DEPARTMENT OF

ANATOMY
Neck

Dr. SREEKANTH THOTA

Viscera

Thyroid and parathyroid glands

PHARYNX
LARYNX
Thyroid and parathyroid glands

The thyroid and parathyroid glands are

endocrine glands positioned anteriorly in
the neck.
Both glands begin as pharyngeal
outgrowths that migrate caudally to their
final position as development continues.
The thyroid gland is a large, unpaired
gland, while the parathyroid glands, usually
four in number, are small and are on the
posterior surface of the thyroid gland
Thyroid gland
The thyroid gland is anterior in the neck
below and lateral to the thyroid cartilage.
It consists of two lateral lobes (which
cover the anterolateral surfaces of the
trachea, the cricoid cartilage, and the
lower part of the thyroid cartilage) with
an isthmus that connects the lateral
lobes and crosses the anterior surfaces of
the second and third tracheal cartilages.
Thyroid gland in the anterior
triangle of neck
Arterial supply
Two major arteries supply the thyroid
gland.
1. Superior thyroid artery
2. Inferior thyroid artery
Thyroid ima artery :Occasionally, a small
thyroid ima artery arises from the
brachiocephalic trunk or the arch of the
aorta and ascends on the anterior surface
of the trachea to supply the thyroid gland.
Superior and inferior thyroid
arteries
 Thyroid Ima Artery

In approximately
10% of people, a
small, unpaired
thyroid ima artery
arises from the
brachiocephalic
trunk, however, it
may arise from the
arch of the aorta
 Venous and lymphatic drainage
Three veins drain the thyroid gland
1.Superior thyroid vein primarily drains
the area supplied by the superior thyroid
artery;
2. Middle and inferior thyroid veins drain
the rest of the thyroid gland.
The superior and middle thyroid veins drain
into the IJVs
Inferior thyroid veins drain into the
brachiocephalic veins
Vasculature of the thyroid
Recurrent laryngeal nerves
The thyroid gland is closely related to the
recurrent laryngeal nerves.
After branching from the vagus nerve [X]
and looping around the subclavian artery
on the right and the arch of the aorta on
the left, the recurrent laryngeal
nerves ascend in a groove between the
trachea and esophagus.
Injury to the Recurrent Laryngeal Nerves
Right recurrent laryngeal nerve is intimately
related to the inferior thyroid artery and its
branches. It is more prone to injury during
thyroidectomy.

Hoarseness is the usual sign of unilateral recurrent

nerve injury; however, temporary aphonia or
disturbance of phonation (voice production) and
laryngeal spasm may occur.
Parathyroid glands
The parathyroid glands are two pairs of
small, ovoid, yellowish structures on the
deep surface of the lateral lobes of the
thyroid gland.
They are designated as the superior and
inferior parathyroid glands
Derived from the third (the inferior
parathyroid glands) and fourth (the superior
parathyroid glands) pharyngeal pouches,
these paired structures migrate to their final
adult position and are named accordingly.
Pharynx
The pharynx is attached above to the base
of the skull and is continuous below,
approximately at the level of vertebra CVI,
with the top of the esophagus.
The walls of the pharynx are attached
anteriorly to the margins of the nasal
cavities, oral cavity, and larynx.
Based on these anterior relationships the
pharynx is subdivided into three regions, the
nasopharynx, oropharynx, and
laryngopharynx
Line of attachment of the pharynx
to the base of the skull.
Nasopharynx
The nasopharynx is behind the posterior
apertures (choanae) of the nasal cavities
and above the level of the soft palate.
The most prominent features on each
lateral wall of the nasopharynx are: the
opening of the pharyngotympanic tube.
There is a large collection of lymphoid
tissue (the pharyngeal tonsil) in the
mucosa covering the roof of the
nasopharynx.
Features of the pharynx
Oropharynx
The oropharynx is posterior to the oral
cavity, inferior to the level of the soft
palate, and superior to the upper margin
of the epiglottis.
The palatine tonsils are on the lateral
walls of the oropharynx.
Laryngopharynx
The laryngopharynx extends from the
superior margin of the epiglottis to the
top of the esophagus at the level of
vertebra CVI.
The laryngeal inlet opens into the
anterior wall of the laryngopharynx.
There is a pair of mucosal recesses
(piriform fossae) between the central
part of the larynx and the more lateral
lamina of the thyroid cartilage
 Piriform fossae

The piriform fossae

form channels that
direct solids and
liquids from the oral
cavity around the
raised laryngeal inlet
and into the
esophagus.
Tonsils
Collections of lymphoid tissue in the
mucosa of the pharynx surrounding the
openings of the nasal and oral cavities are
part of the body's defense system.
Waldeyer's tonsillar ring

The ring consists of (from superior

to inferior):
Pharyngeal tonsil (also known as
'adenoids' when infected)
Tubal tonsil (where Eustachian
tube opens in the nasopharynx)
Palatine tonsils (commonly called
"the tonsils" )
Lingual tonsils
Adenoids
Enlargement of
pharyngeal
tonsil , known
then as adenoids,
can occlude the
nasopharynx so
that breathing is
only possible
through the oral
cavity.
Palatine tonsils
The palatine
tonsils are
visible
through the
oral cavity
just posterior
to the
palatoglossal
folds.
Lingual tonsils

The lingual
tonsils are
rounded masses
of lymphatic
tissue that cover
the posterior
region of
the tongue.
Muscles
The muscles of the pharynx are organized
into two groups based on the orientation
of muscle fibers.
1. Constrictor muscles
2. Longitudinal muscles
Constrictor muscles
1. Superior constrictor
2. Middle constrictors
3. Inferior constrictor
Innervation: Vagus nerve [X]
Function: Constriction of pharynx
Longitudinal muscles
The three longitudinal muscles of the
pharyngeal wall are named according to
their origins
1. Stylopharyngeus
2. Salpingopharyngeus
3. Palatopharyngeus
Innervation: All the muscles of pharynx are
innerVated by Vagus except stylopharyngeus
which is by glassopharyngeal(9th CN)
Function:Elevation of the pharynx
LARYNX
The larynx is both a valve (or sphincter)
to close the lower respiratory tract, and
an instrument to produce sound.
It is composed of: nine cartilages
connected by membranes and ligaments
and containing the vocal folds.
Laryngeal cartilages
The laryngeal skeleton consists of nine
cartilages: three are single (thyroid,
cricoid, and epiglottic) and three are
paired (arytenoid, corniculate, and
cuneiform)
Thyroid cartilage
It is formed by a right and a left lamina,
which are widely separated posteriorly, but
converge and join anteriorly.
The most superior point of the site of
fusion between the two broad flat laminae
projects forward as the laryngeal
prominence ('Adam's apple').
The angle between the two laminae is
more acute in men (90) than in women
(120) so the laryngeal prominence is more
apparent in men than women.
Thyroid cartilage
Cricoid cartilage
It is shaped like a
'signet ring' with a
broad lamina of
cricoid cartilage
posterior to the
airway and a much
narrower arch of
cricoid cartilage
circling anteriorly.
Epiglottis
The epiglottis is
a 'leaf-shaped'
cartilage
attached by its
stem to the
posterior aspect
of the thyroid
cartilage at the
angle.
 Arytenoid cartilages
The two arytenoid cartilages are pyramid-shaped
cartilages with three surfaces, a base of arytenoid
cartilage,apex of arytenoid cartilage, medial
surface and anterolateral surface.
Corniculate and Cuneiform
 Intrinsic ligaments
1. Cricothyroid
ligament:
The free margin
between the two points
of attachment is
thickened to form the
vocal ligament, which
is under the vocal fold
(true 'vocal cord') of
the larynx.
Cricothyrotomy
In emergency situations, when the airway is
blocked above the level of the vocal folds, the
median cricothyroid ligament can be
perforated to establish an airway.
Except for small vessels and the occasional
presence of a pyramidal lobe of the thyroid
gland, normally there are few structures
between the median cricothyroid ligament
and skin.
Cricothyrotomy
Quadrangular membrane
Each quadrangular
membrane has a
free upper margin
and a free lower
margin. The free
lower margin is
thickened to form
the vestibular
ligament under
the vestibular
fold (false 'vocal
cord') of the
larynx.
Movements of the crico-arytenoid joints.
Laryngeal cavity
 Intrinsic muscles
1. Cricothyroid: Stretches and tenses vocal
ligament
2. Posterior cricoarytenoid: Abducts vocal folds
3. Lateral cricoarytenoid: Adducts vocal folds
4. Transverse arytenoid: adduct
5. Oblique arytenoid: adduct
6. Thyro-arytenoid: Relaxes vocal ligament
7. Vocalis:Relaxes posterior vocal ligament
Crico-arytenoid, oblique and transverse
arytenoids, and vocalis muscles.
Main Action
Posterior cricoarytenoid
Paralysis of the posterior cricoarytenoid
muscles may lead to asphyxiation as they
are the only laryngeal muscles to open
the true vocal folds, allowing inspiration
and expiration.
Important
The cricothyroid muscles are the only
intrinsic muscles of the larynx innervated
by the superior laryngeal branches of the
vagus nerves [X].
All other intrinsic muscles are innervated
by the recurrent laryngeal branches of the
vagus nerves [X].
Arteries
The major
blood
supply to
the larynx
is by the
1.Superior
2. Inferior
laryngeal
arteries
Veins
Veins draining the larynx accompany the arteries:
 Nerves
Sensory and
motor innervation
of the larynx is by
two branches of
the vagus nerves
[X]-the superior
laryngeal nerves
and the recurrent
laryngeal nerves
Laryngoscopy
Laryngoscopy is
the procedure
used to examine
the interior of the
larynx. The larynx
may be examined
visually by indirect
laryngoscopy using
a laryngeal mirror
Aspiration of Foreign Bodies and the
Heimlich Maneuver
Tracheostomy