Internal Muscles of the Pharynx

• The internal, chiefly longitudinal muscular layer, consists of 3 muscles: stylopharyngeus, palatopharyngeus, and salpingopharyngeus.
• They all elevate the larynx and pharynx during swallowing and speaking.

The Stylopharyngeus Muscle

• This is a long, thin, conical muscles that descends inferiorly between the external and internal carotid arteries.
• It enters the wall of the pharynx between the superior and middle constrictor muscles.

• Origin: styloid process of temporal bone.
• Insertion: posterior and superior borders of thyroid cartilage with palatopharyngeus muscle.
• Innervation: glossopharyngeal nerve (CN IX).

• It elevates the pharynx and larynx and expands the sides of the pharynx, thereby aiding in pulling the pharyngeal wall over a bolus of food.

The Palatopharyngeus Muscle

• This is a thin muscle and the overlying mucosa form the palatopharyngeal arch.

The Salpingopharyngeus Muscle

• This is a slender muscle that descends in the lateral wall of the pharynx.
• The over lying mucous membrane forms the salpingopharyngeal fold.

• Origin: cartilaginous part of the auditory tube.
• Insertion: blends with palatopharyngeus muscle.
• Innervation: through the pharyngeal plexus.

• It elevates the pharynx and larynx and opens the pharyngeal orifice of the auditory tube during swallowing.

The Tongue

• The tongue (L. lingua; G. glossa) is a highly mobile muscular organ that can vary greatly in shape.
• It consists of three parts, a root, body, and tip.

• The tongue is concerned with mastication, taste, deglutition (swallowing), articulation (speech), and oral cleansing.
• Its main functions are squeezing food into the pharynx when swallowing, and forming words during speech.

Gross Features of the Tongue

• The dorsum of the tongue is divided by a V-shaped sulcus terminalis into anterior oral (presulcal) and posterior pharyngeal (postsulcal) parts.
• The apex of the V is posterior and the two limbs diverge anteriorly.
• The oral part forms about 2/3 of the tongue and the pharyngeal part forms about 1/3.

Oral Part of the Tongue

• This part is freely movable, but it is loosely attached to the floor of the mouth by the lingual frenulum.

• On each side of the frenulum is a deep lingual vein, visible as a blue line.
• It begins at the tip of the tongue and runs posteriorly.
• All the veins on one side of the tongue unite at the posterior border of the hyoglossus muscle to form the lingual vein, which joins the facial vein or the internal jugular vein.

• On the dorsum of the oral part of the tongue is a median groove.
• This groove represents the site of fusion of the distal tongue buds during embryonic development.

The Lingual Papillae and Taste Buds

• The filiform papillae (L. filum, thread) are numerous, rough, and thread-like.
• They are arranged in rows parallel to the sulcus terminalis.

• The fungiform papillae are small and mushroom-shaped.
• They usually appear are pink or red spots.

• The vallate (circumvallate) papillae are surrounded by a deep, circular trench (trough), the walls of which are studded with taste buds.

• The foliate papillae are small lateral folds of lingual mucosa that are poorly formed in humans.

• The vallate, foliate and most of the fungiform papillae contain taste receptors, which are located in the taste buds.

The Pharyngeal Part of the Tongue

• This part lies posterior to the sulcus terminalis and palatoglossal arches.
• Its mucous membrane has no papillae.

• The underlying nodules of lymphoid tissue give this part of the tongue a cobblestone appearance.
• The lymphoid nodules (lingual follicles) are collectively known as the lingual tonsil.

Structure of the Nasal Septum

• This part bony, part cartilaginous septum divides the chamber of the nose into two narrow nasal cavities.
• The bony part of the septum is usually located in the median plane until age 7; thereafter, it often deviates to one side, usually the right.

• The nasal septum has three main components: (1) the perpendicular plate of the ethmoid bone; (2) the vomer, and (3) the septal cartilage.

• The perpendicular plate, which forms the superior part of the septum, is very thin and descends from the cribiform plate of the ethmoid bone.
• The vomer, which forms the posteroinferior part of the septum, is a thin, flat bone. It articulates with the sphenoid, maxilla and palatine bones.

The Cheeks

• The cheeks (L. buccae) form the lateral wall of the vestibule of the oral cavity.
• They have essentially the same structure as the lips with which they are continuous.

• The principal muscular component of the cheeks is the buccinator muscle.
• Superficial to the fascia covering this muscle is the buccal fatpad that gives cheeks their rounded contour, especially in infants.

• The lips and cheeks act as a functional unit (e.g. during sucking, blowing, eating, etc.).
• They act as an oral sphincter in pushing food from the vestibule to the oral cavity proper.
• The tongue and buccinator muscle keep the food between the molar teeth during chewing.

Sensory Nerves of the Cheeks

• These are branches of the maxillary and mandibular nerves.
• They supply the skin of the cheeks and the mucous membrane lining the cheeks.

Blood Supply to the Head and Neck

• Most arteries in the anterior cervical triangle arise from the common carotid artery or one of the branches of the external carotid artery.
• Most veins in the anterior cervical triangle are tributaries of the large internal jugular vein.

The Common Carotid Arteries

• The right common carotid artery begins at the bifurcation of the brachiocephalic trunk, posterior to the right sternoclavicular joint.
• The left common carotid artery begins arises from the arch of the aorta and ascends into the neck, posterior to the left sternoclavicular joint.

• Each common carotid artery ascends into the neck within the carotid sheath to the level of the superior border of the thyroid cartilage.
• Here it terminates by dividing into the internal and external carotid arteries. 

The Internal Carotid Artery

• This is the direct continuation of the common carotid artery and it has no branches in the neck.
• It supplies structures inside the skull.
• The internal carotid arteries are two of the four main arteries that supply blood to the brain.

• Each artery arises from the common carotid at the level of the superior border of the thyroid cartilage.
• It then passes superiorly, almost in a vertical plane, to enter the carotid canal in the petrous part of the temporal bone.

• A plexus of sympathetic fibres accompany it.

• During its course through the neck, the internal carotid artery lies on the longus capitis muscle and the sympathetic trunk.
• The vagus nerve (CN X) lies posterolateral to it.

• The internal carotid artery enters the middle cranial fossa beside the dorsum sellae of the sphenoid bone.
• Within the cranial cavity, the internal carotid artery and its branches supply the hypophysis cerebri (pituitary gland), the orbit, and most of the supratentorial part of the brain. 

The External Carotid Arteries 

• This vessel begins at the bifurcation of the common carotid, at the level of the superior border of the thyroid cartilage.
• It supplies structures external to the skull.

• The external carotid artery runs posterosuperiorly to the region between the neck of the mandible and the lobule of the auricle.
• It terminates by dividing into two branches, the maxillary and superficial temporal arteries.
• The stems of most of the six branches of the external carotid artery are in the carotid triangle. 

The Superior Thyroid Artery

• This is the most inferior of the 3 anterior branches of the external carotid.
• It arises close to the origin of the vessel, just inferior to the greater horn of the hyoid.
• The superior thyroid artery runs anteroinferiorly, deep to the infrahyoid muscles and gives off the superior laryngeal artery. This artery pierces the thyrohyoid membrane in company with the internal laryngeal nerve and supplies the larynx.

The Lingual Artery

• This arises from the external carotid artery as it lies on the middle constrictor muscle of the pharynx.
• It arches superoanteriorly, about 5 mm superior to the tip of the greater horn of the hyoid bone, and then passes deep to the hypoglossal nerve, the stylohyoid muscle, and the posterior belly of digastric muscle.

• It disappears deep to the hyoglossus muscle.
• At the anterior border of this muscle, it turns superiorly and ends by becoming the deep lingual artery.

The Facial Artery

• This arises from the carotid artery either, in common with the lingual artery, or immediately superior to it.
• In the neck the facial artery gives off its important tonsillar branch and branches to the palate and submandibular gland.
• The facial artery then passes superiorly under the cover of the digastric and stylohyoid muscles and the angle of the mandible.

• It loops anteriorly and enters a deep groove in the submandibular gland.

• The facial artery hooks around the inferior border of the mandible and enters the face. Here the pulsation of this artery can be felt (anterior to the masseter muscle).

The Ascending Pharyngeal Artery

• This is the 1^st or 2^nd branch of the external carotid artery.
• This small vessel ascends on the pharynx, deep to the internal carotid artery.
• It sends branches to the pharynx, prevertebral muscles, middle ear and meninges.

The Occipital Artery

• This arises from the posterior surface of the external carotid near the level of the facial artery.
• It passes posteriorly along the inferior border of the posterior belly of digastric.
• It ends in the posterior part of the scalp.
• During its course, it is superficial to the internal carotid artery and three cranial nerves (CN IX, CN X and CN XI).

The Posterior Auricular Artery

• This is a small posterior branch of the external carotid artery.
• It arises from it at the superior border of the posterior belly of the digastric muscle.
• It ascends posteriorly to the external acoustic meatus and supplies adjacent muscles, the parotid gland, the facial nerve, structures in the temporal bone, the auricle, and the scalp. 

The Internal Jugular Vein

• This is usually the largest vein in the neck.
• The internal jugular vein drains blood from the brain and superficial parts of the face and neck.
• Its course corresponds to a line drawn from a point immediately inferior to the external acoustic meatus to the medial end of the clavicle.

• This large vein commences at the jugular foramen in the posterior cranial fossa, as the direct continuation of the sigmoid sinus.

• The dilation at its origin is called the superior bulb of the internal jugular vein.
• From here it runs inferiorly through the neck in the carotid sheath.

• The internal jugular vein leaves the anterior triangle of the neck by passing deep to the SCM muscle.
• Posterior to the sternal end of the clavicle, it unites with the subclavian vein to form the brachiocephalic vein.
• Near its termination is the inferior bulb of the jugular vein contains a bicuspid valve similar to that of the subclavian vein.

• The deep cervical lymph nodes lie along the course of the internal jugular vein, mostly lateral and posterior.

Tributaries of the Internal Jugular Vein

• This large vein is joined at its origin by the: inferior petrosal sinus, the facial, lingual, pharyngeal, superior and middle thyroid veins, and often the occipital vein.

The Salivary Glands

• There are three large, paired salivary glands: the parotid, submandibular, and sublingual glands.
• In addition to the main salivary glands, there are numerous small accessory salivary glands scattered over the palate, lips, cheeks, tonsils, and tongue.