Nasal and Pharynx

Nose & Pharynx Organization of respiratory system  Upper respiratory system      Nose Nasal cavity Paranasal sinuses Pharynx Lower respiratory system     Larynx Trachea Bronchi Lungs Nose- Function   Air conditioning (i.e. warming, humidifying and filtering)  Under most climatic conditions, inspired air is heated (to 37°C) and humidified (to near 100% relative humidity) in the upper airway  Filtration is accomplished mechanically by nasal vibrissae and by the process of impaction whereby large-diameter inspired particles collide with the turbinates and are subsequently cleared by the mucociliary apparatus. Sensation, and communication Nose  External nose  Relation        Ant: Nares, Post: choanae Nasal bridge , Tip of nose, Skin Muscles Bones Cartilages Nasal cavity    Nasal vestibule Olfactory region Respiratory region External nose Muscles Procerus muscle Nasalis m. 1. 2.  3. 4. 1 Transverse part (compressor naris) Alar part (pars alaris or dilator naris posterior)  Depressor septi m. Levator labi superior alaeque nasi 2 4 2 3  Innervation:  All with Facial n.(buccal br.) Cartilaginous skeleton of the external nose Cartilage Columella nose Vascular supply, lymphatic  Arteries: blood supply from branches of the facial, ophthalmic and infraorbital arteries  Veins: drains to the facial and ophthalmic veins  Lymph: drains to superficial parotid nodes submandibular group of nodes Blood supply: Arteries Vascular supply Innervation:  Sensory:    Ophthalmic nerve: nasociliary branch(The infratrochlear and external nasal) Maxillary nerve: (infraorbital nerve) Motor: Facial N. Nasal Cavity Medial wall of nose Nasal Cavity Lateral wall of nose Atrium and agger nasi Middle Meatus Semilunaris hiatus Nasal cavity Nasal cavity  Nasal vestibule  Filtering  Limen nasi  Olfactory region  Respiratory region  Turbinates covered with mucous membrane  Rich vascular supply Gateways Blood supply    Sphenopalatine (maxillary) Ant, post.Ethmoidal(ophtalmic) Septal(facial) Kiesselbach's plexus - Little's area  It is a region in the anteroinferior part of the nasal septum 1. 2. 3. 4. Anterior ethmoidal artery (from the ophthalmic artery) Sphenopalatine artery (terminal branch of the maxillary artery) Greater palatine artery (from the maxillary artery) Septal branch of the superior labial artery (from the facial artery) Veins Nerve supply Paranasal sinuses Paranasal sinuses Coronal CT scan showing paranasal sinus. Radiograph Clinical notes  Congenital nasal deformities: complete absence of the external nose, atresia or failed perforation of the choanal plate  Nasal fracture  Nasal obstruction  Anosmia  Rhinitis:  Upper respiratory infection, allergic reaction   Epistaxis: Nose bleeds   Spread of infection to cranial cavity, middle ear, retropharyngeal space Children: digital trauma: Little's area (Kiesselbach's plexus)  on the nasal septum just inside the nasal vestibule  Nose picking Sinusitis   Infection of ethmoidal cells and Maxillary sinuses Examination: transillumination , coronal CT Pharynx C6 Relations Pharyngeal structure   Mucosa Pharyngeal aponeurosis    Pharyngobasilar fascia Muscles Buccopharyngeal fascia Pharyngeal aponeurosis Pharyngobasilar fascia Pharyngeal muscles  Annular muscles (Constrictors)     Superior pharyngeal constrictor Middle pharyngeal constrictor Inferior pharyngeal constrictor Longitudinal muscles    Salpingopharyngeus Stylopharyngeus Platopharyngeus Pharyngeal constrictor muscles Passavant's muscle (palatopharyngeal sphincter)  It arises from the anterior and lateral parts of the upper surface of the palatine aponeurosis,    On the upper border of the superior constrictor encircles the pharynx as a sphincter-like muscle The change from ‘respiratory’ Pharyngeal isthmus Killian’s Dehiscence Zenker Diverticulum Longitudinal muscles Buccopharyngeal fascia Pharynx Nasopharynx Oropharynx laryngopharynx Nasopharynx & Oropharynx (Fossa of rosenmüller) C1 Oropharyngeal isthmus Palatine tonsil (facial artery) Oropharynx Waldeyer's ring   Waldeyer's ring is a ring of mucosa-associated lymphoid surrounds the openings into the digestive and respiratory tracts. It is made up by: the lingual tonsil, the palatine and tubal tonsils, and the nasopharyngeal tonsil and smaller collections of lymphoid tissue in the inter-tonsillar intervals. Laryngopharynx Piriform fossa Nerve supply  Almost all of the nerve supply to the pharynx is derived from the pharyngeal plexus   Cranial part XI,Glossopharyngeal, vagus nerves and superior cervical sympathetic ganglion. Stylopharyngeus is innervated by the glossopharyngeal nerve SWALLOWING (DEGLUTITION)     Oral preparatory phase: food is reduced in the mouth to a consistency suitable for swallowing and is formed into a cohesive bolus. Oral transit/transfer phase: the bolus is delivered to the oropharynx Pharyngeal phase: transported down the pharynx past the airways and through the upper oesophageal sphincter Oesophageal phase: transported down the oesophagus to the stomach Clinical notes   Foreign bodies in laryngopharynx Sinus tract from the piriform recess:   Tonsillectomy    Thyroiditis Bleeding from large external palatine veins(paratonsillar v.) Adenoiditis Pharyngostomy and epiglottopexy  Loss of control of the pharyngeal phase of swallowing