Dr. Supreet Singh Nayyar, AFMC For more presentations, visit
www.nayyarENT.comwww.nayyarENT.com SURGICAL ANATOMY OF THE
NASOPHARYNX 22-07-2012 www.nayyarENT.com 1
Slide 2
Layout 22-07-2012 2 General Description Layers Of The
Nasopharyngeal Wall Fascial Relations Of The Nasopharynx Muscles Of
The Nasopharynx Blood Vessels Of The Nasopharynx Lymphatics Of The
Nasopharynx Nerves Of The Nasopharynx Imaging Of The Nasopharynx
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Slide 3
General Description 22-07-20123 Development Dimensions
Boundaries Anterior wall The Floor The roof and posterior wall The
lateral wall www.nayyarENT.com
Slide 4
Fossa of Rosenmuller Location- Depth- 2.5 cm Anatomical
relationship 22-07-20124www.nayyarENT.com
Slide 5
LAYERS OF THE NASOPHARYNGEAL WALL 22-07-2012 5 The mucosa -
three types of epithelium Lymphoid nodules Waldeyers ring The
submucosa The muscular layer -outer circular & inner
longitudinal muscle The buccopharyngeal fascia
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Slide 6
FASCIAL RELATIONS OF THE NASOPHARYNX 22-07-2012 6 Cervical
fascial layers superficial and deep cervical fascia Cervical
fascial spaces midline spaces: pharyngeal mucosal, retropharyngeal
and prevertebral spaces Paired lateral spaces: parapharyngeal,
carotid, masticator and parotid spaces www.nayyarENT.com
Slide 7
Cervical fascial layers 22-07-2012 7 Superficial cervical
fascia -Envelops platysma and muscles of facial expression Deep
cervical fascia - Superficial layer - middle layer - deep layer
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Slide 8
Pharyngeal mucosal space 22-07-2012 8 Encloses the pharynx
Buccopharyngeal fascia Sinus of morgagni Buccopharyngeal fascia
fuses www.nayyarENT.com
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Retropharyngeal space 22-07-2012 9 Location: buccopharyngeal
fascia and prevertebral fascia Extent: skull base to T2 Two
compartments Source of Infection: extension from para pharyngeal,
masticator, parotid space www.nayyarENT.com
Slide 10
Prevertebral space 22-07-2012 10 Location: posterior to the
prevertebral fascia Extent: skull base to coccyx Source of
Infection: TB spine, penetrating trauma www.nayyarENT.com
Slide 11
Carotid space 22-07-2012 11 Extent: jugular foramen to the
aortic arch Location: lateral to the prevertebral
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Slide 12
Masticator space 22-07-2012 12 Extent: skull base to lower
border mandible Location: superficial layer of deep cervical fascia
Source of Infection: 3 rd molar www.nayyarENT.com
Slide 13
Parotid space 22-07-2012 13 Location: lateral to the
parapharyngeal space, anterior to carotid space and posterior to
the masticator space Extent: superficial layer of deep cervical
fascia Source of Infection: oral cavity via Stensons duct
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Slide 14
Contents of the cervical fascial spaces 22-07-2012 14
Pharyngeal mucosal space: mucosa, lymphoid tissue, muscles of
pharynx, minor salivary glands Retropharyngeal space: fat, lymph
nodes Prevertebral space: vertebrae and prevertebral muscles
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MUSCLES OF THE NASOPHARYNX 22-07-2012 16 Pharyngeal muscles Pre
vertebral muscles Palatal muscles Masticator muscles
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Slide 17
Pharyngeal muscles 22-07-2012 17 Superior constrictor -
Quadrilateral muscle - Arises from the lower part of the posterior
margin of the medial pterygoid plate -Sphincter that prevents
reflux into the nasopharynx and has a peristaltic function during
swallowing www.nayyarENT.com
Slide 18
22-07-2012 18 Pharyngobasilar fascia -lies in the gap between
the superior constrictor and the skull base, the sinus of Morgagni,
fuses with the buccopharyngeal fascia to form a single layer of
fascia -the auditory tube passes through this gap
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Slide 19
22-07-2012 19 Palatopharyngeal (velopharyngeal) sphincter - a
band of mainly superior constrictor muscle fibers - arises from the
upper surface of the palatine aponeurosis -the band ridges the
pharyngeal wall as Passavants ridge, seen when the soft palate is
elevated www.nayyarENT.com
Slide 20
22-07-2012 20 Salpingopharyngeus -arises from the posterior
region of the pharyngeal projection of the auditory tube - elevates
the upper lateral wall of the pharynx Prevertebral muscles - the
longus capitis arises from the transverse processes of the cervical
vertebrae and inserts into the inferior surface of the basilar part
of the occipital bone separates the nasopharynx from the lower
clivus and vertebrae www.nayyarENT.com
Slide 21
Palatal muscles 22-07-2012 21 The levator palati muscle The
tensor palati muscle The uvular muscle The palatoglossus The
palatopharyngeus www.nayyarENT.com
Slide 22
22-07-2012 22 Levator palati muscle -situated lateral to the
choana -arises within the pharynx from the inferior surface of the
petrous part of the temporal bone - inserts into the palatine
aponeurosis - opens the pharyngeal opening of the auditory tube and
elevates the soft palate during swallowing www.nayyarENT.com
Slide 23
22-07-2012 23 Tensor palati muscle -situated lateral to the
auditory tube and the levator palati arises from the scaphoid fossa
at the base of the medial pterygoid plate inserts into the palatine
aponeurosis -actively opens the auditory tube and tenses the soft
palate during swallowing www.nayyarENT.com
Slide 24
22-07-2012 24 The uvular muscle: -arises from the posterior
nasal spine of the palatine bones and the palatine aponeurosis, and
insert in the uvula -stiffen the soft palate The palatoglossus:
-arises from the soft palate aponeurosis and passes in front of the
palatine tonsil to insert into the lateral side of the tongue -acts
as a constrictor of the fauces The palatopharyngeus: -arises from
the soft palate aponeurosis and the posterior border of hard palate
-elevates the pharynx during swallowing www.nayyarENT.com
Slide 25
Masticator muscles 22-07-2012 25 The lateral pterygoid: -arises
as two heads, one from the greater wing of the sphenoid and the
other from the lateral surface of the lateral pterygoid plate
inserts into the neck of the mandibular condyle opens the mouth and
protrudes the mandible www.nayyarENT.com
Slide 26
22-07-2012 26 The medial pterygoid: -arises in the pterygoid
fossa from the medial surface of the lateral pterygoid plate and
maxillary tuberosity -insert into the medial surface of the ramus
and the angle of the mandible -closes the mouth
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Slide 27
BLOOD VESSELS OF THE NASOPHARYNX- ARTERIES 22-07-2012 27 The
ascending palatine artery -branch of the facial artery -ascends
towards the skull base on the external surface of the pharynx and
then winds medially over the upper border of the superior
constrictor muscle -supplies the levator palati, the soft palate,
the superior constrictor and the auditory tube
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Slide 28
BLOOD VESSELS OF THE NASOPHARYNX- ARTERIES 22-07-2012 28 The
ascending pharyngeal artery -branch of the external carotid
-ascends vertically between the carotid sheath and the pharynx to
the skull base -supplies the lateral and posterior pharyngeal wall
above the level of the palate www.nayyarENT.com
Slide 29
BLOOD VESSELS OF THE NASOPHARYNX- ARTERIES 22-07-2012 29 The
ascending cervical artery arises from the thyrocervical trunk or
from the inferior thyroid artery winds upwards behind the carotid
sheath -anastomoses with the ascending pharyngeal artery
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Slide 30
BLOOD VESSELS OF THE NASOPHARYNX- ARTERIES 22-07-2012 30 The
maxillary artery larger terminal branch of the external carotid
-travels through the parotid gland, passes between the ramus of the
mandible and the sphenomandibular ligament, passes either deep or
superficial to the lateral pterygoid muscle and enters the
pterygopalatine fossa www.nayyarENT.com
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BLOOD VESSELS OF THE NASOPHARYNX- ARTERIES 22-07-2012 31 The
maxillary artery divided into three parts: -mandibular - pterygoid
-pterygopalatine www.nayyarENT.com
Slide 32
BLOOD VESSELS OF THE NASOPHARYNX - VEINS 22-07-2012 32
submucosal plexus of veins communicates with an external pharyngeal
plexus of veins veins corresponding to all branches of the
maxillary artery then drain into the pterygoid plexus main drainage
of the pterygoid plexus is into the internal jugular vein via the
maxillary, retromandibular and common facial veins
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Slide 33
LYMPHATICS OF THE NASOPHARYNX 22-07-2012 33 The retropharyngeal
lymph nodes Medial retropharyngeal lymph nodes Lateral
retropharyngeal lymph nodes ( nodes of Rouviere ) Upper jugular
lymph node ( level IIb ) www.nayyarENT.com
Slide 34
NERVES OF THE NASOPHARYNX 22-07-2012 34 motor, sensory and
autonomic nerve supply - pharyngeal plexus lies medial to the
buccopharyngeal fascia on the external surface of the constrictor
muscle supplies motor innervation to all muscles of the pharynx,
except stylopharyngeus www.nayyarENT.com
Slide 35
NERVES OF THE NASOPHARYNX 22-07-2012 35 Stylopharyngeus-
supplied by the muscular branch of the glossopharyngeal sensory
supply is from the nasopharyngeal branches of the pharyngeal
plexus, pharyngeal branches of the maxillary nerve and the
glossopharyngeal nerve www.nayyarENT.com
Slide 36
IMAGING OF THE NASOPHARYNX 22-07-201236www.nayyarENT.com
References 22-07-2012 38 Lasts Anatomy Regional and Applied,
editor Chummy S. Sinnatamby, 10 th edition, Chapter 6, Part 13.
Scott-Browns Otorhinolaryngology, Head and Neck Surgery, editor
Michael Gleeson, 7 th edition. Stell and Marans Head and Neck
Surgery, editor John C. Watkinson, 4 th edition
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Slide 39
Thank You 22-07-2012 www.nayyarENT.com 39 For more
presentations, visit www.nayyarENT.comwww.nayyarENT.com