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PHARYNX, SOFT PALATE, and LARYNX (Grant's Dissector [16Th Ed.] Pp. 286-290, 294-299, 303-307) TODAY's GOALS: 1. Disarticulate

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PHARYNX, SOFT PALATE, and LARYNX (Grant's Dissector [16Th Ed.] Pp. 286-290, 294-299, 303-307) TODAY's GOALS: 1. Disarticulate PHARYNX, SOFT PALATE, AND LARYNX (Grant's Dissector [16th Ed.] pp. 286-290, 294-299, 303-307) TODAY’S GOALS: 1. Disarticulate the head and cervical visceral compartment From the cervical spine 2. IdentiFy the buccopharyngeal Fascia, the cervical visceral compartment, the prevertebral compartment, and the retrovisceral space 3. IdentiFy the sympathetic trunK, cranial nerves, and vessels ascending/descending along the lateral pharyngeal wall From the skull into the necK 4. IdentiFy the 3 parts oF the pharynx (nasopharynx, oropharynx, laryngopharynx) and associated structures related to each 5. IdentiFy the muscles of the pharyngeal wall 6. IdentiFy the hard and soFt palates and associated musculature 7. IdentiFy the openings oF the auditory tube and sphenopalatine Foramen and the nerve and blood supply to the palatine tonsil and hard and soFt palate 8. IdentiFy the principal cartilages, membranes, and synovial joints oF the larynx 9. IdentiFy the principal intrinsic muscles oF the larynx 10. IdentiFy the internal, external, and recurrent laryngeal nerves 11. IdentiFy the vestibular and vocal Folds, rima glottidis, and 3 cavities within the larynx DISSECTION NOTES: General comments: The pharynx (aKa “throat”) is a Funnel-shaped region in the head and necK that communicates anteriorly with the nasal cavity, oral cavity, and larynx. It is a common space for the upper respiratory and digestive systems beFore these systems separate into their respective “tubes” (i.e., larynx/trachea and esophagus). In order to study the pharyngeal wall and structures related to it, the head and cervical visceral compartment must First be disarticulated From the cervical spine. Use the Following instructions to perForm this disarticulation. I. Disarticulation of the HeaD anD Cervical Visceral Compartment Step 1. Dissect the sternocleidomastoid and posterior digastric muscles to the mastoid process. DO NOT REFLECT THESE ATTACHMENTS. These muscles will accompany the viscerocranium anteriorly. 27 Step 2. Insert the Fingers oF both hands posterior to the carotid sheaths and push them medially until they meet posterior to the cervical viscera. Your Fingers are now in the retropharyngeal/retrovisceral space. WorK your Fingers superiorly to the base oF the skull and inFeriorly toward the superior mediastinum. Step 3. Isolate and protect the contents oF the jugular Foramen, taKing care not to cut CNs IX, X, and XI, internal jugular vein, and internal carotid artery (contents of the carotid sheath at this level). These structures will also accompany the viscerocranium Forwards. Step 4. View the posterior cranial Fossa on your cadaver and reFer to the above diagram. Plan your saw cuts by incising the dura parallel to the petrous ridge oF the temporal bone so that your scalpel passes between the jugular Foramen and the Foramen magnum near the hypoglossal canal. Step 5. Follow the scalpel marKs with a hand saw. Saw through the occipital bone on both sides keeping the saw cut posterior to the mastoid process. The saw cuts should reach the midline in front of the Foramen magnum. Step 6. CareFully pull the viscerocranium anteriorly and cut remaining muscular and Fascial attachments. This should produce a view similar to Fig. 7.64 in the Dissector (p. 288). II. Pharynx A. Posterior aspect oF the pharyngeal wall. Note and identiFy the Following: • Buccopharyngeal fascia – this Fascia is a continuation oF the Fascia overlying the buccinator muscle and covers the posterior pharyngeal wall musculature (it is the posterior portion oF the cervical visceral Fascia). CareFully strip away this Fascia to identiFy the Following muscles, nerves, and vessels: • Pharyngeal constrictors: Paired sKeletal muscles that insert into the posterior midline at the pharyngeal raphe. (Dissector p. 287, Fig. 7.63; p. 290, Table 7.7) o Superior constrictor – its principal attachment site anteriorly is the pterygomandibular raphe (a thin Fibrous “seam” that it shares with the buccinator muscle). It attaches posteriorly to the pharyngeal raphe and to the pharyngeal tubercle in the superior midline. This muscle is deFicient superiorly and does not directly attach to the sKull. Rather, the interval between its superior border and the sKull base is Filled by dense connective tissue called the pharyngobasilar fascia. o MidDle constrictor – its principal anterior attachment is the greater horn oF the hyoid. Its upper Fibers overlap the lower Fibers oF the superior constrictor. o Inferior constrictor – its principal anterior attachment is the oblique line oF the thyroid cartilage and lateral surFace oF the cricoid cartilage. Its upper Fibers overlap the lower Fibers oF the middle constrictor. • Palpate the superolateral region oF the pharynx for the slender styloid process (Dissector p. 287, Fig. 7.63). Using this as a landmarK, use blunt dissection to locate and identify the stylopharyngeus muscle that attaches to its medial surFace. Observe the glossopharyngeal nerve descending on the posterior surFace of this muscle beFore wrapping around it laterally (Dissector p. 288, Fig. 7.64). Follow these two structures inferiorly where they pass between the superior and middle 28 constrictor muscles to the inner surFace oF the pharyngeal wall. This is one oF the longitudinal muscles of the pharynx. • Identify CNs IX, X, XI where they exit the jugular Foramen medial to the internal jugular vein (IJV) (Dissector p. 288, Fig. 7.64). ConFirm their identiFication by following them into the necK where they were previously dissected. • IdentiFy the hypoglossal nerve • IdentiFy the sympathetic trunk and the superior cervical ganglion. This ganglion is FusiForm in appearance and is the largest oF the cervical sympathetic ganglia. LooK For the internal carotid nerve leaving its superior end and coursing with the internal carotid artery to the carotid canal. This nerve Forms the internal carotid nerve plexus on the surFace oF ICA. • IdentiFy the internal jugular vein. The carotiD sheath ends superiorly at the opening of the carotid canal and jugular Foramen and encloses IJV, ICA, and the proximal portions oF CNs IX, X, XI. The connective tissue oF this sheath is necessarily removed to visualize these structures. III. Internal Inspection of the Pharynx A. Once you have identiFied the pharyngeal muscles and associated nerves and vessels descending along its lateral border, divide the posterior pharyngeal wall in its midline (along pharyngeal raphe) by cutting through it with scissors or scalpel from the base oF skull (clivus) to the esophagus. B. As you looK through this incision, identiFy the three parts oF the pharynx: nasopharynx, oropharynx, laryngopharynx (hypopharynx), and their communications with the nasal cavity, oral cavity, and larynx. C. IdentiFy the Following in a superior to inferior direction (many oF these will be revisited aFter the skull has been bisected, allowing a better view oF the interior oF the head and pharynx) : • Choana or posterior nasal aperture – the narrow passageway on either side oF the nasal septum that communicates the nasal cavity with the nasopharynx • Uvula anD soft palate • Posterior 1/3 of the tongue • Epiglottis anD epiglottic valleculae o The root oF the tongue is connected to the anterior border oF the epiglottis via the: Median glossoepiglottic folD (single) Lateral glossoepiglottic folds (paired) Valleculae – the shallow depressions located between the median and lateral glossoepiglottic Folds. They are depressions that ingested Foreign bodies may become enlodged in. • Inlet/aDitus of larynx – this is the opening From the laryngopharynx into the larynx. It is bounded anteriorly by the epiglottis and laterally by a pair oF mucosal Folds called the aryepiglottic folds. Lateral to the aryepiglottic Folds are the : Piriform recesses – additional sites For enlodgement oF ingested Foreign objects. 29 IV. Bisection of the HeaD (To preserve the worK that was done on the orbit [assuming one orbit was dissected], bisection will be perFormed on the opposite side. The goal is to divide the head in the sagittal plane to produce one side that contains an intact nasal septum and another side that exposes the lateral nasal wall for study oF the oral and nasal cavities in the next lab session.) Read through these instructions beFore proceeding to understand where your scalpel and saw cuts will be made. First, maKe the Following cuts using a scalpel: A. Divide the uvula and soFt palate in the midline. B. Cut through the upper lip in the midline and through the nostril and nasal cartilage, parallel to the nasal septum on the side the saw cut will be made. C. Position a handsaw blade just lateral to the crista galli and Keep the blade close to the nasal septum as you progress. Proceed to cut From superior to inFerior through the Frontal and nasal bones, the cribriForm plate, the midline oF the body oF the sphenoid, the clivus, and the hard palate. The two superior halves oF the head should separate from each other. D. Next, divide the tongue in the midline using a scalpel and similarly divide the lower lip in the midline between the central incisors. Place a saw blade between the cut edges and saw through the mandible between the two central incisors. Do not cut through the hyoid bone or larynx. The two halves should now Fall away enabling you to inspect and Further dissect the lateral pharyngeal wall and soFt palate areas. V. Lateral Pharyngeal Wall A. Review the regions oF the pharynx: nasopharynx, oropharynx, laryngopharynx and inspect the following with the mucosa intact (Dissector pp. 289, 296; Figs. 7.65, 7.77): 1. Nasopharynx a. Choana/posterior nasal aperture b. Torus tubarius (a projection oF the auditory tube cartilage along the lateral wall of the nasopharynx) and opening of the auditory tube posterior to the inferior concha. The auditory tube (pharyngotympanic tube) connects the nasopharynx to the middle ear (tympanic) cavity. The part oF this tube closest to the pharynx is cartilaginous (about 2/3s oF its length); the part closest to the middle ear passes through temporal bone.
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