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CLINICAL THROAT ANATOMY
The pharynx, pharynx, is the initial part of the digestive tube located between the oral cavity and the esophagus. At the same time, it is also part of the respiratory tube, connecting the nasal cavity or oral cavity with the larynx. Consequently, in the pharyngeal cavity, the digestive and respiratory tract cross. The pharynx has the shape of a funnel-shaped tube flattened in the anteroposterior direction, suspended from the base of the skull. The line of attachment to the base of the skull passes through the following formations: behind - the pharyngeal tubercle of the basilar part of the occipital bone, on the sides - the temporal bone pyramids (anterior to the external opening of the carotid canal), then the medial plate of the pterygoid process of the sphenoid bone. At the level of 6-7 cervical vertebrae, the pharynx passes into the esophagus. The length of the pharynx in an adult is 12-14 cm. The pharynx is located anterior to the cervical spine.
Three parts are distinguished in the pharynx: the upper part is the nasal part, or nasopharynx, pars nasalis is the epipharynx, the middle part is the oral part is the oropharynx, pars oralis is the mesopharynx, and the lower part is the larynx or the larynx, pars laringea is the hypopharynx (Fig. 3.1).
In the pharynx, there are: upper, back, two side and front walls. The upper wall is fused to the outer base of the skull in the region of the basilar part of the occipital bone and the sphenoid bone body.
The side walls are adjacent to the neurovascular bundles of the neck. The front wall is almost absent, since in its upper and middle parts of the pharynx it communicates with neighboring cavities through the choanas, pharynx, and the entrance to the larynx. The anterior wall is present only in the lower part (larynx). It is formed by the arytenoid and cricoid cartilages, covered with muscles.
The nasopharynx communicates via the choan with the nasal cavity and performs exclusively respiratory functions. The upper wall of the nasopharynx, or arch of the pharynx, borders the sphenoid and part of the occipital bone, the back wall with 1 and 2 cervical vertebrae. In the posterior region of the upper wall and the upper part of the posterior wall, there are accumulations of lymphoid tissue that forms the pharyngeal, or third tonsil, tonsilla pharyngea. At the pharyngeal opening of the auditory tube there is an accumulation of lymphoid tissue called the tubal tonsil, tonsilla tubaria. The oropharynx is conditionally separated from the nasopharynx by a plane, as if continuing a soft palate. From the front, through the pharynx, it communicates with the oral cavity. The pharynx, fauces, is limited from above by the soft palate, from below - by the root of the tongue and from the sides - palatine-lingual and sky-pharyngeal arches, arcus palatoglossus, arcus palatopharyngeus. The soft palate, palatum molle, is a continuation of the hard palate, which is a very mobile muscle plate covered with mucous membrane, which in a calm state hangs down to the base of the tongue and is called the palatine curtain, velum palatinum. Elongated in the form of a process along the midline, the free end of the soft palate is called the uvula. During the passage of food and when pronouncing some sounds, the palatine curtain adheres tightly to the posterior pharyngeal wall, separating the nasopharynx from the oropharynx.
Palatine-lingual (anterior) and palatopharyngeal (posterior) temples descends from the lateral divisions of the palatine curtain. In the triangular niches between the palatine arches on each side of the pharynx there is the amygdala fossa, fossa tonsillaris, where large accumulations of lymphoid (lymphoepithelial) tissue called palatine tonsils, tonsillae palatinae, are located.
The lateral surface of the palatine tonsil is adjacent to the side wall of the pharynx, separated from it by a fibrous capsule. The thickness of the capsule reaches 1 mm. Outside the capsule is a layer of loose paratonsillar tissue, which goes down to the root of the tongue, communicates in front with the tissue of the palatine-lingual arch and at the top with the submucosa of the soft palate (Fig. 3.2). With tonsillectomy (tonsillectomy), the tonsil must be separated from the pharyngeal wall along with the fibrous capsule. It should be noted that at a distance of 1-1.5 cm posterior to the palatine tonsil is the internal carotid artery.
The laryngopharynx begins at the level of the upper edge of the epiglottis and is located in front of the IV, V and VI cervical vertebrae, tapering downward in the form of a funnel. This is the narrowest part of the pharynx lying posterior to the larynx: it extends from the level of the entrance to the larynx to the lower edge of the cricoid cartilage, where the pharynx passes into the esophagus. the front wall of this part of the pharynx is the protrusion of the larynx, prominentia laringea, above which there is an opening leading to the larynx. The entrance to the larynx, aditus laringis, opens into the lumen of the larynx and pharynx in front and below. It is bounded at the front by the epiglottis, laterally by the arytenoid-epiglottis folds. On the sides of the elevation of the larynx there are rather deep pockets - pear-shaped pockets, recessus piriformis, bounded on the medial side by the wall of the larynx, with lateral - the side wall of the pharynx.
Pharyngeal blood vessels. Blood supply to the upper and middle parts of the pharynx is provided by the ascending pharyngeal artery, which is the medial branch of the external carotid artery. The ascending palatine artery, the branch of the facial artery, and the descending palatine artery, the branch of the maxillary artery, also deliver blood to the upper part of the pharynx (Fig. 3.3). Vascularization of the lower part of the pharynx occurs due to pharyngeal branches from the lower thyroid artery. In this regard, to stop bleeding from the lower pharynx, it is necessary to bandage the branches of the external carotid artery and the lower thyroid artery.
Pharyngeal veins divert blood from the venous plexus, located mainly on the outer surface of the posterior and lateral walls of the pharynx.
Throat innervation. The innervation is carried out by the branches of the glossopharyngeal and vagus nerves, as well as by the laryngopharyngeal branches from the upper cervical node of the sympathetic trunk. These branches on the outer surface of the middle pharyngeal constrictor form the pharyngeal nerve plexus, from which in turn move the motor and sensory branches that go to all three pharyngeal constrictors.
Taste analyzer. In the practice of ENT doctors have to deal with the evaluation of the taste analyzer function. Taste - a sensation arising from the action of chemical stimuli on receptors located on the surface of the mucous membrane of the tongue, as well as on the receptors of the oral cavity. The taste analyzer includes three parts: taste buds, pathways and the cortical part of the analyzer. Taste receptor cells are part of the taste buds (bulbs). A person has a total of 2,000 to 9,000 taste buds.
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CLINICAL THROAT ANATOMY
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