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Clinical anatomy and physiology of the pharynx. Clinical anatomy of the pharynx

Topic title:

Pharynx. The structure of the throat. Muscles of the throat. Blood supply and innervation of the pharynx. The act of swallowing

pharynx, throat, represents that part of the digestive tube and respiratory tract, which is the connecting link between the cavity of the nose and mouth, on the one hand, and the esophagus and larynx, on the other. It extends from the base of the skull to the VI-VII cervical vertebrae.

The internal space of the pharynx is the cavity of the pharynx, cavitas pharyngis. The pharynx is located behind the nasal and oral cavities and larynx, in front of the basilar part of the occipital bone and upper cervical vertebrae.

According to the organs located anterior to the pharynx, it can be divided into three parts: pars nasalis, pars oralis and pars laryngea.

The upper wall of the pharynx adjacent to the base of the skull is called vault, fornix pharyngis.

Pars nasalis pharyngis, nasal part, in functional terms, it is a purely respiratory department. Unlike other parts of the pharynx, its walls do not collapse, as they are motionless. The anterior wall of the nasal region is occupied by the choanae. On the lateral walls is located along the funnel-shaped pharyngeal opening of the auditory tube (part of the middle ear), ostium pharyngeum tubae. Top and rear pipe opening limited pipe roller, torus tubarius, which is obtained due to the protrusion of the cartilage of the auditory tube here. On the border between the upper and posterior walls of the pharynx in the midline is an accumulation of lymphoid tissue, tonsilla pharyngea s. adenoidea (hence - adenoids) (in an adult it is hardly noticeable).

Another accumulation of lymphoid tissue, paired, is located between the pharyngeal opening of the tube and the soft palate, tonsilla tubaria. Thus, at the entrance to the pharynx there is an almost complete ring of lymphoid formations: the tonsil of the tongue, two palatine tonsils, two tubal and pharyngeal tonsils (the lymphoepithelial ring described by N.I. Pirogov and Waldeyer is called the Pirogov-Waldeyer lymphoid pharyngeal ring). The composition of the ring is analyzed in detail in the video clip below.

Pars oralis, oral part, represents the middle part of the pharynx, which communicates in front through the pharynx, fauces, with the oral cavity; its back wall corresponds to the third cervical vertebra. The function of the oral part is mixed, since it crosses the digestive and respiratory tracts.

This decussation was formed during the development of the respiratory organs from the wall of the primary intestine. From the primary nasal bay, the nasal and oral cavity, and the nasal one turned out to be located above or, as it were, dorsally in relation to the oral one, and the larynx, trachea and lungs arose from the ventral wall of the foregut.

Therefore, the head section of the digestive tract turned out to lie between the nasal cavity (above and dorsally) and the respiratory tract (ventrally), which is the reason for the intersection of the digestive and respiratory tracts in the pharynx.

Pars laryngea, laryngeal part, represents the lower part of the pharynx, located behind the larynx and extending from the entrance to the larynx to the entrance to the esophagus. On the front wall is the entrance to the larynx.

The basis of the pharyngeal wall is the fibrous membrane of the pharynx, fascia pharyngobasilaris, which is attached to the bones of the base of the skull at the top, covered with a mucous membrane from the inside, and muscular from the outside. The muscular layer, in turn, is covered on the outside with a thinner layer. fibrous tissue, which connects the wall of the pharynx with the surrounding organs, and at the top goes to m. buccinator and is called fascia buccopharyngea.

The mucous membrane of the nose pharynx is covered with ciliated epithelium in accordance with respiratory function this part of the pharynx, in the lower sections the epithelium is stratified squamous. Here, the mucosa acquires a smooth surface that promotes the sliding of the food bolus when swallowing.

This is also facilitated by the secret of the mucous glands embedded in it and the muscles of the pharynx, located longitudinally (dilators) and circularly (narrowers). The circular layer is much more pronounced and breaks up into three compressors located in 3 floors: upper, m. constrictor pharyngis superior, medium, m. constrictor pharyngis medius and lower, m. constrictor pharyngis inferior.

Starting at various points: on the bones of the base of the skull (tuberculum pharyngeum of the occipital bone, processus pterygoideus sphenoid), on the lower jaw (linea mylohyoidea), on the root of the tongue, hyoid bone and cartilages of the larynx (thyroid and cricoid), - the muscle fibers of each side go back and connect with each other, forming a seam along the midline of the pharynx, raphe pharyngis.

The lower fibers of the inferior pharyngeal constrictor are closely related to the muscle fibers of the esophagus. The longitudinal muscle fibers of the pharynx are part of two muscles:

1. M. stylopharyngeus, stylopharyngeal muscle, starts from the processus styloideus, goes down and ends partly in the very wall of the pharynx, partly attached to the upper edge of the thyroid cartilage.

2. M. palatopharyngeus, palatopharyngeal muscle(described above, see "").

The act of swallowing

By contraction of the muscles of the tongue, the food bolus is pressed against the back of the tongue against the hard palate and pushed through the pharynx. In this case, the soft palate is pulled upward (by contraction of mm. levator veli palatini and tensor veli paratini) and approaches the back wall of the pharynx (by contraction of m. palatopharyngeus). Thus, the nasal part of the pharynx (respiratory) is completely separated from the oral.

At the same time, the muscles located above the hyoid bone pull the larynx up, and the root of the tongue by contraction m. hyoglossus descends; he puts pressure on the epiglottis, lowers the latter and thereby closes the entrance to the larynx (into the airways). Next, there is a consistent contraction of the constrictors of the pharynx, as a result of which the food bolus is pushed towards the esophagus.

The longitudinal muscles of the pharynx function as elevators: they pull the pharynx towards the food bolus.

Innervation and blood supply of the pharynx

The nutrition of the pharynx comes mainly from a. pharyngea ascendens and branches of a. facialis and a. maxillaris from a. corotis externa. Venous blood flows into the plexus located on top of the muscular membrane of the pharynx, and then through vv. pharyngeae into v. jugularis interna.

The outflow of lymph occurs in nodi lymphatici cervicales profundi et retropharyngeales. The pharynx is innervated from the nerve plexus - plexus pharyngeus, formed by the branches of nn. glossopharyngeus, vagus et tr. sympathicus.

Wherein sensory innervation carried out for n. glossopharyngeus and n. vagus; the muscles of the pharynx are innervated by n. vagus, with the exception of m. stylopharyngeus, supplied by n. glossopharyngeus.

Educational video on anatomy, blood supply and innervation of the pharynx

Other video lessons on the anatomy of the pharynx on cadaver preparations are presented.

The pharynx is a funnel-like muscular canal that is up to 14 cm long. The anatomy of this organ allows the food bolus to freely enter the esophagus, and then into the stomach. In addition, due to the anatomical and physiological features, air from the nose enters the lungs through the pharynx and vice versa. That is, the digestive and respiratory systems of a person intersect in the pharynx.

Anatomical and physiological features

The upper part of the pharynx is attached to the base of the skull, the occipital bone, and the temporal pyramidal bones. At the level of the 6-7th vertebrae, the pharynx passes into the esophagus.

Inside it is a cavity (cavitas pharyngis). That is, the pharynx is a cavity.

The organ is located behind the oral and nasal cavities, anterior to the occipital bone (its basilar part) and the upper cervical vertebrae. In accordance with the relation of the pharynx to other organs (that is, with the structure, it is conditionally divided into several parts: pars laryngea, pars laryngea, pars nasalis. One of the walls (upper), which is adjacent to the base of the skull, is called the vault.

bow

Pars nasalis is functionally the respiratory section of the human pharynx. The walls of this department are motionless and therefore do not collapse (the main difference from other departments of the organ).

In the anterior wall of the pharynx are the choanae, and on the lateral surfaces are the pharyngeal funnel-shaped openings of the auditory tube, which is a component of the middle ear. Behind and above, this opening is limited by a tube roller, which is formed by a protrusion of the cartilage of the auditory tube.

The border between the posterior and upper pharyngeal walls is occupied by an accumulation of lymphoid tissue (on the midline) called adenoids, which are not very pronounced in an adult.

Between the soft palate and the opening (pharyngeal) of the tube is another accumulation of lymphatic tissue. That is, at the entrance to the pharynx there is an almost dense ring of lymphatic tissue: lingual tonsil, palatine tonsils (two), pharyngeal and tubal (two) tonsils.

oral part

Pars oralis - this is the middle section in the pharynx, in front of which communicates through the pharynx with the oral cavity, and its back part is located at the level of the third cervical vertebra. The functions of the oral part are mixed, due to the fact that the digestive and respiratory systems intersect here.

Such a crossover is a feature of the human respiratory system and was formed during periods from the primary intestine (its wall). The oral and nasal cavities were formed from the nasorotic primary bay, the latter being located at the top and slightly dorsally relative to the oral cavity. The trachea, larynx, and lungs developed from the wall of the (ventral) foregut. That is why the head section of the gastrointestinal tract is located between the nasal cavity (upper and dorsal) and the respiratory tract (ventrally), which explains the intersection of the respiratory and digestive systems in the pharynx.

Laryngeal part

Pars laryngea is the lower part of the organ, located behind the larynx and runs from the beginning of the larynx to the beginning of the esophagus. The laryngeal entrance is located on its front wall.

The structure and functions of the pharynx

The basis of the pharyngeal wall is that it is attached to the bone base of the skull from above, lined with mucous membrane inside, and outside - with a muscular membrane. The latter is covered with thin fibrous tissue, which unites the pharyngeal wall with neighboring organs, and from above, goes to m. buccinator and turns into her fascia.

The mucosa in the nasal segment of the pharynx is covered with ciliated epithelium, which corresponds to its respiratory function, and in the underlying sections - with flat multilayered epithelium, due to which the surface becomes smooth and the food bolus easily slips when swallowing. In this process, the glands and muscles of the pharynx also play a role, which are arranged circularly (constrictors) and longitudinally (dilators).

The circular layer is more developed and consists of three constrictors: the superior constrictor, the middle constrictor, and the inferior constrictor of the pharynx. Starting at different levels: from the bones of the base of the skull, the lower jaw, the root of the tongue, the cartilage of the larynx and the hyoid bone, the muscle fibers go back and, having united, form the pharyngeal suture along the midline.

The fibers (lower) of the inferior constrictor are connected to the muscular fibers of the esophagus.

The longitudinal muscle fibers make up the following muscles: stylopharyngeal (M. stylopharyngeus) originates from the styloid process (part temporal bone), passes down and, dividing into two bundles, enters the wall of the pharynx, and is also attached to (its upper edge); palatopharyngeal muscle (M. palatopharyngeus).

The act of swallowing

Due to the presence in the pharynx of the intersection of the digestive and respiratory tract, the body is equipped with special devices that separate the respiratory tract from the digestive tract during swallowing. Thanks to contractions, the bolus of food is pressed against the palate (hard) with the back of the tongue and then pushed into the pharynx. At this time, the soft palate is pulled up (due to muscle contractions tensor veli paratini and levator veli palatini). So the nasal (respiratory) section of the pharynx is completely separated from the oral section.

Along with this, the muscles that are located above the hyoid bone pull the larynx up. At the same time, the root of the tongue descends and presses on the epiglottis, due to which the latter descends, closing the passage to the larynx. After that, successive contractions of constrictors occur, due to which the lump of food penetrates to the esophagus. At the same time, the longitudinal muscles of the pharynx work as lifters, that is, they raise the pharynx towards the movement of the food bolus.

Blood supply and innervation of the pharynx

The pharynx is supplied with blood mainly from the pharyngeal ascending artery (1), the superior thyroid artery (3), and the branches of the facial (2), maxillary and carotid external arteries. The venous outflow occurs in the plexus, which is located on top of the pharyngeal muscular membrane, and further along the pharyngeal veins (4) into the internal jugular vein (5).

Lymph flows into the lymphatic cervical nodes (deep and retropharyngeal).

The pharynx is innervated by the pharyngeal plexus (plexus pharyngeus), which is formed by branches of the vagus nerve (6), sympathetic symbol (7) and glossopharyngeal nerve. Sensitive innervation in this case passes through the glossopharyngeal and vagus nerves, the only exception is the stylopharyngeal muscle, the innervation of which is carried out only by the glossopharyngeal nerve.

Dimensions

As mentioned above, the pharynx is a muscular tube. Its largest transverse dimension is at the levels of the nasal and oral cavities. The size of the pharynx (its length) averages 12-14 cm. The transverse size of the organ is 4.5 cm, that is, more than the anterior-posterior size.

Diseases

All diseases of the pharynx can be divided into several groups:

Inflammatory acute pathologies.
Trauma and foreign bodies.
chronic processes.
Tonsil lesions.
Angina.

Inflammatory acute processes

Among inflammatory diseases occurring acutely, the following can be distinguished:

Acute pharyngitis is a lesion of the lymphoid tissue of the pharynx due to the multiplication of viruses, fungi or bacteria in it.
Candidiasis of the pharynx - damage to the mucous membrane of the organ by fungi of the genus Candida.
Acute tonsillitis (tonsillitis) is a primary lesion of the tonsils, which has infectious nature. Angina can be: catarrhal, lacunar, follicular, ulcerative-film.
Abscess in the region of the root of the tongue - purulent tissue damage in the region of the hyoid muscle. The cause of this pathology is infection of wounds or as a complication of inflammation of the lingual tonsil.

Throat injuries

The most common injuries include:

1. Various burns caused by electrical, radiation, thermal or chemical effects. Thermal burns develop as a result of getting too hot food, and chemical burns - when exposed to chemical agents (usually acids or alkalis). There are several degrees of tissue damage during burns:

The first degree is characterized by erythema.
The second degree is the formation of bubbles.
The third degree is necrotic tissue changes.

2. Foreign bodies in the throat. It can be bones, pins, food particles and so on. The clinic of such injuries depends on the depth of penetration, localization, size of the foreign body. More often there are stabbing pains, and then pain when swallowing, coughing, or a feeling of suffocation.

Chronic processes

Among chronic lesions of the pharynx are often diagnosed:

Chronic pharyngitis is a disease that is characterized by lesions of the mucous membrane of the pharyngeal posterior wall and lymphoid tissue as a result of acute or chronic damage to the tonsils, paranasal sinuses, and so on.
Pharyngomycosis is damage to the tissues of the pharynx caused by yeast-like fungi and developing against the background of immunodeficiencies.
Chronic tonsillitis is an autoimmune pathology of the palatine tonsils. In addition, the disease is allergic-infectious and is accompanied by a persistent inflammatory process in the tissues of the palatine tonsils.

And - on the other. It stretches from the base to VI-VII. The interior of the pharynx is pharyngeal cavity, cavitas pharyngis.

The pharynx is located behind the nasal and oral cavities and larynx, in front of the basilar part and upper cervical vertebrae. According to the organs located anterior to the pharynx, it can be divided into three parts: pars nasalis, pars oralis and pars laryngea.

The upper wall of the pharynx, adjacent to the base of the skull, is called the vault, fornix pharyngis.
Pars nasalis pharyngis, the nasal part, is functionally a purely respiratory section. Unlike other parts of the pharynx, its walls do not collapse, as they are motionless.
The anterior wall of the nasal region is occupied by the choanae.
On the lateral walls there is a funnel-shaped pharyngeal opening (part of the middle ear), ostium pharyngeum tubae. From above and behind the opening of the tube is limited by a tube roller, torus tubarius, which is obtained due to the protrusion of the cartilage of the auditory tube here.

On the border between the upper and posterior walls of the pharynx in the midline is an accumulation of lymphoid tissue, tonsilla pharyngea s. adenoidea (hence - adenoids) (in an adult it is hardly noticeable). Another accumulation of lymphoid tissue, paired, is located between the pharyngeal opening of the tube and, tonsilla tubaria.

Thus, at the entrance to the pharynx there is an almost complete ring of lymphoid formations: the tonsil of the tongue, two palatine tonsils, two tubal and pharyngeal (lymphepithelial ring described by N. I. Pirogov).

Pars oralis, represents the middle part of the pharynx, which communicates in front through the pharynx, fauces, with the oral cavity; its back wall corresponds to the third cervical vertebra. The function of the oral part is mixed, since it crosses the digestive and respiratory tracts. This decussation was formed during the development of the respiratory organs from the wall of the primary intestine. The nasal and oral cavities were formed from the primary nasal bay, and the nasal one turned out to be located above or, as it were, dorsally in relation to the oral one, and, and arose from the ventral wall of the foregut. Therefore, the head section of the digestive tract turned out to lie between the nasal cavity (above and dorsally) and the respiratory tract (ventrally), which is the reason for the intersection of the digestive and respiratory tracts in the pharynx.

Pars laryngea, laryngeal part, represents the lower part of the pharynx, located behind the larynx and extending from the entrance to the larynx to the entrance to the esophagus. On the front wall is the entrance to the larynx.

The basis of the pharyngeal wall is the fibrous membrane of the pharynx, fascia pharyngobasilaris, which is attached to the bones of the base of the skull at the top, covered with a mucous membrane from the inside, and muscular from the outside. The muscular membrane, in turn, is covered on the outside with a thinner layer of fibrous tissue, which connects the wall of the pharynx with the surrounding organs, and at the top passes to m. buccinator and is called fascia buccopharyngea.

The mucous membrane of the nasal part of the pharynx is covered with ciliated epithelium in accordance with the respiratory function of this part of the pharynx, while in the lower parts the epithelium is stratified squamous. Here, the mucosa acquires a smooth surface that promotes the sliding of the food bolus when swallowing. This is also facilitated by the secret of the mucous glands embedded in it and the muscles of the pharynx, located longitudinally (dilators) and circularly (narrowers).

The circular layer is much more pronounced and breaks up into three compressors located in 3 floors: upper, m. constrictor pharyngis superior, medium, m. constrictor pharyngis medius and lower, m. constrictor pharyngis inferior.

Starting at various points: on the bones of the base of the skull (tuberculum pharyngeum of the occipital bone, processus pterygoideus sphenoid), on the lower jaw (linea mylohyoidea), on the root of the tongue, and on the cartilages of the larynx (thyroid and cricoid), - the fibers of the muscles of each side go back and connect with each other, forming a suture along the midline of the pharynx, raphe pharyngis. The lower fibers of the inferior pharyngeal constrictor are closely related to the muscle fibers of the esophagus.

The longitudinal muscle fibers of the pharynx are part of two muscles:

M. stylopharyngeus, the stylopharyngeal muscle, starts from the processus styloideus, goes down and ends partly in the very wall of the pharynx, partly attached to the upper edge of the thyroid cartilage.
M. palatopharyngeus, palatopharyngeal muscle (see. Sky).

The act of swallowing. Since the respiratory and digestive tracts cross in the pharynx, there are special devices that separate the respiratory tract from the digestive tract during the act of swallowing. By contraction of the muscles of the tongue, the food bolus is pressed against the back of the tongue against the hard palate and pushed through the pharynx. In this case, the soft palate is pulled upward (by contraction of mm. levator veli palatini and tensor veli palatini) and approaches the back wall of the pharynx (by contraction of m. palatopharyngeus).

Thus, the nasal part of the pharynx (respiratory) is completely separated from the oral. At the same time, the muscles located above the hyoid bone pull the larynx up, and the root of the tongue by contraction m. hyoglossus descends; he puts pressure on the epiglottis, lowers the latter and thereby closes the entrance to the larynx (into the airways). Next, there is a consistent contraction of the constrictors of the pharynx, as a result of which the food bolus is pushed towards the esophagus. The longitudinal muscles of the pharynx function as elevators: they pull the pharynx towards the food bolus.

The pharynx is innervated from the nerve plexus - plexus pharyngeus, formed by the branches of nn. glossopharyngeus, vagus et tr. sympathicus. In this case, sensitive innervation is also carried out along n. glossopharyngeus and n. vagus; the muscles of the pharynx are innervated by n. vagus, with the exception of m. stylopharyngeus, supplied by n. glossopharyngeus.

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(pharyngs) is the initial part of the digestive tube and respiratory tract. The pharyngeal cavity ( cavitas pharingis) (Fig. 1) connects the oral cavity and nasal cavity with the esophagus and larynx. In addition, it communicates through the auditory tube with the middle ear. The pharynx is located behind the cavities of the nose, mouth and larynx and extends from the base of the skull to the point of transition into the esophagus at the level of the VI cervical vertebra. The pharynx is a hollow wide tube, flattened in the anteroposterior direction, narrowing as it passes into the esophagus. In the pharynx, the upper, posterior, and lateral walls can be distinguished. The length of the pharynx averages 12-14 cm.

Rice. 1. Throat, rear view. (The back wall of the pharynx is removed): 1 - choanae; 2 - basilar part of the occipital bone; 3 - pharyngeal tonsil; 4 - styloid process; 5 - septum of the nasal cavity; 6 - pipe roller; 7 - pharyngeal opening of the auditory tube; 8 - roller of the muscle that raises the palatine curtain; 9 - tubal-pharyngeal fold; 10 - soft palate; 11 - the root of the tongue; 12 - epiglottis; 13 - entrance to the larynx; 14 - oral part of the pharynx; 15 - nasal part of the pharynx; 16 - pharyngeal pocket

There are 3 parts in the pharynx: nasal (nasopharynx); oral (oropharynx); guttural (larynx). The upper part of the pharynx, adjacent to the outer base of the skull, is called the pharyngeal vault.

Nasal pharynx(pars nasalis pharyngis) is the upper part of the pharynx and differs from other parts in that its upper and partially lateral walls are fixed on the bones and therefore do not collapse. The anterior wall of the pharynx is absent, since the front of the nasopharynx communicates with the nasal cavity through two choanae. On the side walls of the nasal part of the pharynx, at the level of the posterior end of the lower shell, there is a paired funnel-shaped pharyngeal opening of the auditory tube, which is bounded behind and above pipe roller (torus tubarius). This roller is formed due to the protrusion of the cartilage of the auditory tube into the pharyngeal cavity. From the pipe roll down goes a short tubal-pharyngeal fold mucous membrane (plica salpingopharyngea). Ahead of this fold, the mucous membrane forms a muscle roller, raising the palatine curtain (torus levatorius) covering the muscle of the same name. Along the front edge of this roller stretches tubal-palatine fold (plica salpingopalatina). Behind the tube roller, the mucous membrane forms a large, irregular in shape pharyngeal pocket (recessus pharyngeus), the depth of which depends on the development of tubal tonsils. At the point of transition upper wall in the back between the pharyngeal openings of the auditory tubes in the mucous membrane of the pharynx there is an accumulation of lymphoid tissue - pharyngeal (adenoid) tonsil (tonsilla pharyngealis). In children, it is developed to the maximum, and in adults it undergoes reverse development. The second, paired, accumulation of lymphoid tissue lies in the mucous membrane of the pharynx in front of the pharyngeal openings of the auditory tubes. This is tubal tonsil (tonsilla tubaria). Together with the palatine and lingual tonsils and laryngeal lymphoid nodules, the pharyngeal and tubal tonsils make up lymphoid pharyngeal ring (anulus lymphoideus pharngis). On the vault of the pharynx along the midline, near the place of transition of the upper wall to the back, sometimes there is a round depression - pharyngeal bursa (bursa pharyngealis).

Oral part of the pharynx(pars oralis pharyngis) occupies the space from the soft palate to the entrance to the larynx and communicates through the pharynx with the oral cavity, so the oral part has only side and back walls; the latter corresponds to the third cervical vertebra. The oral part of the pharynx functionally belongs to both the digestive and respiratory systems, which is explained by the development of the pharynx. When swallowing, the soft palate, moving horizontally, isolates the nasopharynx from the oral part, and the root of the tongue and the epiglottis close the entrance to the larynx. With a wide open mouth, the back wall of the pharynx is visible.

Laryngeal part of the pharynx(pars laryngea pharyngis) is located behind the larynx, at the level from the entrance to the larynx to the beginning of the esophagus. It has front, back and side walls. Outside the act of swallowing, the anterior and posterior walls are in contact. The anterior wall of the laryngeal part of the pharynx is laryngeal prominence (prominentia laryngea), above which is the entrance to the larynx. On the sides of the ledge lie deep pits - pear-shaped pockets (recessuspiriformis), formed on the medial side by the laryngeal protrusion, and on the lateral side - by the lateral wall of the pharynx and the posterior edges of the plates of the thyroid cartilage. The pear-shaped pocket is divided fold of the laryngeal nerve (plica nervi laryngei) into two sections - a smaller upper and a larger lower. The laryngeal nerve passes through the fold.

The nasopharynx of newborns is very small and short. The arch of the pharynx is flattened and inclined anteriorly in relation to its oral region. In addition, in newborns, the pharynx is relatively shorter than in adults, and the velum of the palate is in contact with the entrance to the larynx. The soft palate is short when raised and does not reach the posterior pharyngeal wall. The tonsils strongly protrude into the pharyngeal cavity of newborns and children of the first years of life. The pharyngeal openings of the auditory tubes are close together and lie lower than in adults, at the level of the hard palate. The pharyngeal pouches, as well as tubal ridges and tubal-palatine folds, are weakly expressed.

The structure of the wall of the pharynx. The wall of the pharynx consists of a mucous membrane, a fibrous layer, a muscular membrane and a buccal-pharyngeal fascia covering it.

mucous membrane(tunica mucosa) the nasal part of the pharynx is covered with multi-row ciliated epithelium, and the oral and laryngeal parts are covered with stratified squamous. AT submucosal there is a large number of mixed (muco-serous - in the nasopharynx) and mucous (in the oral and laryngeal parts) glands, the ducts of which open into the pharyngeal cavity on the surface of the epithelium. In addition, there are accumulations in the submucosal layer lymphoid nodules, most of which form the pharyngeal and tubal tonsils. Between the nodules are many small mixed glands. At the location of the pharyngeal tonsil, the mucous membrane will give spurs into the thickness of the tonsil, forming a number of folds and dimples. In the dimples of the pharyngeal tonsil there are depressions - tonsillar crypts (criptae tonsillares), into which the ducts of mixed glands located between the lymphoid nodules open.

The submucosa is well expressed. In its own layer of the mucous membrane, many elastic fibers are embedded. As a result, the pharyngeal cavity changes its size during the passage of food. Near the junction with the esophagus, the pharynx narrows. In its narrow section, the mucous membrane is smooth and contains especially many elastic fibers, which ensures the passage of the food bolus.

Pharyngobasilar fascia(fascia pharyngobasilaris) makes up the fibrous basis of the pharynx. In the upper part, it is strengthened by bundles of collagen fibers that go to it in the form of ligaments from the pharyngeal tubercle, the edge of the external aperture of the carotid canal, and from the membranous plate of the auditory tube. This fascia begins on the external base of the skull along a line passing through the pharyngeal tubercle of the occipital bone transversely along the basilar part of this bone, anterior to the attachment of the deep layer of the anterior muscles of the neck. Further, the line of the beginning of the fascia turns forward and outward, crosses the pyramid of the temporal bone anteriorly from the external aperture of the carotid canal and follows to the sphenoid spine. From here, this line deviates anteriorly and medially and runs along the sphenoid-stony synchondrosis in front of the cartilage of the auditory tube to the base of the medial plate of the pterygoid process. sphenoid bone. Then it follows the medial plate of the process down and anteriorly along the raphe pterygomandibularis to the posterior end of the linea mylohyoidea mandibulae. In the composition of the pharyngeal-basilar fascia, in addition to collagen bundles, there are many elastic fibers.

Muscular layer of the pharynx(tunica muscularis pharyngis) consists of two groups of striated muscles: constrictors - constrictors located circularly, and pharynx lifters running longitudinally. The constrictors of the pharynx, paired formations, include the upper, middle, and lower constrictors (Fig. 2).

Rice. 2. Muscles of the pharynx, rear view:

1 - pharyngeal tubercle of the occipital bone; 2 - pharyngeal-basilar fascia; 3 - upper constrictor of the pharynx; 4 - tubal-pharyngeal muscle; 5 — average constrictor of a throat; 6 - the upper horn of the thyroid cartilage; 7 - plate of the thyroid cartilage; 8 - circular layer of the muscular membrane of the esophagus; 9 - longitudinal layer of the muscular membrane of the esophagus; 10 - large horn of the hyoid bone; 11 - medial pterygoid muscle; 12 - stylo-pharyngeal muscle; 13 - styloid process

1. Superior pharyngeal constrictor (m. constrictor pharyngis superior) starts from the medial plate of the pterygoid process ( pterygopharyngeal part, pars pterygopharyngea), from the pterygo-mandibular suture ( buccal-pharyngeal part, pars buccopharyngea), maxillofacial line ( maxillary-pharyngeal part, pars mylopharyngea) and from the transverse muscle of the tongue ( glossopharyngeal part, pars glossopharyngea). The muscle bundles that began on the listed formations form the lateral wall of the pharynx, and then arcuately directed posteriorly and medially, forming its posterior wall. Posteriorly along the midline, they meet with bundles of the opposite side, where they form a tendon pharyngeal suture (raphe pharyngis), going from the pharyngeal tubercle in the middle of the entire back wall of the pharynx to the esophagus. The upper edge of the upper constrictor of the pharynx does not reach the base of the skull, therefore, in the upper section (for 2-3 cm) the wall of the pharynx is devoid of a muscular membrane and is formed only pharyngeal-basilar fascia and mucous membrane.

2. Middle pharyngeal constrictor (t. constrictor pharynges medius) starts from the top of the greater horn of the hyoid bone ( carob-pharyngeal part muscles, pars ceratopharyngea) and from the lesser horn and stylohyoid ligament ( cartilaginous part, pars chondropharyngea). The upper muscle bundles go upwards, partially covering the upper constrictor of the pharynx (when viewed from behind), the middle bundles go horizontally backwards (almost completely covered by the lower constrictor). The bundles of all parts end at the seam of the pharynx. Between the middle and upper constrictors are the lower bundles of the stylo-pharyngeal muscle.

3. Inferior pharyngeal constrictor (m. constrictor pharynges inferior) starts from the outer surface of the cricoid cartilage ( cricopharyngeal part, pars crycopharyngea), from the oblique line and parts of the thyroid cartilage adjacent to it and from the ligaments between these cartilages ( thyroid part, pars thyropharyngea). The muscle bundles go backwards in ascending, horizontal and descending directions, ending at the suture of the pharynx. The lower constrictor is the largest, covering the lower half of the middle one.

Function: narrows the pharyngeal cavity, pushes the food bolus with successive contraction (Fig. 3).

Rice. 3. Muscles of the pharynx, side view:

1 - muscle straining the palatine curtain; 2 - a muscle that raises the palatine curtain; 3 - pharyngeal-basilar fascia; 4 - styloid process; 5 - posterior belly of the digastric muscle (cut off); 6 - upper constrictor of the pharynx; 7 - awl-lingual muscle; 8 - stylohyoid ligament; 9 - stylo-pharyngeal muscle; 10 — average constrictor of a throat; 11 - hyoid-lingual muscle; 12 - a large horn of the hyoid bone; 13 - thyroid membrane; 14 - crico-pharyngeal part of the lower constrictor of the pharynx; 15 - esophagus; 16 - trachea; 17 - cricoid cartilage; 18 - cricothyroid muscle; 19 - thyroid cartilage; 20 - hyoid bone; 21 - maxillofacial muscle; 22 - anterior belly of the digastric muscle; 23 - oblique line of the lower jaw; 24 - pterygomandibular suture; 25 - pterygoid hook; 26 - pterygoid process

To the muscles that lift and dilating the pharynx, include the following.

1. Stylo-pharyngeal muscle(t. stylopharyngeus) starts from the styloid process near its root, goes down and medially to the posterolateral surface of the pharynx, penetrating between its upper and middle constrictors. Muscle fibers go to the edges of the epiglottis and thyroid cartilage.

Function: elevates and expands the pharynx.

2. The palatopharyngeal muscle(t. palatopharyngeus).

Buccal-pharyngeal fascia covers the contracting muscles from the outside. The buccal muscle originates in the same place as the superior constrictor of the pharynx ( pterygomandibular suture), so the fascia from the buccal muscle passes to the upper, and then to other constrictors of the pharynx.

Behind the pharynx are the deep muscles of the neck (the long muscles of the head and neck) and the bodies of the first cervical vertebrae. Here, between the buccal-pharyngeal fascia, which covers the pharynx from the outside, and the parietal sheet of the intracervical fascia, there is an unpaired cellular pharyngeal space(spatium retropharyngeum), which is important as a possible site for the formation of retropharyngeal abscesses. On the sides of the pharynx is a pair of cellular lateral parapharyngeal space(spatium lateropharyngeum), limited medially by the lateral wall of the pharynx, laterally - by the pterygoid muscles, the muscle that strains the palatine curtain, and the muscles starting on the styloid process, behind - by the parietal sheet of the intracervical fascia. Both of these spaces are combined under the name peripharyngeal space(spatium peripharyngeum). The processes of the intracervical fascia in it secrete sleepy vagina(vagina carotica), in which the internal carotid artery, internal jugular vein and nervus vagus.

The upper poles are adjacent to the lateral surfaces of the laryngeal part of the pharynx. thyroid gland and common carotid arteries, in front of it is the larynx (Fig. 4).

Rice. 4. Syntopy of the pharynx, rear view:

1 - external carotid artery; 2 - internal carotid artery; 3 - superior laryngeal nerve; 4 - facial artery; 5- lingual artery; 6 - internal branch of the superior laryngeal nerve; 7 - external branch of the superior laryngeal nerve; 8 - superior thyroid artery; 9 - internal jugular vein; 10 - common carotid artery; 11 - vagus nerve; 12 - the right lobe of the thyroid gland; 13 _ trachea; 14 - longitudinal layer of the muscular membrane of the esophagus; 15 - recurrent laryngeal nerves; 16 - parathyroid glands; 15 - ascending cervical artery; 16 - lower parathyroid gland; 17 - seam of the pharynx; 18 - lower constrictor of the pharynx; 19 - average constrictor of the pharynx; 20 - upper constrictor of the pharynx

Vessels and nerves. The blood supply to the pharynx comes from the system outdoor carotid artery ascending pharyngeal, ascending palatine and descending palatine arteries. The laryngeal part of the pharynx, in addition, receives branches from superior thyroid artery. Intraorganic veins of the pharynx form in the submucosa and on the outer surface of the muscular membrane venous plexuses, from where blood flows through the pharyngeal veins into the internal jugular vein or its tributaries.

Lymphatic vessels of the pharynx are formed from lymphocapillary networks located in all layers of the pharyngeal wall. The efferent vessels go to the pharyngeal (partially to the facial) and mainly to anterior cervical deep lymph nodes.

The innervation of the pharynx is carried out by the branches of the vagus, glossopharyngeal nerves and the cervical part of the sympathetic trunk, forming on the back and side walls of the pharynx pharyngeal nerve plexus.

Human Anatomy S.S. Mikhailov, A.V. Chukbar, A.G. Tsybulkin

Pharynx(pharyx) is the initial part of the digestive tract and respiratory tract. It is a hollow muscular organ located behind the nasal cavity, mouth and larynx at the level of 1-6 cervical vertebrae. The lower part of the pharynx passes into the esophagus. The walls of the pharynx consist of 4 membranes: mucous, fibrous, muscular and adventitia.

mucous membrane contains many mucous glands and in the submucosal layer a large amount of lymphoid tissue in the form of individual nodules and large clusters that form the tonsils. The histological structure of the lymphadenoid tissue of the pharynx is the same - between the connective tissue fibers there is a mass of lymphocytes with their spherical accumulations, which are called follicles.

fibrous sheath is a plate of dense connective tissue, closely associated with the mucous and muscular layer.

Muscular membrane consists of circular and longitudinal muscles that compress the pharynx and raise it.

Adventitia - dense connective sheath - covers the muscular layer of the pharynx from the outside.

The back wall of the pharynx is located in front of the cervical vertebrae. In this area, between the fascia of the pharynx and the fascia of the spine, there is a pharyngeal space filled with loose fiber and lymphoid tissue, which is especially pronounced in children. The communication of this space with the mediastinum is important clinical significance with the development of a pharyngeal abscess.

The lateral walls of the pharynx border on the neurovascular bundle of the neck.

Anatomically, the pharynx is divided into 3 sections: the nasopharynx, oropharynx and laryngopharynx.

Nasopharynx- the upper part of the pharynx, the anterior border of which is the choanae and the edge of the vomer. Behind the nasopharynx are the 1st and 2nd cervical vertebrae. The lower border of the nasopharynx is the mental continuation of the plane of the hard palate posteriorly. The mucous membrane of this part of the pharynx, like the mucous membrane of the nasal cavity, is covered with stratified squamous ciliated epithelium and contains a large number of mucous glands.

On the side walls of the nasopharynx are the mouths of the auditory tubes, around them there is an accumulation of lymphoid tissue - paired tubal tonsils. In the vault of the nasopharynx there is a third unpaired pharyngeal tonsil - adenoids, consisting of 5-9 roller-like accumulations of lymphoid tissue up to 25 mm long.

Oropharynx- the middle part of the pharynx, located at the level of 3-4 cervical vertebrae, is limited only by the posterior and lateral walls. In this section of the pharynx, the respiratory and digestive tracts cross.

From the front, the oropharynx communicates with the oral cavity through an opening called the pharynx. The boundaries of the pharynx are the soft palate, the uvula, on the sides, the anterior and posterior arches, between which the paired palatine tonsils are located. The lower border of the oropharynx is the root of the tongue.

The structure of the palatine tonsils is of great clinical importance. The outer or fibrous surface of the tonsil is associated with the underlying fiber and is covered with a layer of connective tissue called the tonsil capsule. Fibrous strands depart from it, forming fine-fibred plexuses, in which spherical accumulations of lymphocytes - follicles - are located. The lymphocytes of these follicles are formed during embryonic development and play an important role in the formation of local and general immunity.

On the free surface of the tonsils there are gaps, or lacunae, which go deep into the tissue and branch there. The number of lacunae is from 8 to 30. The mucous membrane of the palatine tonsils has areas through which lymphocytes come to the surface of the lacunae. Remains of food falling into the gaps, desquamated epithelium, microbes and lymphocytes form plugs that contribute to the development of the inflammatory process in the amygdala. During the act of swallowing, self-cleaning of the amygdala occurs, but, due to individual anatomical features, it can be disturbed.

On the back wall of the pharynx there are small accumulations of lymphadenoid tissue, called granules or follicles, and significant accumulations on the side walls of the pharynx - lateral ridges.

Lower throat - laryngopharynx- located at the level of 5-6 cervical vertebrae. It tapers in the form of a cone and is located in front above the entrance to the larynx. Between the protruding cartilages of the larynx and the side walls of the pharynx there are recesses - pear-shaped sinuses, which pass into the initial part of the esophagus. On the front wall in the region of the root of the tongue is an unpaired lingual tonsil.

All of the listed tonsils and accumulations of lymphadenoid tissue on the posterior pharyngeal wall form the pharyngeal Waldeer-Pirogov ring, which performs a protective function.