Anatomy of Oral

Cavity, Pharynx &

Oesophagus
Dr. Vishal Sharma

Oral Cavity

Parts of Oral Cavity

Floor of mouth

Lymphatic drainage

Intrinsic tongue muscles

Extrinsic tongue muscles

Coronal section of tongue

Actions of tongue muscles

Inferior Longitudinal: moves tip up & down
Superior Longitudinal: moves tip up & down
Transverse: narrows & lengthens tongue
Vertical: flattens & depresses tongue
Genioglossus: Prevents tongue from falling back
Styloglossus: Pulls tongue up & back
Palatoglossus: Pulls tongue back
Hyoglossus: Depresses tongue

Nerve Supply of Tongue

Sensory

Anterior 2/3

Posterior 1/3

Lingual

Glossopharyngeal

Motor
Taste

Hypoglossal ***
Chorda tympani

Glossopharyngeal

*** except palatoglossus which is supplied by

pharyngeal plexus

Nerve
Supply
of
Tongue

Papillae in tongue

Papillae in tongue
Lingual taste buds sit on lateral borders of
raised papillae. They are classified as:

Fungiform: at tip & sides of tongue

Circumvallate: just in front of terminal sulcus

Foliate: at posterior lateral margins of tongue

Filiform: centre of tongue, have no taste buds

Papillae in tongue

Tongue Map ?

Sweet = Sucrose

Salty = NaCl

Sour = HCl

Bitter = Quinine

Umami = Glutamate

Taste Bud

Taste Pathway

Pharynx

Divisions

Divisions

Lower Limit of
Nasopharynx Lower border of soft palate or
Junction b/w hard & soft palate
Oropharynx

Tip of epiglottis or
Body of hyoid bone or
Base of vallecula

Hypopharynx Lower border of cricoid or

Lower border of C6 vertebra

Anterior Relations

Nasopharynx

Nasopharyngeal isthmus

Nasopharyngeal Isthmus
Separates nasopharynx from oropharynx
Bounded anteriorly by soft palate & posteriorly
by mucosal ridge on nasopharyngeal wall called
Passavants ridge (due to palatopharyngeus)
Closure of this isthmus prevents nasal
regurgitation & nasal intonation

Parts of Oropharynx

Parts of Oropharynx

Oropharyngeal Isthmus

Oropharyngeal Isthmus
Separates oral cavity from oropharynx
Boundaries are:
Superior: Junction between hard & soft palate
Inferior: Circumvallate papillae
Lateral: Anterior tonsillar pillars (palatoglossus)

Waldeyers Tonsillar Ring

Waldeyer's tonsillar ring

Vertically oriented, sub-epithelial lymphoid

tissue ring located in pharynx, thought to

function as a barrier to infection in first few
years of life. Named after nineteenth century
German anatomist Heinrich Wilhelm Gottfried
von Waldeyer-Hartz.

Parts of Hypopharynx

Coronal section of Pharynx

Layers of Pharyngeal Wall

Mucosa: ciliated columnar in nasopharynx &

stratified squamous elsewhere

Pharyngo-basilar fascia

Longitudinal muscles: stylo-pharyngeus +

salpingo-pharyngeus + palato-pharyngeus

Constrictor muscles: superior + middle + inferior

Bucco-pharyngeal fascia

Muscles

Structures Passing
Between Skull Base &
Superior Constrictor
(Sinus of Morgagni)

Eustachian tube + Levator

palatini + Tensor palatini +
Ascending palatine artery

Between Superior &

Middle Constrictors

Glossopharyngeal nerve &

Stylopharyngeus muscle

Between Middle &

Inferior Constrictors

Internal Laryngeal nerve &

Superior Laryngeal artery

Below Inferior
Constrictor

Recurrent Laryngeal nerve

& Inferior Laryngeal artery

Nerve Supply

Nasopharynx: pterygo-palatine ganglion (V2)

Oropharynx: glossopharyngeal & vagus nv

Hypopharynx: Superior & recurrent laryngeal nv

All muscles by pharyngeal nerve plexus (vagus

nv carrying cranial part of accessory nv) except
stylopharyngeus (glossopharyngeal nv) &
cricopharyngeus (also by recurrent laryngeal)

Arterial Supply

Facial artery

Lingual artery

Ascending pharyngeal artery

Ascending palatine artery

Greater palatine artery

Artery of pterygoid canal

Superior laryngeal artery

Venous Drainage
Upper pharynx:

Pharyngeal venous plexus situated on middle

constrictor pterygoid venous plexus &
internal jugular vein

Lower pharynx:

Inferior thyroid veins

Lymphatic Drainage

Nasopharynx: upper deep cervical + retropharyngeal + parapharyngeal +

posterior triangle

Oropharynx: upper deep cervical + retropharyngeal + parapharyngeal

Hypopharynx: deep cervical + parapharyngeal +

paratracheal + supraclavicular

Killians Dehiscence

Killians Dehiscence

Triangular weak area between thyropharyngeus

& cricopharyngeus part of inferior constrictor

Mucosa herniates through it to form hypopharyngeal pouch (Zenkers diverticulum)

Perforation occurs here during forceful

oesophagoscopy (gateway of tears)

Oesophagus

Introduction

Also called gullet

23 to 25 cm long

Extends from crico-pharyngeal sphincter (C6

vertebra) to cardiac orifice of stomach (T11
vertebra)

Anterior Curvature
Follows anteroposterior curve of
vertebral column
through neck, thorax
(postr mediastinum)
& upper abdomen

Lateral curvatures
Starts in midline
deviates to left at C7
returns to midline
at T5 deviates to
left again at T7 to
reach gastric cardia

Natural Constrictions

Natural Constrictions
Site

Vertebral Level

Distance from
central incisor

Cricopharynx

C6

15 cm

Aortic arch

T4

25 cm

Lt main
bronchus

T5

28 cm

Oesophageal
hiatus

T 10

40 cm

Importance of constrictions

Common sites for lodgement of oesophageal

foreign bodies

Common sites for caustic stricture of

oesophagus

Blood Supply
Part

Arterial

Venous

Cervical

Inferior thyroid

Inferior thyroid

Thoracic

Descending
thoracic aorta,
Bronchial
Abdominal Left gastric,
Inferior
phrenic

Azygos,
Hemi-azygos
Left gastric,
Abdominal azygos

Oesophageal varices
Left gastric vein is a
site of portal-systemic
anastomosis. Portal
obstruction leads to
varicose veins in
lower oesophagus

Nerve Supply
Cervical: recurrent laryngeal nerve & cervical
sympathetic trunk
Thoracic: vagal trunks, oesophageal plexus & thoracic
sympathetic trunk
Abdominal: vagal trunks & thoracic sympathetic trunk
Esophageal pain mimics cardiac angina due to
common nerve supply

Lymphatic Drainage
deep cervical + posterior mediastinal + left
gastric lymph nodes

drain into coeliac lymph nodes

thoracic duct

Histology

Histology
Four coats from outside inwards:
1. Fibrous coat (adventitia)
2. Muscular coat (muscularis propria)
3. Submucous coat
4. Mucous coat

Detailed Histology

Mucous coat
1. Epithelium: non-keratinizing stratified sqamous
2. Lamina propria: loose areolar tissue with
lymphoid aggregates
3. Muscularis mucosae: produces local
movement of mucosa & helps in
drainage of gland secretions

Mucous coat
Pink, smooth, protective
oesophageal mucosa
leads to red, mamillated,
secretory gastric mucosa
across Z (zigzag) line at
38-40 cm from incisors.
Higher Z line seen in
Barrets esophagus.

Z line in endoscopy

Barrets esophagus

Submucous coat
Loose supporting areolar tissue contains:

Seromucous glands

Blood vessels

Lymphatic channels

Parasympathetic ganglia forming Meissner's

nerve plexus

Muscularis propria

External longitudinal muscle

Internal circular muscle

Parasympathetic ganglia forming Auerbach's

nerve plexus lies b/w them

Upper 1/3: striated muscle

Middle 1/3: striated & smooth

Lower 1/3: smooth muscle

Fibrous coat (adventitia)

Layer of loose, supportive fibrous tissue

Conducts major vessels & nerves longitudinally

A serosa formed by visceral peritoneum

replaces adventitia of intra-abdominal segment
of oesophagus

Thank You