Applied Anatomy

Post nasal space tumors

  • Occur in nasopharynx

  • Among commonest head and neck tumors

  • Usually start from the pharyngeal recess

  • Block choane and present with breathing difficulty

  • Compress the lower cranial nerves

  • Present with difficulty in swallowing (dysphagia) and dysphonia


  • These are enlarged pharyngeal tonsils

  • Common in children

  • Obstruct choane

  • Impair nasal breathing

  • Block eustachean tube and cause giddiness


  • Inflammation of the palatine tonsils

  • A common ENT problem

  • Pain often referred to the ear because of common innervation by glossopharyngeal nerve

  • Present with pain and difficulty in swallowing

  • Causes inflammation of submandibular and especially jugulo-digastric (tonsillar) nodes

Killihans Dehiscence

  • A weak part between the thyropharyngeus and the cricopharyngeus (considered by others to exist between the inferior constrictor and esophagus).

  • Pharyngeal mucosa can herniate through this part and enlarge to form a pharyngeal diverticulum
  • The pouches or diverticulae are impotant clinically because:

               (+) Food particles can lodge here
               (+) Gastroscope can enter and perforate.

Piriform Recess

  • A recess in the lateral aspect of laryngo-pharynx

  • Foreign bodies e.g. fish bones, pea nuts can lodge there.

  • Favourite hiding place for tumours.

  • Internal laryngeal nerve in the wall can be injured.

Cancer of the tongue

  • Commonly spreads via lymphatics and hence the importance of studying the pattern of lymphatic drainage


  • The mucosa is tightly adherent to bone therefore 'pimples' are very painful

  • A site of congenital malformations - cleft palate

Swallowing problems

  • These can arise from

    a) Local problems in the food passages - pharynx and esophagus

    b) Adjacent areas/ structures e.g. enlarged thyroid, retropharyngeal abscess and tumors

    c) Damage to cranial nerves: 9,10, 12

    d) Brain stem lesions

Anatomical spaces delineated by fascial planes represent potential vertical highways for spread of pathological processes

Pharyngeal mucosal space

  • Located superficially along pharyngeal mucosal walls
  • Includes mucosa of pharynx, waldeyers ring, cartilaginous Eustachian tube. Pharyngobasilar fascia, levator and constrictor muscles
  • Represents superficial layer in which tumors often develop before they spread to deeper structures

Parapharyngeal space

  • Extends from skull base to hyoid bone
  • Contains fat, branches of trigeminal nerves and pterygoid veins
  • Tumors in this space spread very rapidly

Carotid space

  • Major vertical highway
  • Extends from skull base to aortic arch
  • Contains carotid arteries, internal jugular vein, cranial nerves 9-11 and deep cervical nodes
  • Encasement of carotid arteries may tender tumors inoperable

Retropharyngeal space

  • Potential midline space
  • Extends from skull base to T3


Nasopharyngeal carcinoma

  • Arises from the fossa of Rossen Mueller
  • Presents with unilateral otitis media or mastoiditis
  • Spreads along spinal accessory chain of nodes in posterior triangle of neck




Anatomical basis

A lump in the neck

Lymph node involvement
Direct spread

Hearing Loss or ringing sounds in the ear

Blocked auditory tubes

Fluid collection in the ear

Blocked auditory tube

Blocked stuffy nose

Choanal obstruction

Blood stained nasal discharge

Discharge from tumor in nasopharynx

Numbness in face

Cranial nerve compression

Difficulty in swallowing

Compression of palate, oropharyx

Change in voice e.g. hoarseness

Compression of vagus nerve

Double vision

Compression of cranial nerve 3,4,6



The Oral cavity and Pharynx