pharynx, cranio- vertebral joints, and prevertebral region 2009 dental & optometry students...
TRANSCRIPT
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PHARYNX, CRANIO- PHARYNX, CRANIO- VERTEBRAL JOINTS, AND VERTEBRAL JOINTS, AND PREVERTEBRAL REGIONPREVERTEBRAL REGION
20092009DENTAL & OPTOMETRY DENTAL & OPTOMETRY
STUDENTSSTUDENTS
-George Salter, Ph.D-George Salter, Ph.D
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is a 15 cm. long tube is a 15 cm. long tube connecting inferiorlyconnecting inferiorlywith the oesophagus.with the oesophagus.It is 5 cm. wideIt is 5 cm. widesuperiorly, and superiorly, and it is only 1.5 cmit is only 1.5 cm wide as itwide as itmerges withmerges with the oesophagus.the oesophagus.This point is theThis point is the most narrowmost narrowdiameter of thediameter of the GI tract.GI tract.
PHARYNX
ESOPHAGUS
PHARYNX:
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SUBDIVISIONS OF PHARYNX
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Nasopharynx
Oropharynx
Laryngopharynx
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Nasopharynx
Oropharynx
Laryngo-pharynx or
Hypopharynx
Nasal Cavity
Oral Cavity
Laryngeal Cavity
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WALLS OF PHARYNX- in the form of four layers
1. Mucous membrane-including “tonsil”2. Pharyngobasilar fascia = Submucosa3. Muscle layer4. Buccopharyngeal fascia
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(1)Mucosa;
(2) Submucosa or Pharyngobasilar Fascia (including
the palatine tonsil);
(3) Muscular; and
(4)Buccopharyngeal Fascia
Cross Section,(Oral Pharynx)
for example:
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PHARYNX IN POSTERIOR VIEW
Use scissors in lab
Submucosa extended superiorlyas the pharyngobasilar fascia
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Nasal cavity
Oral cavity
Laryngeal cavity
RELATIONSHIPS
ANTERIOR
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Choanae
Aditus
Soft Palate & Uvula
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CHARACTERISTICSCHARACTERISTICSOF EACH OFOF EACH OF
THE THREE PARTSTHE THREE PARTSOF THE PHARYNXOF THE PHARYNX
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(1) NASOPHARYNX (MUCOSA INTACT)
Pharyngeal tonsil
Auditory tube orifice
Pharyngeal recess
Torus tubarius
Salpingopharyngeal fold
Pharyngeal isthmus
Uvula
Choana
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NASOPHARYNX – with mucosa removed
Torus Tubarius
Tensor (veli) palatini
Levator (veli) palatini
Salpingopharyngeus
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Pharyngo-Tympanic
Tube
MiddleEar
Naso-pharynx
Torus Tubarius
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Uvula
SOFT PALATE --comprised of glands &muscle & separates nasopharynx from oral pharynx
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(2) OROPHARYNX (MUCOSA INTACT)
Palato-glossalfold
PalatineTonsil Bed
Palato-pharyn-gealfold
Pharyngeal Isthmus
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TONSILLAR BED I-with mucosa removed
Palatoglossus
Pharyngobasilar
Fascia
-
Palatopharyngeus
Area between the 2 muscles or folds is the throat or fauces.
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TONSILLAR BED
Palatoglossus
Superior Constrictor(forming the bed)
Palatopharyngeus
(WITH MUCOSA & SUBMUCOSA REMOVED)
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TONSILLAR BED- II Superior constrictorwith inferior part re-moved
Tonsillar br. of facial a.
External palatine(paratonsillar) v.
Glossopharyngeal n. (IX)
?
Middle constrictor
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Styloglossus—lying lateral to superiorconstrictor & joining with hyoglossus
A notable relationship:
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Hard palate
Soft palate
Uvula
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(3)Laryngopharynx (with mucosa intact)
Aryepiglottic fold-forming part of theaditus
Piriform recess-with mucosal foldindicating the location of the internal laryngeal n.
Bulge indicating location of cricoid cartilage
Indicates aditus or opening to larynx
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MUSCLES OF PHARYNX
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(1)
(2)
(3)
Outer Layer (circular)- constrictors-3
Inner Layer(longitudinal)-3
(1)
(2)
(3)
Now, let’s blowthese longitudinalmuscles up
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Inner, Longitudinal Mm (3):
(1) Salpingopharyngeus
(2) Palatopharyngeus
(3) Stylopharyngeus – in reality only its in-ferior fibers are shown
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(1) Superior Constrictor
(2) Middle Constrictor
(3) Inferior Constrictor
Outer, Circular Ms.-3
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Salpingo-pharyngeus
Palato-pharyngeusStylo-Pharyngeus(inferiorfibers)
InnerLongitudinalMuscle Layer
Outer CircularMuscular Layer
Superior Constrictor
Middle Constrictor
Inferior Constrictor
(3)(3)
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ThreeConstrictorMuscles:
Insertions:
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Constrictor Muscles Insertion(s)-all insert posteriorly
Midline Raphe
Pharyngeal tubercle
Origins of constrictors- next:
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Pterygomandibular raphe& bone at either end
Superior constrictor
Middle constrictor
Inferior constrictor
Esophagus
Stylohyoid ligament, body & lesser horn of hyoid bone
Origins of the three constrictor muscles (all arise anteriorly):
Thyroid and cricoidcartilages
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Superior constrictor
Middle constrictor
Inferior constrictor
Esophagus
GAPS ABOVE, BETWEEN,& BELOW CONSTRICTORS:
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Gap betweenSup. & Inf. Const.
Gap between Middle & InferiorConstrictor
Gap inferior toInferior Constrictor
Gap superiorto Sup. Const.
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Thyrohyoid Membranepierced by the ____ ?
Recurrent Laryngeal N
Stylopharyngeus, Stylo-hyoid Ligament & IX N.
Region of Killian’s Dehiscence
PharyngobasilarFascia pierced byLevator palati m.& Auditory Tube
Structures relatedto the gaps
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NERVES OF PHARYNX
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Red (Crimson)= V2- naso-pharyngeal n.
Blue = IX n.—pharyngeal brs.
Auburn = X n.-internal laryngeal brs.
Afferent Fibers From Pharynx:
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Motor Innervation of Pharynx
Pharyngeal brs.of X (SVE)--disruption of these fibers leadsto dysphagia
Pharyngeal brs.of sympathetic tr. (GVE)
Br. Of IX toStylopharyn-geus (SVE)
Add these sensoryfibers and the to-
tal equals the pharyngeal plexus
And Pharyngeal Plexus
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BLOOD SUPPLY & LYMPHATICS
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Pos
S A L F O P S M
A=AscendingPharyngeal A.
Ascending palatine br. of facial artery
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DeepCervicalLymph Nodes
RetropharyngealLymph NodesDrain to
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PALATINE TONSIL
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Jugulodigastricor TonsillarNode
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ATLANTO-OCCIPITAL & ATLANTO-OCCIPITAL & ATLANTO-AXIAL JTS.ATLANTO-AXIAL JTS.
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Dens
C1
C2
C3
C4
Facet foroccipitalcondyle
Facet fortransverseligament
Atlas and Axis(superior view)
Atlanto-occipital Joints (Ellipsoid)Allow flexion/extension of head (nodding “yes”)Allow lateral flexion of head
Lateral atlanto-axial joints (gliding)Median atlanto-axial joint (pivot)- (shaking “No”)
C1-C4 Vertebrae
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MUSCLES PRODUCING MOVEMENT OF THE ATLANTO-OCCIPITAL (AO) JOINTS
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MUSCLES PRODUCING MOVEMENT OF THE ATLANTO-OCCIPITAL (AO) JOINTS
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Tectorial membrane
Posterior longitudinal ligament
Alar ligaments
Superior longitudinal band
Transverse ligament of atlas
Inferior longitudinal band
CRUCIATELIGAMENT
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HYPEREXTENSION OF THE HEAD ON THE NECK FRACTURE OF THE AXIS (HANGMAN’S FRACTURE)
Pars inter-articularis
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ORIGINALLY, THERE WERE 8 CERVICAL SYMPATHETIC GANGLIA, ONE ASSOCIATED WITH EACH CERVICAL SPINAL NERVE. BUT, THESE GANGLIA COALESCED INTO 3 (4) GANGLIA. THEREFORE, THESE REMAINING CERVICAL SYMPATHETIC GANGLIA WERE LEFT TO SEND POSTSYNAPTIC FIBERS (VIA GRC) TO SEVERAL SPINAL NERVES EACH.
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The sympathetic trunk is located posterior to the
carotid sheath on the prevertebral
fascia
K. Kryger
R. Common Carotid A
internal carotid a
I. Carotid npostgang. fibers
Superior Cervical Ganglion
(upper 4 ganglia)
Middle cervical ganglion
(ganglia 5 & 6)
Inferior cervical ganglion
(ganglia 7 & 8)
1st rib (cut)R. subclavian a. (cut)
hyoid
Ext. Carotid N.
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Lateral horns of cord levels T1-2
superior cervical ganglion (in neck)
Target tissue
smooth muscle in vessel walls,
dilator pupillae m, & sweat glands.
Preganglionic axons ascendin the sympathetic trunk
Postganglionic axons distributed via Ext. & Int. carotid ns.( carotid plexus)
K. Kryger
Functions:
1) vasoconstriction
2) dilate pupils
3) stimulate sweat glandsPreganglionic fibres enter the
sympathetic trunk
Overview of Sympathetics to HeadOverview of Sympathetics to Head
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NOW, LET’S CONSIDER NOW, LET’S CONSIDER SYMPATHETIC FIBERSSYMPATHETIC FIBERS
TO TO THETHE CERVICAL VISCERACERVICAL VISCERA
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Sympathetic fibers to the neck viscera, eg. Sympathetic fibers to the neck viscera, eg. the pharynx, would ascend as presynaptic the pharynx, would ascend as presynaptic
fibers to reach the cervical sympathetic fibers to reach the cervical sympathetic ganglia. Synapse would then occur, and ganglia. Synapse would then occur, and
postsynaptic fibers wouldpostsynaptic fibers wouldpass to the viscera via direct branches or pass to the viscera via direct branches or
via the blood vessels.via the blood vessels.
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Cervical Viscera
Origin
T1-L2
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LABLAB
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1. REMOVE ALL MUSCULATURE FROM OCCIPITAL BONE & POSTERIOR ARCH OF ATLAS.
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2. REMOVE WEDGE OF OCCIPITAL BONE
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3. REMOVE POST. ARCH OF ATLAS, TRANSECT & REMOVE CERVICAL SPINAL CORD & ASSOCIATED MENINGES
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Tectorial membrane
Posterior longitudinal ligament
Alar ligaments
Superior longitudinal band
Transverse ligament of atlas
Inferior longitudinal band
CRUCIATELIGAMENT
TectorialMembrane
4. CUT & REFLECT TECTORIAL MEMBRANE INFERIORLY.
5. CUT ALAR LIGS. & SUP. LONGITUDINAL BAND.
6. DISARTICULATE AO JOINTS (Indicated by the vertebral artery ) W/ HAMMER & CHISEL.
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7. WORK YOUR HANDS INTO RETROPHARYNGEAL SPACE, AND PULL CERVICAL VISCERA AND HEAD FORWARD AWAY FROM VERTEBRAL COLUMN.
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8. Cut prevertebral muscleattachment into the capitus
Rectus capitis lateralis
???
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HAPPY TRAILSTO YOU….
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Superficial cervicalNodes of head & face – inthe shape ofa collar (red line) around head and located in relationshipto E.J.V. in Neck
Deep Cervical Nodes – located in relation-ship to the I.J.V.
Division of deep cervicalnodes into superior & inferior groups by omo-hyoid tendon
SuperficialCervical Nodes
Lymph drainage review
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Facet for dens
Groove for vertebral a.
Sup. facet foroccipital condyle
Post. facet fortransverse lig.
Spinous pr.Inf. articular pr.
Sup. facet for atlas
Interarticular part
ATLAS (C1): SUPERIOR VIEW
AXIS (C2): POSTEROSUPERIOR VIEW
Tubercle fortransverse lig.
Atlas-Inferior View
Axis-Anterior view
Dens
Post. tuberclePost. arch
Ant. archAnt. tubercle
Lat. Proc.