Upper Airway and Digestive Tract Anatomy and Physiology

Lierature Reading
Upper Airway and Digestive Tract

Anatomy and Physiology
dr R. Isma Nurul A’Ini
Supervisor : dr. Bambang Purwanto, Sp.THT-

KL(K),.MM
DEPT. OF OTORHINOLARYNGOLOGY HEAD & NECK SURGERY
HASAN SADIKIN HOSPITAL

2017
INTRODUCTION
Upper Digestive Tract:

- Oral Cavity
- Pharynx
- Larynx
- Esophagus
2
Witmer LM. Clinical anatomy and histology of the upper gastrointestinal system. 2003.
ANATOMY
3
The Oral Cavity
4
The Pharynx
5
The Larynx
Esophagus
 Neuromuscular tube :
• laryngopharyng-cardiac
esophageal
• 25-30 cm
• Diameter  rest : 20 mm
Baby : 18 cm
1 yo : 20 cm
3 yo : 22 cm
6 yo : 25 cm
10 yo : 27 cm
14 yo : 34 cm
Adulth : 40 cm
Segment at Esophagus
Natural Constriction
Natural constriction :
- Cricopharyngeus
- Aorta & left bronchus
anteriorly cross
- LES
HISTOLOGY OF ESOPHAGUS
11
The Esophageal Mucosal Layer
*  Mucosa –
Stratified squamous
 Submucosa –
Blood vessels, Lymphatics,
myenteric plexus of Meissner
(parasympathetic ganglion
cells)
* *
12
Innervation :
N.vagus ( Parasympatic )
Thoracal and Cervical (sympatic)
Myenteric plexus of Auerbach,

responsible for peristaltic
Meissner's plexus 
•controls glandular secretions
•alters electrolyte and water transport
•regulates local blood flow
13
PHYSIOLOGY
14
Valve for Deglutition
1. Lips
2. Tongue
3. Velum to back of tongue (the glossopalatal valve)
4. Velopharynx
5. Larynx
6. Upper esophageal (cricopharyngeal) sphincter
15
Goyal R, Sivarao D. Functional anatomy and physiology of swallowing and esophageal motility. In: Castell D, Richter J, (eds) The esophagus,
Philadelphia: Lippincott Williams & Wilkins, 1999; 1–32.
Diamant N. Neuromuscular mechanisms of primary peristalsis. Am J Med 1997; 103:40S–43S.
DEGLUTITION
Three stages of deglutition :

1. The oral (voluntary) stage
2. The pharyngeal (involuntary) stage
3. The esophageal (involuntary) stage
 Regulated through the swallowing centre in the medulla
16
INNERVATION
Sensory information to the swallowing center is

carried along N. V, VII, IX, X
The motor respons from the swallowing center

are carried along N. V, VII, IX, X & XII and
also the ansa cervicalis (C-1 and C-2)
17
N. IX, X & XI
Nucleus
ambigus
Nucleus &
trac.solitarius
N. XII
SIX VALVES
21
The Oral Stage
Essential process :
Mechanical disruption of the food
Mixing with salivary bicarbonate & enzymes
Bolus is voluntary moved posteriorly
Pharynx
22
The Oral Stage
Once the food has been delivered to the

pharynx, the process become involuntary
The oral stage requires proper functioning of the

striated muscles of the tongue and pharynx
23
The Pharyngeal Stage
The food is passed from the pharynx
The Upper Esophageal Sphincter
The Proximal Esophagus
 Contraction & Relaxation
24
The Pharyngeal Stage
Food in the pharynx stimulates sensory receptors,
which send impulses to the swalowing center.
The CNS then initiates a series of involuntary
responses :
1. The soft palate is pulled upward and closes the
posterior nares
2. The palatopharyngeal folds are pulled
medially, limiting the opening through the
pharynx
25
3. The vocal folds are closed and the epiglottis
swings backward and down to close the
larynx
26
3. The larynx is pulled upward and forward by
the muscles atached to the hyoid bone ,
stretching the opening of the esophagus and
UES
27
4. The UES relaxes. Active
relaxation of the usually
tonic cricopharyngeus is
essential to permit the
passive opening of the UES
created by the movement of
the larynx
28
5. Peristaltic contraction of
the constrictor muscles
of the pharynx produces
the force that propels
food into the esophagus
29
The Esophageal Stage
Requires contraction of both the longitudinal and circular

muscular coats of the esophagus and relaxation of the
sphincters
Peristaltic wave
(Peristaltic clearing wave)
30
31
Circular muscle contraction  3 patterns
1. Primary peristalsis
- usual form of circular muscle
- requires 8-10 seconds to reach distal
esophagus
- The LES relaxes at the onset of the
swallow & remains relaxed untill it
contracts as a continuation of the
progressive peristaltic wave
32
2. Secondary peristalsis
- represent a peristaltic contraction of
the circular esophageal muscle without
central stimulation
- as a result of esophageal distention,
continuous until the esophagus is empty
- the mechanism for clearing ingested
and material refluxed from the stomach
33
3. Tertiary contractions
- identified during barium x-ray
- A nonperistaltic series of contractile waves that
appear as localized segmented indentations in the
barium column
- Has no known physiologic function
34
Importance of the Sphincters
Upper Esophageal Sphincters

- Maintains a constant clossure
- Normal pressure :
100 mmHg anteroposterior
50 mmHg laterally
35
Lower Esophageal Sphincter :
Pressure : 10-45 mmHg > intragastric
pressure
36
Two functions of the LES :
- Prevention of the
gastroesophageal reflux
- Its ability to relax to allow
movement of ingested
material to the stomach
Normal subjects : reflux occur during TLESRs (Transient

Lower Esophageal Sphincter Relaxation)
37
Effects of bolus characteristics on the
oropharyngeal swallow
Various types of boluses : volumes and viscosities.
On swallow of small vol. (1 – 5 ml) : the oral stage

proceeds first, followed by the pharyngeal stage.
Larger volume (10 – 20 ml) : the oral and

pharyngeal stage occur essentially
simultaneously.
38
Effects of posture
Changing head position changes pharyngeal

dimensions and the direction of food flow.
When the patient is lying down, any residual food

simply adheres to the pharyngeal after the swallow
when the patient return to breathing.
Postural changes are often used as compensatory

strategies in the management of swallowing
disorders.
39
SUMMARY
40
Thank You
41

Upper Airway and Digestive Tract Anatomy and Physiology

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Lierature Reading

Upper Airway and Digestive Tract

Supervisor : dr. Bambang Purwanto, Sp.THT-

HASAN SADIKIN HOSPITAL

Upper Digestive Tract:

Myenteric plexus of Auerbach,

Three stages of deglutition :

 Regulated through the swallowing centre in the medulla

Sensory information to the swallowing center is

The motor respons from the swallowing center

Bolus is voluntary moved posteriorly

Once the food has been delivered to the

The oral stage requires proper functioning of the

The food is passed from the pharynx

The Upper Esophageal Sphincter

The Proximal Esophagus

 Contraction & Relaxation

Requires contraction of both the longitudinal and circular

Upper Esophageal Sphincters

Normal subjects : reflux occur during TLESRs (Transient

On swallow of small vol. (1 – 5 ml) : the oral stage

Larger volume (10 – 20 ml) : the oral and

Changing head position changes pharyngeal

When the patient is lying down, any residual food

Postural changes are often used as compensatory

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