Throat messages. Pharynx. The structure of the throat. Muscles of the throat. Blood supply and innervation of the pharynx. The act of swallowing. Inflammatory acute processes

Pharynx, pharynx, is the initial part of the digestive tube and respiratory tract. The pharyngeal cavity, cavum pharyngis, connects the oral and nasal cavities 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 mouth, nose and larynx, extending from the base of the skull, from which it begins, 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 anterior-posterior direction, narrowing at the transition to the esophagus. In the pharynx, the upper, anterior, posterior and lateral walls can be distinguished. The length of the pharynx averages 12-14 cm.

Depending on the organs behind which the pharynx is located, three parts of it are distinguished: 1) nasal, pars nasalis (or nasopharynx), 2) oral, pars oralis (or oropharynx), 3) laryngeal, pars laryngea (or laryngopharynx). The upper part of the pharynx, adjacent to the outer base of the skull, is called the pharyngeal vault, fornix pharyngis.

Nasal pharynx , pars nasalis pharyngis, is its upper part and differs from other parts in that the upper and partially lateral walls are fixed on the bones and therefore do not collapse. The anterior wall of the pharynx is absent here, 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, ostium pharyngeum tubae, which is bounded behind and above by a tube roller, torus tubarius. This roller is formed due to the protrusion of the cartilage of the auditory tube into the pharyngeal cavity. From the tube roller descends a short tube-pharyngeal fold of the mucous membrane, plica salpingopharyngea. Behind the roller, the mucous membrane forms a large pharyngeal pocket, variable in shape, recessus pharyngeus, the depth of which depends on the degree of development of the tubal tonsils. In the place of transition of the upper wall to the back between the pharyngeal openings of the auditory tubes in the mucous membrane of the pharynx there is an accumulation of lymphoid tissue - the pharyngeal tonsil, tonsilla pharyngea. 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. It is called the tubal tonsil, tonsilla tubaria. Together with the palatine, lingual, laryngeal lymphatic follicles, the pharyngeal and tubal tonsils make up the lympho-epithelial pharyngeal ring. On the arch of the pharynx along the midline near the transition point of the upper wall to the back, there is sometimes a round depression - the pharyngeal bag, bursa pharyngea.

Oral part of the pharynx , pars oralis pharyngis, occupies the level from the soft palate to the entrance to the larynx, communicating widely through the pharynx with the oral cavity. Therefore, 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 (see the Teaching about the viscera - splanchnology section of this edition). When swallowing, the soft palate, moving horizontally, isolates the nasopharynx from its 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 the laryngeal protrusion, prominentia pharyngea, above which is the entrance to the larynx. On the sides of the protrusion lie deep pits - pear-shaped pockets, recessus piriformes, 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 by an oblique fold of the laryngeal nerve, plica nervi laryngei, into two sections - a smaller one - the upper one, and a large one - the lower one. The superior 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 and does not reach when lifting its posterior pharyngeal wall. In the pharyngeal cavity of newborns and children in the first years of life, the tonsils strongly protrude. 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 pharynx . The pharynx consists of: 1) a mucous membrane, 2) a fibrous layer formed by the pharyngeal-basic fascia, 3) a muscular membrane, 4) a buccal-pharyngeal fascia covering it.

mucous membrane the nasal part of the pharynx is covered with multi-row ciliated epithelium, and the oral and laryngeal parts are covered with stratified squamous. In the submucosa 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, in the submucosal layer, there are accumulations of lymphatic follicles that form the pharyngeal and tubal tonsils. Between the follicles there are many small glands of a mixed type. At the location of the pharyngeal tonsil, the mucous membrane gives off spurs into the thickness of the tonsil, forming a series of folds and dimples, fossulae tonsillares. In the dimples of the pharyngeal tonsil there are depressions - tonsil crypts, cryptae tonsillares, into which the ducts of mixed glands lying between the lymphatic follicles open.

The submucosa is well expressed, and the tunicae mucosae has many elastic fibers in its own layer. As a result, the mucous membrane has the ability to change 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 here.

Pharyngeal-basic fascia , fascia pharyngobasilaris, forms the fibrous basis of the pharynx. The pharyngeal-basic fascia begins on the outer base of the skull on the pharyngeal tubercle of the occipital bone and goes on each side transversely along a curved line anteriorly from the place of attachment of the deep layer of the anterior muscles of the neck along the main part of this bone to synchondrosis retrooccipitalis. Further, the line of the beginning of the fascia turns anteriorly and outwards, crosses the pyramid of the temporal bone anteriorly from the foramen caroticum externum and follows to the spina ossis sphenoidalis. From here, the line of the beginning of the fascia deviates forward and medially and runs along the synchondrosis sphenopetrosa in front of the cartilage of the auditory tube to the base of the medial plate of the pterygoid process of the sphenoid bone. Then it follows the medial plate of the process down and anteriorly along the raphe pterygomandibularis to the posterior margin of the linea mylohyoidea mandibulae.

In the upper section, the pharyngeal-basic fascia is very strong, since here it is strengthened by bundles of collagen fibers that go into the fascia in the form of ligaments from the pharyngeal tubercle, from the edge of the foramen caroticum externum, and from the membranous plate of the auditory tube. In the composition of the pharyngeal-basic fascia, in addition to collagen bundles, there are many elastic fibers. Below, the pharyngeal-basic fascia is attached to the thyroid cartilage and the large horns of the hyoid bone, giving spurs into folds: plicae pharyngoepiglotticae and plicae epiglotticae.

Muscular layer of the pharynx , tunica muscularis pharyngis, consists of two groups of striated muscles: constrictors, constrictores pharyngis, located circularly, P I lifters, levatores pharyngis, running longitudinally. To the muscles - constrictors of the pharynx, paired formations belong to the upper, middle and lower constrictors (Fig. 113).

Rice. 113. Muscles of the pharynx (rear view). 1 - posterior belly of the digastric muscle; 2, 8, 14 - stylo-pharyngeal muscle; 3 - awl-hyoid muscle; 4 - medial pterygoid muscle; 5, 13 - middle constrictor of the pharynx; c - hyoid bone; 7, 10 - upper and lower horns of the thyroid cartilage; 11 - esophagus; 12 - lower constrictor of the pharynx; 15, 17 - upper constrictor of the pharynx; 16 - styloid process; 18 - the main part of the occipital bone; 9, 19 - pharyngeal suture; 20 - fibrous membrane of the pharynx

1.Muscle - upper constrictor of the pharynx, m. constrictor pharyngis superior, starts from laminae medialis processus pterygoidei (wing-pharyngeal part of the muscle, pars pterygopharyngea), raphe pterygomandibulare (buccal-pharyngeal part, pars buccopharyngea), linea mylohyoidea mandibulae (maxillary-pharyngeal part, pars mylopharyngea) and the transverse muscle of the tongue ( glossopharyngeal part, pars glossopharyngea). Starting on the listed formations, the muscle bundles form the lateral wall of the pharynx, and then arcuately directed posteriorly and medially, forming the posterior wall. Posteriorly along the midline, they meet with bundles of the opposite side on the tendinous pharyngeal suture, raphe pharyngis, running from the tnberculum pharyngeum along the middle of the entire posterior wall to the esophagus. The upper edge of the muscle - the upper constrictor of the pharynx does not reach the base of the skull. Therefore, in the upper section (over 4-5 cm), the pharyngeal wall is devoid of a muscular membrane and is formed only by the pharyngeal-basic fascia and mucous membrane.

2.Muscle - middle constrictor of the pharynx, m. constrictor pharyngis medius, starts from the upper part of the large horn of the hyoid bone (horns of the o-pharyngeal part of the muscle, pars ceratopharyngea) and from the small horn and lig. stylohyoideum (cartilage-pharyngeal part, pars chondropharyngea). The upper muscle bundles go up, partially covering the upper pharyngeal constrictor (when viewed from behind), the middle bundles go horizontally backwards (almost completely closed by the lower constrictor) and the lower ones go down (completely closed by the lower constrictor). Bundles of all parts end in raphe pharyngis. Between the middle and upper constrictors are the lower bundles of the stylo-pharyngeal muscle.

3.Muscle - lower pharyngeal constrictor, m. constrictor pharyngis inferior, starts from the outer surface of the cricoid cartilage (crico-pharyngeal part of the muscle, pars cricopharyngea), from the oblique line and parts of the thyroid cartilage adjacent to it, and from the ligaments between these cartilages (thyroid-pharyngeal part, pars thyreopharyngea). The muscle bundles go backwards in ascending, horizontal and descending directions, ending at the suture of the pharynx. The lowest bundles surround the junction of the pharynx with the esophagus. The top compressor is the largest and covers the bottom half of the middle compressor.

Function: narrow the pharyngeal cavity, with a consistent reduction push the food bolus.

The muscles that lift and expand the pharynx include:

1.Stylo-pharyngeal muscle, m. stylopharyngeus, originates 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, partially intertwined with the lower and middle constrictors, go to the edges of the epiglottis and thyroid cartilage.

Function: elevates and expands the pharynx.

2.Palato-pharyngeal muscle, m. palatopharyngeus, see the Oral cavity proper section of this edition.

The buccal-pharyngeal fascia covers the constrictor muscles from the outside. Since the buccal muscle has a common place of origin with the upper decompressor (raphe pterygomandibulare), the fascia with m. buccinator moves to the upper and then to other pharyngeal constrictors.

Syntopy of the pharynx. Behind the pharynx are the long muscles of the neck (mm. longus capitis and longus colli) and the body of the first cervical vertebrae. Here, between the buccal-pharyngeal fascia, which covers the pharynx from the outside, and the parietal sheet of fasciae endocervicalis, there is an unpaired pharyngeal cellular space, spatium retropharyngeum, which is important as a possible location for pharyngeal abscesses. On the sides of the pharynx there is a second, paired, cellular space - peripharyngeal, spatium parapharyngeum, limited medially by the lateral wall of the pharynx, laterally - by the branch of the lower jaw, m. pterygoideus medialis and muscles starting on the styloid process from behind - the anterior surface of massa lateralis atlantis and lamina parietalis fasciae endocervicalis. The peripharyngeal space, in which the internal carotid artery and the internal jugular vein are located, posteriorly passes into the pharyngeal space.

The upper poles of the thyroid gland and the common carotid arteries are adjacent to the lateral surfaces of the laryngeal part of the pharynx. In front of her is the larynx.

The blood supply of the pharynx is carried out from the system of the external carotid artery: ascending pharyngeal (from a. carotis ext), ascending palatine (from a. facialis) and descending palatine (from a. maxillaris). The laryngeal part of the pharynx, in addition, receives branches from the superior thyroid artery: Intraorganic veins of the pharynx form venous plexuses in the submucosa and on the outer surface of the muscular membrane, from where blood flows through the pharyngeal veins into the internal jugular vein or its tributaries.

Lymphatic vessels of the pharynx are formed from capillary networks that lie in all layers of the pharyngeal wall. The efferent collectors go to the retropharyngeal (partially to the facial) and mainly to the deep cervical lymph nodes.

Pharynx

What is a throat.

Throat (pharynx) represents the initial part of the digestive tube located between the oral cavity and the esophagus. At the same time, the pharynx is part of the breathing tube through which air passes from the nasal cavity to the larynx.

The pharynx extends from the base of the skull to the level of the VI cervical vertebra, where it narrows into the esophagus. The length of the pharynx in an adult is 12-14 cm and is located anterior to the cervical spine.

What departments is the pharynx divided into and their boundaries.

In the pharynx, the upper, posterior, anterior and lateral walls can be distinguished.

Upper wall of the pharynx - vault (fornixpharyngis)- attached to the outer surface of the base of the skull in the region of the basilar part of the occipital bone and the body of the sphenoid bone.

Posterior wall of the pharynx adjacent to prevertebral plate (laminaprevertebralis) cervical fascia and corresponds to the bodies of the five upper cervical vertebrae.

Lateral walls of the pharynx are close to the internal and external carotid arteries, internal jugular vein, vagus, hypoglossal, glossopharyngeal nerves, sympathetic trunk, large horns of the hyoid bone and plates of the thyroid cartilage.

Anterior wall of the pharynx in the upper section in the region of the nasopharynx, through the choanae, it communicates with the nasal cavity, in the middle section it communicates with the oral cavity.

In the cavity of the pharynx, there are three divisions(Fig. 3.1):

upper - bow, or nasopharynx(pars nasalis, epipharynx);

Rice. 3.1. Departments of the pharynx: 1 - nasopharynx; 2 - oropharynx; 3 - laryngopharynx

average - oral part, or oropharynx(pars oralis, mesopharynx);

lower - guttural part, or laryngopharynx(pars laryngea, hypopharynx).

Nasopharynx(nasopharyngs, epipharyngs)- located from the arch of the pharynx to the level of the hard palate. Its anteroposterior size is often reduced due to the protrusion of the 1st cervical vertebra. (Atlanta). Her front wall is occupied choanae (choanae) communicating it with the nasal cavity. On the side wall on each side at the level of the posterior ends of the inferior turbinates are funnel-shaped pharyngeal openings of the auditory tube, communicating the pharynx with the tympanic cavity. Top and back, these openings are limited pipe rolls, formed by protruding cartilaginous walls of the auditory tubes. Behind the tubal ridges and the mouth of the auditory tube on the side wall of the nasopharynx there is a depression - pharyngeal pocket (fossa Rosenmulleri), in which there is an accumulation of lymphadenoid tissue. These lymphadenoid formations are called tubal tonsils. On the posterior superior wall of the nasopharynx is III, or pharyngeal (nasopharyngeal), tonsil. Hypertrophy of this tonsil (adenoid growths) can partially or completely cover the choanae, causing difficulty in nasal breathing, or the mouth of the auditory tubes, disrupting their function. The pharyngeal tonsil is well developed only in childhood; with age, after 14 years, it atrophies. The boundary between the upper and middle parts of the pharynx is the plane of the hard palate mentally extended backwards.

Oropharynx(oropharyngs, mesopharyngs) extends from the level of the hard palate to the level of the entrance to the larynx. The posterior wall of this section corresponds to the body of the third cervical vertebra. From the front, the oropharynx communicates with the oral cavity through the pharynx. Zev (fauces) limited from above soft palate, bottom - the root of the tongue and from the sides palatoglossal (anterior) and palatopharyngeal (posterior) arches.

Soft sky(palatum molle)- continuation of the hard palate, is a movable plate, which in a calm state hangs down to the base of the tongue. The soft palate is formed mainly by muscles and aponeurosis of the tendon bundles. The back of the soft palate, going obliquely back and down, together with the root of the tongue limits the opening of the pharynx (isthmus faucium). The free end of the soft palate, elongated in the form of a process along the midline, is called tongue (uvula).

On each side, the palatine curtain passes into two arches. One (front) goes to the root of the tongue - palatoglossal (arcus palatoglossus), the other (posterior) passes into the mucous membrane of the lateral wall of the pharynx - palatopharyngeal (arcus palatopharyngeus). From the posterior surface of the palatoglossal arch departs expressed in varying degrees, thin triangular fold mucous membrane (plica triangularis), or His fold. Under the cover of the mucous membrane, the soft palate contains the aponeurotic plate, as well as a number of muscles that play an important role in the act of swallowing:

* muscle stretching the soft palate (m. tensor veli palatini), stretches the anterior soft palate and pharyngeal section of the auditory tube;

* muscle that raises the palatine curtain (m. Levator veli palatini), raises the soft palate, narrows the lumen of the pharyngeal opening of the auditory tube;

* palatoglossus muscle (m.palatoglossus) located in the palatoglossal arch, attached to the lateral surface of the tongue and, when stressed, narrows the pharynx, bringing the anterior arches closer to the root of the tongue;

palatopharyngeal muscle (m. palatopharyngeus) located in the palatopharyngeal arch, attached to the lateral wall of the pharynx, when stressed, brings together the palatopharyngeal arches and pulls up the lower part of the pharynx and larynx. Between the palatine arches on each side of the pharynx there is a triangular recess - tonsillar niche (tonsillar fossa or bay), (fossa tonsillaris), the bottom of which is formed by the superior constrictor of the pharynx and the pharyngeal fascia. The largest accumulations of lymphoid tissue are located in the tonsillar niches - I and II or palatine tonsils (tonsilae palatinae)(Fig. 3.2).

hypopharynx(laryngopharyngs, hypopharyngs)- begins at the level of the upper edge of the epiglottis and the root of the tongue, narrows downwards in the form of a funnel and passes into the esophagus. The hypopharynx lies posterior to the larynx and anterior to the IV, V, and VI cervical vertebrae. This is the narrowest part of the throat. In the initial section of the laryngopharynx at the root of the tongue is located IV, or lingual tonsil (tonsilla lingvalis)(Fig. 3.5).

Below the attachment of the epiglottis, the laryngopharynx passes into the larynx. On the sides of the entrance to the larynx, between the wall of the larynx and the side walls of the pharynx, from top to bottom on the right and left, there are cone-shaped narrowings of the pharynx, which are called pear-shaped pockets (recessus piriformis)- they carry food into the esophagus. From the front, the entrance to the larynx is limited by the epiglottis, from the sides - by scoop-epiglottic folds.

The wall of the pharynx is formed by four membranes:

fibrous (tunica fibrosa);

connective tissue (tunica adventitia); muscular (tunica muscularis);

mucous (tunica mucosa).

Between the muscular and mucous membranes there is a submucosal layer, characterized by the presence of fibrous tissue in it, therefore this layer is called fibrous sheath. Outside, the muscles, in turn, are covered with a thinner connective tissue layer - adventitia, on which lies loose connective tissue, allowing the mobility of the pharynx in relation to the surrounding anatomical formations.

mucous membrane The pharynx is a continuation of the mucous membrane of the nasal cavity and mouth and below it passes into the mucous membrane of the larynx and esophagus. In the upper part of the pharynx near the choanae, the mucous membrane is covered with multi-row ciliated epithelium, in the middle and lower parts - with flat multi-row epithelium. The mucous membrane of the pharynx contains many mucous glands, and on the back wall there are small accumulations of lymphoid tissue in the form of tubercles on the mucous membrane measuring 1-2 mm - lymphoid granules. The mucous membrane here is tightly fused with the muscular membrane and does not form folds.

muscle layer the pharynx is composed of striated fibers and is represented by circular and longitudinal muscles, constricting and lifting the throat.

Three constrictors compress the pharynx: upper, middle and lower. These muscles are located from top to bottom in the form of plates covering each other in a tiled manner.

Upper throat constrictor (m. constrictor pharyngis superior) has the shape of a quadrangular plate, starts in front of the sphenoid bone and lower jaw. Muscle bundles run horizontally along the lateral wall of the pharynx to the back and join

with bundles of muscles of the opposite side, forming the upper part of the median suture of the pharynx.

Middle throat constrictor (m. constrictorpharyngis medius) starts from the horns of the hyoid bone, goes posteriorly fan-shaped to the suture of the pharynx, partially covering the upper constrictor, and below is under the lower constrictor.

Lower throat constrictor (m. constrictor pharyngis inferior) starts from the outer surface of the cricoid cartilage, from the lower horn and the posterior edge of the thyroid cartilage, goes posteriorly and along the midline of the pharynx forms a pharyngeal suture with its attachment.

Longitudinal muscles raise their throat. These include two muscles: stylopharyngeal (m. stylopharyngeus) and palatopharyngeal (m. pharyngopalatinus).

The lateral and posterior walls of the pharynx are bordered by peripharyngeal space (spatium parapharyngeum), in which they distinguish retropharyngeal space and lateral peripharyngeal space.

pharyngeal space (spatium retropharyngeum)(Fig. 3.6) is located anterior to the cervical vertebrae, the muscles covering them and the prevertebral plate of the cervical fascia; it

is a narrow

gap filled with loose connective tissue. This back space is limited prevertebral plate of the cervical fascia (lamina praevertebralis), in front - with a connective tissue cover and mucous membrane, and from the sides with fascia and fiber - surrounding the area of ​​\u200b\u200blarge vessels and nerves of the neck. Fiber swallow-

Rice. 3.6. pharyngeal space:

1 - prevertebral plate of the cervical fascia; 2 - fiber of the pharyngeal space

The leg space, starting from the base of the skull and descending down the back wall of the pharynx, passes into the retroesophageal tissue and then into the posterior mediastinum. Lateral parapharyngeal space (spatium lateropharyngeum)(Fig. 3.7) is made by loose connective tissue, in front it is limited by the inner surface of the lower jaw branch, on the inside - by the medial pterygoid muscle, behind

Prevertebral plate of the cervical fascia, laterally

Deep leaf of the fascia of the parotid salivary gland. The lateral parapharyngeal space is divided by the stylopharyngeal muscle into anterior and posterior sections. The lateral parapharyngeal space extends from the base of the skull down, where it passes into the mediastinum.

Similar information.

The pharynx is a hollow organ that is simultaneously part of the digestive and respiratory systems. It has the appearance of a muscular tube, which originates at the base of the skull, connects the nasal cavity with the larynx and in its lower sections passes into the esophagus.

The structure of the pharynx

Taking into account the anatomical and physiological features, the pharynx is usually divided into 3 parts:

1. Nasal.
2. Oral.
3. throaty.

The nasopharynx has the appearance of a small cavity and occupies the uppermost parts of the organ. It connects the inner part of the nose through the choanae with the underlying respiratory tract, namely the larynx. This section of the pharynx is motionless and is located at the level of the first two cervical vertebrae. On the lateral surfaces of the nasopharynx there are openings of the Eustachian tubes, which provide a connection between the pharynx and the tympanic cavity.

The oropharynx is a continuation of the nasal part of the organ. It has direct communication with the oral cavity through the pharynx, which is an opening limited on the sides by the palatine arches, above - by the soft palate, below - by the root of the tongue. The oral part of the pharynx serves as a crossroads for the digestive and respiratory tracts, it is directly involved in the conduction of food and air.

At the level of the upper parts of the epiglottis, the next part of the pharynx begins - the hypopharynx. It is located at the level of the 4th-5th cervical vertebrae, behind the larynx, so that the posterior wall of the latter becomes the anterior wall of the pharynx. At the same time, at rest, the walls of the organ are in contact with each other and diverge only during the act of swallowing. On the anterior surface of the pharynx there is an entrance to the larynx with pear-shaped pockets to the right and left of it. The laryngopharynx narrows downward and passes into the esophagus.

Lymph-epithelial pharyngeal ring

Lymphoid formations of the pharynx are represented by tonsils and small follicles. The latter are located on the back of the pharynx (in the form of granules), behind the palatine arches (lateral ridges), in pear-shaped pockets at the entrance to the larynx.

The tonsils, located in the pharynx in the form of a ring, play a protective role, being part of the immune system. There are six of them in humans:

• two palatine,
• one throat,
• one lingual,
• two pipes.

The pharyngeal and tubal tonsils are located in the nasal part of the pharynx on the upper (in the zone of its transition to the back) and side walls.

The pharyngeal tonsil should be given special attention. Its second name is . In diseases of the upper respiratory tract, it becomes inflamed, increasing in size, and prevents free nasal breathing. If such problems recur frequently, then the adenoid tissue grows so much that it leads to chronic respiratory failure through the nose. This can contribute to the development of deformation of the facial skeleton, hypoxia and frequent colds. This amygdala is most pronounced in childhood. With the onset of puberty, it begins to gradually decrease and undergo reverse development.

The palatine tonsils are located in the oral part of the pharynx between the palatine arches. These tonsils have a rather complex structure and are connected to the lateral surface of the pharynx with a fibrous capsule. They consist of connective tissue trabeculae, between which there are clusters of lymphocytes in the form of follicles.

On the free surface of the tonsils facing the pharynx, there are more than 16 deep fissures or lacunae with many branches. The surface of these cracks is covered with stratified squamous epithelium, which is constantly rejected, and the tonsils are self-cleaning. In addition to the epithelium, the lumen of the lacunae contains immune cells and microorganisms. However, deeply and tree-branched lacunae are not always emptied in full. In combination with frequent infections of the upper respiratory tract, this contributes to the development.

The lingual tonsil is located at the root of the tongue and is often connected to the lower poles of the palatine tonsils.

Organ wall structure

The wall of the pharynx consists of 4 main layers:

• mucous,
• fibrous
• muscular,
• adventitia.

The mucous membrane lines the inner surface of the pharynx, it contains a large number of mucous glands and is covered with stratified epithelium, with the exception of the nasopharynx. In this area, the structure of the mucous membrane is somewhat different, since it is covered with a cylindrical ciliated epithelium, which continues here from the nasal cavity.

The fibrous membrane is a thin connective tissue plate, fused with the mucous and muscular layer, which is attached to the bones of the base of the skull - from above, the thyroid cartilage and hyoid bone - from below.

The muscular membrane of the pharynx consists of striated muscle fibers that lift and compress the pharynx. Outside, the muscles are covered with adventitia, which is loosely connected with the surrounding tissues.

Behind the pharynx and on the sides of it are cellular spaces, the presence of which contributes to the rapid spread of inflammation to the surrounding tissues and the development of complications.

Physiology of the pharynx

The pharynx is of great importance in the human body. Its main functions are:

1. Ensuring the flow of air into the lower parts of the respiratory tract and vice versa.
2. Participation in the act of swallowing (due to peristaltic contraction of the muscles that constrict the pharynx, palatine arches and soft palate) and the passage of a food bolus from the oral cavity into the esophagus.
3. It creates an obstacle in the form of a reflex contraction of the muscles of the pharynx on the way to the penetration of foreign bodies and irritants into the respiratory tract and digestive tube.
4. Serves as a sound resonator together with the inner part of the nose and paranasal sinuses (gives the voice an individual sound).
5. Protective function (in the pharynx, the warming and purification of air from the nasal cavity or mouth continues; the presence of a lymphoepithelial pharyngeal ring and the bactericidal properties of mucus protect the body from the introduction of infectious agents).

Conclusion

The normal functioning of the pharynx is very important for the body. Any failures in the work of this body are reflected in the general condition. This can make breathing or swallowing difficult, which poses a threat to human health and life.

Informative video "Throat":

The pharynx (pharynx) is included in the initial section of the digestive tract and respiratory tract. It is a hollow organ formed by muscles, fascia and lined from the inside with a mucous membrane. The pharynx connects the cavities of the nose and mouth with the larynx and esophagus, through the auditory tubes the pharynx communicates with the middle ear. The pharyngeal cavity is projected vertically onto the bases of the occipital and sphenoid bones, horizontally onto the bodies of six cervical vertebrae. Three sections are distinguished in the pharynx: the upper one is the nasopharynx, the middle one is the oropharynx, and the lower one is the laryngopharynx (Fig. 2.1).

Rice. 2.1.

(inside view).

1 - slope of the skull; 2 - roller of the pharyngeal mouth of the auditory tube; 3 - nasopharyngeal pocket; 4 - stylohyoid muscle; 5 - pharyngeal mouth of the auditory tube; 6 - palatine curtain; 7 - posterior palatine arch (palatopharyngeal fold), 8 - lingual tonsil; 9 - the root of the tongue; 10 - pharyngeal-epiglottic fold; 11 - scoop-epiglottic fold; 12 - mucous membrane of the esophagus; 13 - trachea; 14- esophagus; 15 - pear-shaped sinus; lb - fold of the laryngeal nerve; 17 - entrance to the larynx; 18 - laryngopharynx (hypopharynx); 19 - epiglottis; 20 - oropharynx, (mesopharynx); 21 - uvula of the soft palate; 22 - nasopharynx (epipharynx); 23 - tubal-pharyngeal fold; 24 - coulter; 25-vagus nerve; 26 - internal carotid artery; 27 - internal jugular vein; 28 - choanae.

Nose from the pharynx (nasopharynx, or epipharynx) performs a respiratory function, its walls do not collapse and are motionless. At the top, the vault of the nasopharynx is fixed to the base of the skull, borders on the base of the occipital bone and the anteroinferior part of the sphenoid bone, behind - with C and C, in front there are two choanas, on the side walls at the level of the posterior ends of the inferior turbinates there are funnel-shaped pharyngeal openings of the auditory tubes. From above and behind, these openings are limited by tubular ridges formed by protruding cartilaginous walls of the auditory tubes. From the posterior edge of the tube roller downwards there is a fold of the mucous membrane, in which the muscle bundle (m.salpingopharyngeus) is laid from the upper muscle that compresses the pharynx, which is involved in the peristalsis of the auditory tube. Behind this fold and the mouth of the auditory tube, on each side wall of the nasopharynx, there is a recess - the pharyngeal pocket, or Rosenmuller's fossa, in which there is usually an accumulation of lymphadenoid tissue. These lymphadenoid formations are called "tubal tonsils" - the fifth and sixth tonsils of the pharynx.

On the border between the upper and rear walls of the nasopharynx is the pharyngeal (third, or nasopharyngeal) tonsil.

The pharyngeal tonsil is normally well developed only in childhood (Fig. 2.2). Since puberty, she

A - clinical picture: 1 - extended bridge of the nose; 2 - constantly open mouth; 3 - elongated face (dolichocephaly), b - location of adenoid vegetations in the nasopharynx: 4 - obturation of the choanal adenoids (sagittal section).

It begins to decrease and by the age of 20 appears as a small strip of adenoid tissue, which continues to atrophy with age. The boundary between the upper and middle parts of the pharynx is the plane of the hard palate, mentally extended backwards.

The middle part of the pharynx and - oropharynx (mesopharynx) is involved in the conduction of both air and food; here the respiratory and digestive tracts cross. In front, the oropharynx has a hole - a pharynx, leading to the oral cavity (Fig. 2.3), its back wall borders on the Ssh. The pharynx is bounded by the edge of the soft palate, the anterior and posterior palatine arches, and the root of the tongue. In the middle part of the soft palate there is an elongation in the form of a process called the uvula. In the lateral sections, the soft palate splits and passes into the anterior and posterior palatine arches, in which the muscles are embedded; when these muscles contract, the opposite arches approach each other, acting as a sphincter at the time of swallowing. In the softest palate there is a muscle that lifts it and presses it against the back wall of the pharynx (m.levator veli palatini), with the contraction of this muscle, the lumen of the auditory tube expands. The second muscle of the soft palate strains and stretches it to the sides, expands the mouth of the auditory tube, but narrows its lumen in the rest (m.tensor veli palatini).

Between the palatine arches in triangular niches are palatine tonsils (first and second). The histological structure of the lymphadenoid tissue of the pharynx is the same; between the connective tissue fibers (trabeculae) there is a mass of lymphocytes, some of which are in the form of spherical clusters called follicles (Fig. 2.4). However, the structure of the palatine tonsils has clinically important features. The free, or yawning, surface of the palatine tonsils faces the pharyngeal cavity and is covered with stratified squamous epithelium. Unlike other tonsils of the pharynx, each palatine tonsil has 16-18 deep gaps, called lacunae, or crypts. The outer surface of the tonsils is connected to the lateral wall of the pharynx through a dense fibrous membrane (the intersection of the cervical and buccal fascia), which in the clinic is called the tonsil capsule.

Between the capsule of the tonsil and the pharyngeal fascia covering the muscles, there is loose paratonsillar fiber, which facilitates the removal of the tonsil during tonsillectomy. A lot of connective tissue fibers pass from the capsule to the parenchyma of the tonsil, which are interconnected by crossbars (trabeculae), forming a densely looped network. The cells of this network are filled with a mass of lymphocytes (lymphoid tissue), which are locally formed into follicles (lymphatic, or nodular, tissue), forming a whole lymphadenoid tissue. Other cells are also found here - mast cells, plasma cells, etc. Follicles are spherical accumulations of lymphocytes in varying degrees of maturity.

Lacunae penetrate the thickness of the tonsil, have branches of the first, second, third and even fourth order. The walls of the lacunae are lined with squamous epithelium, which is rejected in many places. In the lumen of the lacunae, along with the torn off epithelium, which forms the basis of the so-called tonsil plugs, microflora, lymphocytes, neutrophils, etc. are always contained.

An important factor from the point of view of pathology is that the emptying (drainage) of deep and tree-branched lacunae is easily disturbed due to their narrowness, depth and branching, as well as due to cicatricial narrowing of the mouths of the lacunae, some of which are also covered in the anteroinferior part of the palatine tonsil. a flat fold of mucous membrane (fold of His), which is an expanded part of the anterior arch.

Above the upper pole of the amygdala is a part of the amygdala

Rice. 2.3.

(sagittal section).

1 - hard palate; 2 - palatine curtain; 3 - superior nasal concha; 4 - "higher" nasal concha; 5 - fistula of the main sinus; 6 main sinus; 7 - choana; 8 - tubal-palatine fold; 9 - pharyngeal mouth of the auditory tube; 10 - nasopharyngeal (pharyngeal) tonsil; 11 - pharyngeal pocket; 12 - pipe roller; 13 - arch of the atlas (1 cervical vertebra); 14 - nasopharynx; 15 - tubal-pharyngeal fold; 16 - uvula of the soft palate; 17 - palatine-lingual fold (anterior palatine); 18 - palatine tonsil; 19 - palatopharyngeal (posterior palatine) arch; 20 - oropharynx; 21- epiglottis; 22 - throat-pharynx; 23 - cricoid cartilage; 24 - esophagus; 25 - trachea; 26 - thyroid cartilage (Adam's apple angle area); 27 - cavity of the larynx; 28 - the body of the hyoid bone; 29 - maxillofacial muscle; 30 - chin-hyoid muscle; 31- chin-lingual muscle; 32 - vestibule of the mouth; 33 - oral cavity; 34 - lower nasal concha; 35 - middle nasal concha; 36-frontal sinus.

1 - crypt (lacuna); 2 - lymphoid follicles; 3 - connective tissue capsule; 4 - the mouth of the gap (crypt).

The facial niche, filled with loose fiber, which is called the supra-almond fossa (fossa supratonsillarae). The upper lacunae of the amygdala open into it. The development of paratonsillitis is often associated with structural features of this area. The above anatomical and topographic features create favorable conditions for the occurrence of chronic inflammation in the palatine tonsils. The structure of the upper pole of the amygdala is especially unfavorable in this regard; as a rule, it is here that inflammation most often develops.

Sometimes, in the region of the upper pole, a segment of the palatine tonsil may lie in the soft palate above the tonsil (internal additional tonsil according to B.S. Preobrazhensky), which the surgeon must take into account when performing tonsillectomy.

Lymphadenoid tissue is also present on the posterior wall of the pharynx in the form of small (punctate) formations called granules or follicles, and behind the palatine arches on the side walls of the pharynx there are lateral ridges. In addition, small accumulations of lymphadenoid tissue are found at the entrance to the larynx and in the pyriform sinuses of the pharynx. At the root of the tongue is the lingual (fourth) tonsil of the pharynx, which, through lymphoid tissue, can be connected to the lower pole of the palatine tonsil (with tonsillectomy, this tissue must be removed).

Thus, lymphadenoid formations are located in the pharynx in the form of a ring: two palatine tonsils (first and second), two tubal tonsils (fifth and sixth), one pharyngeal (nasopharyngeal, third), one lingual (fourth) and smaller accumulations of lymphadenoid tissue. All of them taken together and received the name "lymphadenoid (lymphatic) pharyngeal ring of Valdeyra-Pirogov".

The laryngeal part of the pharynx is the larynx and pharynx a (hypopharynx). The boundary between the oropharynx and the laryngopharynx is the upper edge of the epiglottis and the root of the tongue; down, the laryngopharynx narrows in a funnel-shaped manner and passes into the esophagus. The laryngeal part of the pharynx is located in front of the C, v-Cv cervical vertebrae. The entrance to the larynx opens in front and below the hypopharynx. On the sides of the entrance to the larynx, between it and the side walls of the pharynx, there are recesses, tapering cone-shaped at the bottom - pear-shaped pockets (pits, sinuses), along which the food bolus moves towards the entrance to the esophagus (Fig. 2.5).

The main part of the lower pharynx (hypopharynx) is located behind the larynx so that its back wall is the anterior wall of the pharynx. With indirect laryngoscopy, only the upper part of the lower pharynx is visible, up to the lower part of the pear-shaped pockets, and below the anterior and posterior walls of the pharynx are in contact and only diverge when food passes.

1 pear-shaped sinus; 2 - epiglottis; 3 - aryepiglottic folds; 4-voice folds; 5 - vestibular folds.

The wall of the pharynx consists of four layers. It is based on a fibrous membrane, which is covered from the inside by the pharyngeal cavity with a mucous membrane, and outside by a muscular layer. The muscles located outside are covered with a thinner connective tissue layer - adventitia, on which lies loose connective tissue, which ensures the mobility of the pharynx in relation to the surrounding anatomical formations.

The mucosa of the pharynx and in its upper part, near the choanae, is covered with multi-row ciliated epithelium in accordance with the respiratory function of the nasopharynx, in the middle and lower parts - stratified squamous epithelium. In the mucous membrane of the pharynx, especially in the nasopharynx, on the pharyngeal surface of the soft palate, on the root of the tongue and in the tonsils, there are many mucous glands.

The fibrous membrane of the pharynx at the top is attached to the main part of the occipital bone, the medial plate of the pterygoid process and to other bones of the base of the skull.

Downwards, the fibrous membrane becomes somewhat thinner and passes into a thin elastic membrane, which is attached to the hyoid bone and plates of the thyroid cartilage. From the side of the pharynx, the fibrous layer is covered with a mucous membrane, outside - with a muscular layer.

The muscular layer of the pharynx consists of striated fibers and is represented by circular and longitudinal muscles that compress and lift the pharynx. The pharynx is compressed by three constrictors - upper, middle and lower. These muscles are placed from top to bottom in the form of plates covering each other in a tiled manner. The superior pharyngeal constrictor muscle originates in front of the sphenoid bone and mandible, goes back to the midline of the posterior pharyngeal wall, where it forms the upper part of the median pharyngeal suture. The middle muscle that compresses the pharynx starts from the horns of the hyoid bone and the stylohyoid ligament, goes fan-shaped posteriorly to the pharyngeal suture, partially covers the upper muscle that compresses the pharynx, and below is located under the lower muscle that compresses the pharynx. This muscle starts from the outer surface of the cricoid cartilage, the lower horn and the posterior edge of the thyroid cartilage, goes posteriorly and, along the midline of the posterior pharyngeal wall, forms the pharyngeal suture with its attachment. Above, the lower pharyngeal constrictor muscle covers the lower part of the middle pharyngeal constrictor; below, its bundles function as a constrictor of the esophagus.

The pharynx is raised by two longitudinal muscles - the stylo-pharyngeal (main) and palatopharyngeal, forming the posterior palatine arch. Contracting, the muscles of the pharynx carry out a peristaltic type of movement; the pharynx at the time of swallowing rises, and thus the food bolus moves down to the mouth of the esophagus. In addition, the upper constrictor gives muscle bundles to the auditory tube and is involved in its function.

Between the mucous membrane of the posterior pharyngeal wall and the prevertebral fascia is the pharyngeal space in the form of a flat slit filled with loose connective tissue. From the sides, the pharyngeal space is limited by fascial sheets that go to the wall of the pharynx from the prevertebral fascia. Starting from the base of the skull, this space passes down behind the pharynx to the esophagus, where its tissue passes into the retroesophageal tissue, and then into the tissue of the posterior mediastinum. The pharyngeal space is divided sagittally into two symmetrical halves by a median septum. In children, near the median septum, there are lymph nodes into which the lymphatic vessels flow from the palatine tonsils, the posterior parts of the nasal and oral cavities; with age, these nodes atrophy; in children, they can suppurate, forming a retropharyngeal abscess. On the sides of the pharynx there is a peripharyngeal space filled with fiber (Fig. 2.6), in which the neurovascular bundle passes and the main lymph nodes of the neck are located.

The length of the pharynx of an adult from its arch to the lower end is 14 (12-15) cm, the transverse size of the pharynx is greater than the anteroposterior and averages 4.5 cm.

I - chewing mouse; 2 - lower jaw; 3 - internal alveolar artery; 4 - VII (facial) nerve; 5 - parotid gland. 6 - external carotid artery; 7 - posterior facial vein; 8 - parotid fascia; 9 - internal jugular vein and glossopharyngeal (IX) nerve; 10 - additional (XI) nerve; II - internal carotid artery and vagus (X) nerve; 12 - upper cervical sympathetic node; 13 - atlas with prevertebral fascia; 14 - long muscle of the head and neck; 15 - hyoid (XII) nerve; 16 - palatine tonsil; 17 - styloid process; 18 - internal pterygoid muscle; 19 - peripharyngeal space.

The main blood supply of the pharynx comes from the pharyngeal ascending artery (a.pharyngica ascendens - a branch of the external carotid artery - a.carotis externa), the ascending palatine artery (a.platina ascendens - a branch of the facial artery - a.facialis, which also comes from the external carotid artery), descending palatine arteries (aa.palatina descendens - branches of the maxillary artery - a.maxillaris, the final branch of the external carotid artery). The lower pharynx is partially fed from the inferior thyroid artery (a.thyreoidea inferior - a branch of the subclavian artery - a.sub-clavia - on the left and the brachiocephalic trunk - truncus brachiocephalicus - on the right). The blood supply to the palatine tonsils is carried out from the system of the external carotid artery with various options (Fig. 2.7).

Pharynx- a muscular organ located in the neck and is an integral part of the respiratory and digestive systems.

The structure of the pharynx

Located behind the nasal and oral cavities and in front of the occipital bone, the pharynx has the shape of a funnel-shaped tube about 10-15 cm long. The upper wall of the pharynx is fused with the base of the skull, in this place on the skull there is a special protrusion - the pharyngeal tubercle. Behind the pharynx is the cervical spine, so the lower border of the pharynx is determined at the level between the VI and VII cervical vertebrae: here it, narrowing, passes into the esophagus. Large vessels (carotid artery, internal jugular vein) and nerves (vagus nerve) adjoin the side walls of the pharynx on each side.

Three divisions of the pharynx

• upper (nasopharynx)
• middle (oropharynx)
• lower (laryngeal)

Nasopharynx it is intended only for conducting air, which from the nasal cavity enters here through 2 large choanae. Unlike other sections of the pharynx, the walls of its nasal part do not collapse, as they are firmly fused with neighboring bones.

On the side walls of the nasopharynx (on each side) there are openings of the auditory tube connecting the pharynx with the tympanic cavity of the organ of hearing. Thanks to this message, the air pressure in the tympanic cavity is always equal to atmospheric, which creates the necessary conditions for the transmission of sound vibrations.

During takeoff, the atmospheric pressure changes so rapidly that the pressure in the tympanic cavity does not have time to correct itself. As a result, the ears are blocked and the perception of sounds is disturbed. If at the same time you yawn, suck on a lollipop or make swallowing movements, then hearing is restored very quickly.

The nasopharynx is the location of the tonsils, the most important formations related to the immune system. The unpaired pharyngeal tonsil is located in the region of the arch and the posterior wall of the pharynx, and the paired tubal tonsils are located near the pharyngeal openings of the auditory tube. Being located on the way of the possible introduction of foreign substances or microbes into the body, they create a kind of protective barrier.

Enlargement of the pharyngeal tonsil (adenoids) and its chronic inflammation can lead to difficulty in normal breathing in children, and therefore it is removed.

The oropharynx, located at the level of the oral cavity, has a mixed function, since both food and air pass through it. The place of transition from the oral cavity to the pharynx - the pharynx - is limited at the top by a hanging fold (palatine curtain), ending in the center with a small tongue. With each swallowing movement, as well as when pronouncing guttural consonants (“g”, “k”, “x”) and high notes, the palatine curtain rises and separates the nasopharynx from the rest of the pharynx. When the mouth is closed, the tongue fits snugly against the tongue and creates the necessary tightness in the oral cavity to prevent the lower jaw from sagging.

On the side walls of the pharynx are paired palatine tonsils, the so-called tonsils, and on the root of the tongue - the lingual tonsil. These tonsils also play a significant role in protecting the body from harmful bacteria that enter through the mouth. With inflammation of the palatine tonsils, a narrowing of the passage into the pharynx and difficulty in swallowing and speech are possible.

Thus, in the region of the pharynx, a kind of ring is formed from the tonsils involved in the protective reactions of the body. The tonsils are strongly developed in childhood and adolescence, when the body grows and matures.

The organ of taste. It is our tongue, covered with more than five thousand taste buds of various shapes.

Types of taste buds of the tongue

• fungiform papillae (occupying mainly the two anterior thirds of the tongue)
• grooved (located at the root of the tongue, they are relatively large and easy to see)
• foliate (closely spaced folds on the side of the tongue)

Each of the papillae contains taste buds, which are also found in the epiglottis, on the back of the pharynx, and on the soft palate.

The kidneys have their own specific set of taste buds that are sensitive to different taste sensations. So, at the tip of the tongue there are more receptors for sweet, the edges of the tongue feel sour and salty better, and its base is bitter. Taste zones may overlap one another, for example, in the zone where the taste of sweet occurs, there may be bitter taste receptors.

There are approximately 10,000 taste buds in the human mouth.

At the top of the taste bud is a taste opening (pore), which opens on the surface of the mucous membrane of the tongue. Substances dissolved in saliva penetrate through the pore into the fluid-filled space above the taste bud, where they come into contact with the cilia - the outer parts of the taste buds. Excitation in the receptor arises as a result of the interaction of a substance with a nerve cell and is transmitted along the sensory nerves to the center of taste (gustatory zone), located in the temporal lobe of the cerebral cortex, where four different sensations arise: salty, bitter, sour and sweet. The taste of food is a combination of these sensations in different proportions, to which the sensation of the smell of food is also added.

The laryngeal region of the pharynx lies behind the larynx. On its front wall there is an entrance to the larynx, which is closed by the epiglottis, moving like a "lifting door". The wide upper part of the epiglottis descends with each swallowing movement and closes the entrance to the larynx, preventing food and water from entering the respiratory tract. Water and food move through the laryngeal part of the pharynx into the esophagus.

Throat wall. Its basis is created by a dense fibrous membrane, covered from the inside by a mucous membrane, and from the outside by the muscles of the pharynx. The mucous membrane in the nasal part of the pharynx is lined with ciliated epithelium - the same as in the nasal cavity. In the lower parts of the pharynx, the mucous membrane, becoming smooth, contains numerous mucous glands that produce a viscous secret that promotes the sliding of the food bolus during swallowing.

The role of the pharynx in the process of breathing

After passing through the nasal cavity, the air is warmed, moistened, purified and enters first into the nasopharynx, then into the oral part of the pharynx, and finally into its laryngeal part. When breathing, the root of the tongue is pressed against the palate, closing the exit from the oral cavity, and the epiglottis rises, opening the entrance to the larynx, where the air stream rushes.

Among the functions of the pharynx there is also a resonator one. The peculiarity of the timbre of the voice is largely due to the individual characteristics of the structure of the pharynx.

When talking or laughing while eating, food can get into the nasopharynx, causing extremely unpleasant sensations, and into the larynx, leading to bouts of excruciating convulsive cough - a protective reaction caused by irritation of the mucous membrane of the larynx with food particles and helping to remove these particles from the respiratory tract