The middle pharyngeal constrictor overlaps the superior constrictor above and the inferior constrictor below, forming the mid-section of the pharyngeal tube from the hyoid to the oropharynx. Its origin from the hyoid bone means it is mobilised along with the hyoid during the laryngeal elevation of swallowing, maintaining its functional relationship with the moving larynx.
| Origin | Greater and lesser horns of the hyoid bone and the lower stylohyoid ligament |
|---|---|
| Insertion | Pharyngeal raphe, overlapping the superior constrictor above and the inferior constrictor below |
| Nerve Supply | Pharyngeal plexus (CN IX and X) |
| Blood Supply | Ascending pharyngeal and facial arteries |
| Actions | Narrows the oropharyngeal lumen during swallowing; Propels the food bolus toward the hypopharynx |
|---|
The overlapping arrangement of the three constrictors — like nested cones — allows the pharyngeal tube to contract sequentially from above downward during the pharyngeal swallow, peristaltically propelling the bolus while preventing retrograde escape.
The middle constrictor is commonly involved in dysphagia after radiation therapy for head and neck cancer, where fibrosis reduces pharyngeal compliance and peristaltic strength, producing post-swallow residue in the pyriform sinuses and chronic aspiration risk. Pharyngeal strengthening exercises and Mendelsohn manoeuvre training are used in post-radiation dysphagia rehabilitation.
Not externally palpable. Assessed by videofluoroscopic swallow study showing pharyngeal constriction wave speed and completeness.
Post-radiation middle constrictor stiffness producing impaired pharyngeal peristalsis with bolus residue and aspiration risk, managed with swallowing therapy and pharyngeal dilation for strictures.
