branch**, which continues along the inferior pharyngeal constrictor.\n\nIn sum, we can see that the vagus nerve (CN X) provides motor stimulation to all muscles of pharynx except for stylopharyngeus, which is innervated by glossopharyngeal nerve (CN IX).\n\n## Sensory Innervation\nPharyngeal sensory innervation is organized by region: \n\nThe nasopharynx is innervated by the maxillary nerve.\nThe oropharynx is innervated by the glossopharyngeal nerve (which is why CN IX is the afferent limb of the [gag reflex](\/term\/neuroanatomy\/oral-palatal-deviations-the-gag-reflex)).\nThe laryngopharynx is innervated by the vagus nerve.","keywords":[],"favorite":0,"numAnnotations":0},{"id":"3437","type":{"id":"25","name":"Gross Anatomic \u0026 Microscopic Structures","urlId":"gross-anatomic-microscopic-structure","subtypes":[],"numTerms":0},"urlId":"pharyngeal-blood-supply","role":"term","course":{"id":"2","urlId":"gross-anatomy","name":"Gross Anatomy"},"name":"Pharyngeal Blood Supply","demo":0,"description":"\u003E ### **Pharyngeal Blood Supply**\n\nArterial supply of the pharynx is derived from branches of the thyrocervical trunk and the external carotid artery.\n\n## Set up diagram in lateral view\nSet up the diagram with the same bony, cartilaginous, and muscular features as our previous diagram. \n\nShow the subclavian artery, and indicate that it gives rise to the **common carotid artery** and the **thyrocervical trunk**.\n\nThe **thyrocervical trunk** gives rise to the **inferior thyroid artery** and the **pharyngeal branches**. These arteries supply the lower pharynx.\n\nNow, to show blood supply to the upper pharynx, show the common carotid artery splitting into internal and external branches. \n\n## Key Branches of the External Carotid Artery\n\nThe **ascending pharyngeal artery**, which originates just after the common carotid artery bifurcates and gives rise to an anterior pharyngeal division and a posterior neuromeningeal division.\n\nThe **lingual artery**, which passes over the middle pharyngeal constrictor on its way to the tongue.\n\nThe **facial artery** gives rise to the **tonsillar branch**, which pierces the superior constrictor to reach the palatine tonsil, and the **ascending palatine artery**, which serves the soft palate.  \n\nThe external carotid artery terminates where it splits into the superficial temporal artery and the maxillary artery.\n\nWithin the skull, the **maxillary artery** travels with the maxillary nerve. \n\nThe maxillary artery gives rise to the **pharyngeal branch**, which serves the mucosa of the nasopharynx, pharyngotympanic tube, and the sphenoid sinus.\n\n[Carotid Artery Review](\/term\/neuroanatomy\/common-carotid)\n\n## Venous Drainage\n\nVenous drainage occurs via the venous plexus. Inferiorly, the venous plexus drains into the facial and internal jugular veins; superiorly, it drains into the pterygoid plexus in the infratemporal fossa. \n\n![veins of head and neck, brachiocephalic vein, jugular vein](\/media\/1307\/136bce3007b3d01bce67f1586dce4512db9554587285de5a762fb298da7dce26.png)\n","keywords":[],"favorite":0,"numAnnotations":0}],"name":"Pharyngeal Muscles","demo":0,"description":"Here we\u2019ll learn the muscles that comprise the pharynx, aka, the throat; recall that the pharynx is the common pathway for foods, liquids, and air.\n\nThe pharynx is a half-cylinder musculofascial structure that attaches to the base of the skull and is continuous with the esophagus (at approximately level CVI). It opens to the oral and nasal cavities superiorly, and connects them to the larynx and esophagus, inferiorly. \n\n\u003E ### **Posterior View - Superficial**\n\nLet\u2019s set up our first diagram, which will show the superficial muscles in posterior view. \nWe\u2019ll primarily be able to see the constrictor muscles in this view, which have a circular orientation. \n\n## Key Landmarks\nThe base of the skull, hyoid, larynx, and trachea; pharyngeal tubercle of the occipital bone. \nThe pharyngeal raphe, a cord-like ligament, extends inferiorly and merges with the connective tissue of the esophagus. \nWe\u2019ll show that the pharyngeal constrictors come together at this midline raphe.\n\n## Stylopharyngeus\nOne of the three longitudinal muscles, stylopharyngeus is a long cylindrical muscle that originates from the medial aspect of the styloid process and, as we\u2019ll see, descends between the superior and middle constrictor muscles to blend in with the deep surface of the pharyngeal wall. \nStylopharyngeus is innervated by the glossopharyngeal nerve (CN IX).\n\nNow, we\u2019re ready to show the three constrictor muscles; these muscles are named for their relative location: superior, middle, inferior. As we\u2019ll show, they overlap like stacked mugs.\n\n## Pharyngobasilar fascia\nStrong internal pharyngeal lining. \n\n## Superior constrictor muscle\nSeveral points of anterior points of origin: the pterygomandibular raphe, adjacent bone on mandible, and the pterygoid hamulus. Its fibers fan posteriorly to meet at the pharyngeal raphe. \n\nThe space between the superior pharyngeal constrictor and the base of the skull is covered by the pharyngobasilar fascia (pharyngo = pharynx, basilar = a part of the occipital bone). \n\nNotice that stylopharyngeus runs superficial to the superior pharyngeal constrictor. \n\n## Middle pharyngeal constrictor\nOverlies portions of stylopharyngeus and the superior pharyngeal constrictor. \nThe middle pharyngeal constrictor arises from the greater horn of the hyoid bone and the adjacent margins of the lesser horn, and from the stylohyoid ligament. \nIts fibers fan posteriorly to insert along the pharyngeal raphe.\n\n## Inferior pharyngeal muscle\nAnteriorly, it arises from oblique line of the thyroid cartilage, the cricoid cartilage, and the ligament that spans between these attachments. \nIts fibers fan posteriorly to insert along the pharyngeal raphe; show that inferior fibers also blend into wall of esophagus, which creates the seamless connection between these two segments. \n\n## Fascia \nFascia reinforces the pharyngeal wall, which is especially important where the irregularly shaped muscles do not completely overlap laterally. \n\n## Gaps\nGaps allow neurovascular structures and small muscles (ie, stylopharyngeus, which we\u2019ve shown) to pass through the pharynx to anterior structures such as the larynx. You can learn more about these gaps and the structures that pass through them in our notes. \n\n## Innervation \u0026 Actions\nThe constrictors are innervated by the vagus nerve (CN X); during swallowing, they contract sequentially from top to bottom, which moves a bolus of food inferiorly through the pharynx to the esophagus (see our notes for more information on swallowing).  \n\n\u003E ### **Posterior View - Deep**\n\nNow, let\u2019s \u201copen up\u201d the pharynx to show these muscles from the inside-out, which will allow us to show the remaining longitudinal muscles. \n\nThe longitudinal muscles elevate the pharynx during swallowing.\n\nFirst, we re-draw the base of the skull, hyoid, larynx with epiglottis, and the trachea. \nNow, on only one side of the diagram, we show stylopharyngeus and the constrictors: superior, middle, and inferior.\n\nFor context, show the tongue in front of the epiglottis, and indicate the esophagus at the end of the pharynx.\n\nOn the other side of the skull, we\u2019ll show these muscles as if we\u2019ve cut along the pharyngeal raphe and pulled the muscles away from the midline. \n\nStart inferiorly and show the inferior and middle pharyngeal constrictors pulled away from the midline. \n\nThen, we show stylopharyngeus as it arises from the medial aspect of the styloid process and travels inferiorly to the posterior border of the thyroid cartilage and blends in with the pharyngeal constrictors. \nStylopharyngeus is innervated by the glossopharyngeal nerve (CN IX).\n\nNow, we show the superior pharyngeal constrictor and the pharyngobasilar fascia pulled away from the midline; notice that this sandwiches the stylopharyngeus muscle between the superior and middle constrictors.\n\n## Choana\nThe opening between the nasal cavity and the nasopharynx; the vomer bone separates the right and left choanae. (more images in the notes). \n\n## Pharyngotympanic tube\nLateral to the choana, we see the pharyngotympanic (aka, auditory or Eustachian) tube \u2013 this tube connects the middle ear to the nasopharynx; we show it piercing the pharyngobasilar fascia.\n\n## Levator veli palatini muscle\n\nInferior to the choana, we see the levator veli palatini muscle as it passes inferiorly from the cartilage of the pharyngotympanic tube and the petrous portion of the temporal bone (not shown) to the midline palatine aponeurosis. \n\nAs its name suggests, this muscle elevates the soft palate, closing off entry to the nasopharynx during swallowing. \n\nIt is not a muscle of the pharyngeal wall, but we\u2019ve drawn it so that we can show the next muscle: palatopharyngeus.\n\n## Palatopharyngeus\nPalatopharyngeus is also a muscle of the soft palate; it attaches to the upper surface of the palatine aponeurosis and passes posteriorly and inferiorly to blend with deep surface of pharyngeal wall. \nIt is innervated by CN X via the pharyngeal plexus (which itself comprises fibers from CN IX and X, and sympathetic fibers from the cervical ganglion).\n\n## Salpingopharyngeus. \u201c\n\nSalpinx\u201d means tube \u2013 salpingopharyngeus originates on the inferior aspect of the pharyngotympanic tube and descends to blend in with the palatopharyngeus muscle. It is innervated by CN X. \n\n## Tonsils\n\nPharyngeal tonsil in the roof of the nasopharynx.\n\nPalatine tonsils in the wall of the lateral oropharynx (the palatine tonsils are also called the faucil tonsils because they are in the fauces, which is the narrow passage between the soft palate and the base of the tongue). \n\n\u003E ### **Lateral View**\n\nThis is an external view of the pharynx.\n\n## Key Landmarks\n\nLateral side of the skull; label the styloid process. We include the mandible and teeth for context.\n\nHyoid bone, larynx, and trachea; we show the thyrohyoid membrane between the thyroid cartilage and hyoid bone.\n\nThe pharyngeal raphe extends inferiorly from the pharyngeal tubercle.\n\nThe pterygomandibular raphe is a thin tendinous band that extends from the medial pterygoid plate to the mandible. \n\nThe stylohyoid ligament extends from styloid process to the hyoid bone. \n\nThe oblique line of the thyroid cartilage. \n\n## Superior pharyngeal constrictor\nIn lateral view we can see its attachments to the pterygomandibular raphe and the adjacent bone on mandible, and that its fibers extend posteriorly to insert along the pharyngeal raphe.\n\n## Stylopharyngeus \nArises from the styloid process and extends inferiorly.\n\n## Middle pharyngeal constrictor\nArises from the hyoid bone and the stylohyoid ligament and fans posteriorly to wrap over stylopharyngeus and the inferior portion of the superior pharyngeal constrictor and insert on the pharyngeal raphe.\n\n## Inferior pharyngeal constrictor \nArises from the oblique line of the thyroid cartilage and the cricoid cartilage and wraps posteriorly over the bottom portion of the middle pharyngeal constrictor. Its inferior fibers blend with the esophagus.\n\n## Gaps between constrictors\nIn this view we can highlight key gaps between the constrictor muscles:\n\nThe gap between the superior and middle pharyngeal constrictors allows stylopharyngeus, the glossopharyngeal nerve, and stylohyoid ligament to pass through pharyngeal wall to reach the internal pharynx.\n\nThe gap between the middle and inferior pharyngeal constrictors allows the internal laryngeal nerve and superior laryngeal artery and vein to pass to the larynx (we show where neurovascular structures pierce the thyrohyoid membrane).\n\nThe gap inferior to the inferior constrictor allows the recurrent laryngeal nerve and the inferior laryngeal artery to pass into the larynx. \n\n\n\u003E ### **Medial View**\n\nThis is an internal view of the pharynx, as if we\u0027ve dissected the head and neck along the midline. \n\n## Key landmarks\nThe skull, hyoid, and larynx. \n\nThe hard palate and soft palate (the soft palate comprises muscles and palatine aponeurosis).\n\nCartilage of the pharyngotympanic tube (aka, auditory or Eustachian tube). \n\nPharyngeal raphe, pterygomandibular raphe and stylohyoid ligament.\n\n## Now, we can show all three longitudinal muscles.\n\n## Stylopharyngeus\n\n## Palatopharyngeus \nAttaches to the palatine aponeurosis and soft palate and passes posteriorly and inferiorly to blend with deep surface of pharyngeal wall. \n\n## Salpingopharyngeus\nOriginates on the inferior aspect of pharyngotympanic tube and descends to blend in with the pharyngeal wall. It\u0027s helpful to know that \u0022salpinx\u0022 means tube, and this muscle attaches to the pharyngotympanic tube.\n\n## Pharyngeal Constrictors\nSuperior, Middle, and Inferior\n\nThe inferior muscle is the most superficial, the superior constrictor is the deepest. \n\nAlso notice that we can see where stylopharyngeus threads between the superior and middle constrictors to pass from the styloid process to the internal pharynx. \n\nDuring swallowing, the 3 pharyngeal constrictors contract sequentially from top to bottom, transferring a bolus of food inferiorly through the pharynx to the esophagus; the longitudinal muscles move the pharynx up and over the bolus. \n\n\n\n\n\n\n \n\n \n\n \n","keywords":[],"images":[{"id":"9529","url":"term\/images\/pharyngeal-muscles-pharyngeal-constrictors-9529.png","title":"Pharyngeal muscles, pharyngeal constrictors","demo":false},{"id":"9532","url":"term\/images\/pharyngeal-muscles-pharynx-pharyngeal-constrictors-deep-pharyngeal-muscles-9532.png","title":"Pharyngeal muscles, pharynx, pharyngeal constrictors, deep pharyngeal muscles","demo":false},{"id":"9626","url":"term\/images\/3349-1746458845944.png","demo":false},{"id":"9530","url":"term\/images\/pharyngeal-muscles-lateral-view-pharyngeal-constrictors-pharyngeal-longitudinal-muscles-9530.png","title":"Pharyngeal muscles lateral view, pharyngeal constrictors, pharyngeal longitudinal muscles","demo":false}],"radiographs":[],"curricula":[{"id":"2","level":"graduate","category":"individual","urlId":"gross-anatomy","name":"Gross Anatomy","subjectGroups":[{"id":"1713","name":"Pharynx","urlId":"pharynx","subjects":[{"id":"6292","urlId":"pharynx","name":"Pharyngeal Muscles","tutorials":[{"id":"2326","urlId":"pharynx-muscles-posterior-view","title":"Pharynx Muscles - Posterior View","hasQuizQuestions":0,"hasNotes":0,"hasStarterImage":0,"hasSlides":0},{"id":"2325","urlId":"pharynx-muscles-lateral-medial","title":"Pharynx Muscles - Lateral \u0026 Medial","hasQuizQuestions":0,"hasNotes":0,"hasStarterImage":0,"hasSlides":0}]}],"numTutorials":2}]}],"favorite":0,"numAnnotations":0}