Nasopharyngeal Tonsil ( Adenoids )

It is a subepithclial colletion of lymphoid tissue at the junction of roof and

posterior wall of nasopharynx and causes the overlying mucous membrance to
be thrown into radiating folds, it increases in size up to the age of six years and
then gradually atrophies.
Nasopharyngeal Bursa ( Fig. 46.4 )
It is an epithclial lined median recess found within the adenoid mass and
extends from pharyngeal mucosa to the periosteum of the basiocciput. It
represents the attachment of notochord to the pharyngeal entoderm during
embry onic life. When infected, it may be the cause of persistent postnasal
discharge or crusting. Sometimes an abscess can form in the bursa
( thornwaldts discase ).
Rathkes Pouch
It is represented clinically by a dimple above the adenoids and is reminiscent of
the buceal mucosal invagination, to form the anterior lobe of pituitary. A
craniopharyngioma may arise from it.
Tubal Tonsil
It is collection of subepithclial lymphoid tissue situated at the tubal elevation. It
is continuous with adenoid tissue and forms a part of the waldeyers ring. When
enlarged due to infection, it causes eustachian tube occlusion.
Sinus of Morgagni
It is s space between the base of the skull and upper free border of superior
constrictor muscle. Through is enters ( i ) the eustachian tube, ( ii ) the levator
veli palatini, ( iii ) tensor veli palatini and ( iv ) ascending palatine artery branch
of the facial artery ( fig. 46.1 )
Passavants ridge
It is a mucosal ridge raised by fibres of palatopharyngeus. It encircles the
posterior and lateral walls of nasopharyn geal isthmus. Soft palate, during its
contraction, makes firm contact with this ridge to cut off nasopharynx from the
oropharynx during the deglutition or speech.
Epithelial lining of nasopharynx
Functionally, nasopharynx is the posterior extension of nasal cavity. It is lined by
pseudostratifed cilited colum nar epithclium.
Lymphatic Drainage
Lymphatics of the nasopharynx, including those of the adenoids and pharyngeal
end of custachian tube, drain into upper deep cervical nodes either directly or
indirectly through retropharyngeal and parapharyngeal lymph nodes in the
posterior triangel of the neck. Lymphatics of the nasopharynx may also cross
midline to drain into contralateral lymph nodes.
Oropharynx
Applied anatomy
Oropharynx extends from the plane of hard palate above to the plane of hyoid
bone below. It lies opposite the oral.

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Diseases of pharynx
Cavity with which it communicates through oropharyngeal istlnusus . the latter is
bounded above, by the soft palate ; below, by the upper surface of tongue, and o
either side, by palatoglossal arch ( anterior pillar ).
Boundaries of oropharynx
Posterior wall it is related to retropharyngeal space and lies opposite the
second and upper part of the third cervical vertebrae.
Anterior wall it is deficient above, where oropharynx communicates with the
oral cavity, but below it presents :
a) Base of tongue, posterior to circumvallate papillae.
b) Lingual tonsil, one on either side, situated in the base of tongue. They may
show compensatory enlargement following tonsillectomy or may be the
sat of infection.
c) Valleculae, they are cup-shaped depressions lying between the base of
tongue and anterior surface of epiglottis. Each is bounded medially by the
median glossoepiglottic fold and laterally by pharyngoepiglottic fold ( fig.
46.5 ). They are the seat of retention cysts.
Lateral wall it presents :
a) Palatine ( fancial ) tonsil ( for details, see page 271 )
b) Anterior pillar ( palatoglossal arch ) formed by the palatoglossus muscle.
c) Poterior pillar ( palatopharyngeal arch ) formed by the palatopharyngeal
muscle.
Both anterior and posterior pillars diverge from thye soft palate and enclose a
triangular depression called tonsillar fossa in which is situated the palatine tonsil
( fig 46.6 )
Boundary between oropharynx above and the hypopharynx below os formed by
upper border of epiglottis and the pharyngoepiglottic fold.
Lymphatic drainage
Lymphatics from the oropharynx drain into upper jugular chain particularly the
jugulodiglastric ( tonsillar ) node. The soft palate, lateral and posterior
pharyngeal walls and the base of tongue also drain into retropharyngeal and
parapharyngeal nodes and from there to the jugulodigastric and posterior
cervical group. The base of tongue may drain bilaterally.

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Hypopharynx ( laryngopharynx )
Applied anatomy
Hypopharynx is the lowest part of the pharynx and lies behind and partly on the
sides of the larynx. Its superior limit is the plane passing from the body of hyoid
bone to the posterior pharyngeal wall, while the inferior limit is loower border of
cricoid cartilage where hypopharynx becomes continuous with oesophagus.
Hypopharynx lies oppsite the 3td, 4td, 5td, 6th cervical vertebrae. Clinically, it is
subdivided into three regions the pyroform sinus, post cricoid region and the
posterior pharyngeal wall.
1. Pyriform sinus ( fossa ). It lies on either side of the larynx and extends
from pharyngoepiglottic fold to the upper end of oesophagus.
It is bounded laterally by the thytohyoid membrane and the thyroid
catilage and medially by the aryepiglottic fold, posterolateral sucface of
arytenoid and cricoid cartilages. It forms the lateral channel for food.
Foreign bodies may lodge in the pyriform fossa. Internal laryngeal nerve
runs submucosally in the lateral wall of the sinus and thus is easly
accessible for local anaesthesia, it is also through this nerve that pain is
referred to the ear in carcinoma of the pyriform sinus.
2. Post cricoid refion. It is the part of the anterior wall of laryngopharynx
between the upper and lower borders of cricoid lamina. It is a common site
for carcinoma in females suffering from plummer vinson syndrome ( fig
46.7 )
3. Posterior pharyngeal wall. It extends from the level of hyoid bone to the
level of cricoarytenoid joint.
Lymphatic drainage
Pyriform sinus is richly supplied by lymphatics which exit through the thyrohyoid
membrane an drain into the upper jugular chain.
Lymphatics of the posterior wall terminate in the lateral pharyngeal or
parapharyngeal nodes and thence to the deep cervical lymph nodes.
Lymphatics of post cricoid region also drain into the parapharyngeal nodes but
may also darin nodes of supraclavicular and paratracheal chain.
Rich lymphatic network of pyriform fossae explains the high frequency with
which nodal metastases are seen in carcinoma of this region.

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