Vincent Van Gogh – Skull with Cigarette (1886)
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Mod. L. middle septum, L, mediastinus, midway
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Nose is divisible into :
External nose
Nasal cavity
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Extends the nasal cavities onto the front of the face
Pyramidal in shape
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External nose has bony & cartilaginous parts.
Bones
Nasal bones
Frontal process of maxilla
Nasal part of frontal bone
Cartilages
Lateral cartilages (paired)
Alar cartilages (paired)
Septal cartilage (single)
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uppermost parts of the respiratory tract
olfactory receptors
separated from:
each other by a midline nasal septum
oral cavity below by the hard palate
cranial cavity above by parts of the frontal, ethmoid, &sphenoid bones.
Posteriorly, each nasal cavity
communicates with the nasopharynx
through two openings choana.
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Each nasal cavity consists of 3 regions.
1) nasal vestibule internal to the naris
2) respiratory region largest , rich neurovascular supply
3) olfactory region @ apex of each nasal cavity, olfactory receptors
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the most anterior part
of the nasal cavity.
Olfaction (sense of smell)
Respiration
Filtration of the dust in the inspired air
Humidification and warming of the inspired air (cooling the internal
carotid artery for brain)
Reception of the secretions from the paranasal sinuses and
nasolacrimal ducts
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2. PARANASAL SINUSES
air filled spaces lying within the bones around the nasal cavity
lined by respiratory mucosa.
open into the nasal cavities
innervated by branches of the trigeminal nerve [V].
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Frontal sinuses
Ethmoid sinuses
Sphenoid sinuses
Maxillary sinuses
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between C3- C6
3. LARYNX
organ of phonation (vocalization)
continuous below with the trachea
above opens into the pharynx
immediately posterior & slightly inferior to the tongue
Cartilage
Muscles
Connective tissue
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Unpaired cartilages
1) Thyroid cartilage (biggest)
2) Cricoid cartilage
3) Epiglottic cartilage
Paired cartilages
1) Arytenoid
2) Corniculate
3) Cuneiform
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largest cartilage of the larynx
2 laminae which fuse anteriorly at the thyroid angle & form
laryngeal prominence (Adam’s apple)
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a ring shaped cartilage, most inferior of the laryngeal cartilages
Inferiorly attaches to 1st tracheal ring via cricotracheal ligament.
Completely encircles the airway
Broad lamina of cricoid cartilage posteriorly
Narrower arch of cricoid cartilage anteriorly
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pyramidal in shape
3 processes
Apex (superior) articulation w/corniculate cartilage
Vocal process (anterior) vocal ligament attaches here
Muscular process (lateral) posterior & lateral crico-arytenoid muscles
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a leaf-shaped cartilage
attached by its stem to the posterior aspect of the thyroid cartilage
@ the angle
Most superior end is free.
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corniculate cartilages two small conical cartilages
Located on the arytenoid cartilages
cuneiform cartilages small cartilages anterior to corniculate cartilages
lie in the posterior part of
the aryepiglottic fold.
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Thyrohyoid membrane
Below superior margin of the thyroid
cartilage, above hyoid bone
lateral thyrohyoid ligament
(posterior thickening), triticeal cartilage
median thyrohyoid ligament
(midline thickening)
Hyo-epiglottic ligament
from the midline of the epiglottis to the
body of hyoid bone
Cricotracheal ligament
between lower border of cricoid
cartilage & upper border of 1st tracheal
cartilage
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lies under the mucosa of the larynx
links together the laryngeal cartilages
completes the architectural framework of the laryngeal cavity
forms some of the ligaments between the cartilages.
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2 parts
1) lower conus elasticus
2) upper quadrangular membrane
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Conus elesticus
cricothyroid ligament, cricovocal membrane, cricothyroid membrane
Free upper margin thickens & forms vocal ligament  vocal fold
opening between the 2 vocal folds
(rima) glottis
median cricothyroid ligament anterior midline thickening of conus elasticus
Conus elasticus
cricothyroid ligament, cricovocal membrane, cricothyroid membrane
Each vocal ligament free upper margin
attaches to anterior part of inner surface of thyroid cartilage
@ thyroid angle
posteriorly attach to vocal processes of the arytenoid cartilages.
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Rima glottis
Inspiration
Widens
Phonation
Narrows- 2 vocal fold come together
Pitch increases with tensing, decreases by relaxation.
Intensity of expiration determines the loudness of sound.
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Quadrangular membrane
vestibular ligament
attached
posteriorly arytenoid cartilage
anteriorly thyroid angle
superior to the attachment of the vocal ligament.
free lower margin is thickened
lateral margin of
epiglottis
anterolateral
surface
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Quadrangular membrane
vestibular ligament
attached
posteriorly arytenoid cartilage
anteriorly thyroid angle
superior to the attachment of the vocal ligament.
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tubular
architectural support
fibro-elastic membrane of the larynx
laryngeal cartilages
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1)
opens into anterior aspect of pharynx
just below and posterior to the tongue
continuous with the lumen of trachea
completely encircled by cricoid cartilage
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2)
oblique and points posterosuperiorly into the pharynx
horizontal in position
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3)
can be closed by downward movement of the epiglottis.
continuously open
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vestibular and vocal folds divide into three major regions
Vestibule
between laryngeal inlet & vestibular folds
Middle part
between vestibular folds & vocal folds
Infraglottic space
between the vocal folds & inferior opening of the larynx
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Rima glottidis
between vocal folds
separates middle chamber from infraglottic cavity.
base
formed by interarytenoid fold @ bottom of interarytenoid notch.
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EXTRINSIC LARYNGEAL MUSCLES
INTRINSIC LARYNGEAL MUSCLES
MOVE THE LARYNX AS A WHOLE
MOVE THE LARYNGEAL COMPONENTS
ALTERING THE LENGTH AND TENSION
OF THE VOCAL FOLDS AND THE SIZE
AND SHAPE OF THE RIMA GLOTTIDIS
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*Superior
.
laryngeal
nerve
Pulls the thyroid angle anteriorly/inferiorly
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pulls the arytenoid cartilages anteriorly, toward the thyroid angle
relaxes the vocal ligaments to lower the pitch of the voice.
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lateral crico-arytenoid muscles
muscular processes
vocal processes
anterior
medial
transverse and oblique arytenoid muscles
Vibration of vocal ligaments
Phonation
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posterior crico-arytenoid muscles
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Respiration
Quiet: laryngeal inlet, rima glottidis open
arytenoid cartilages abducted
Forced: rima glottidis widens
arytenoid cartilages rotated laterally, vocal folds abducted
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Effort closure
occurs when air is retained in the thoracic cavity to stabilize the trunk
increasing intra-abdominal pressure
Rima glottidis is completely closed.
Completely and forcefully shut the airway
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Phonation
arytenoid cartilages & vocal folds adducted
rima glottidis closed
Air is forced through the
closed rima glottidis
Vocal folds vibrate against
each other and produce
sounds.
Tension in the vocal folds
adjusted by
vocalis & cricothyroid muscles
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Swallowing
Rima glottidis closed.
Laryngeal inlet narrowed
Larynx moves up & forward – opens the esophagus
attached to the posterior aspect of the lamina of cricoid cartilage
Epiglottis goes down toward the arytenoid cartilages
laryngeal inlet narrowed or closed
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recurrent (inferior)
laryngeal nerve
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from the inferior end of larynx to the level of T5-T6
Terminates by dividing into right & left main bronchi @ sternal angle.
Main bronchi give branches inside the lungs & form bronchial tree.
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formed of tracheal rings which are incomplete posteriorly
Posterior parts of the tracheal rings closed by
smooth muscle trachealis muscle.
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5. PLEURA
covers the pulmonary cavities and external surfaces of the lungs in these cavities
visceral pleura invests all surfaces of the lungs
parietal pleura lines the pulmonary cavities & thorax’s inner surface
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Visceral pleura insensitive to pain
Parietal pleura extremely sensitive to pain
Irritation causes local pain or referred pain
projecting to the dermatomes supplied by the same spinal nerve.
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potential space between the layers of pleura
contains a capillary layer of serous pleural fluid
lubricates the pleural surfaces
allows layers of pleura slide smoothly over each other during respiration.
lung surface in contact with thoracic wall
lung expands fills with air when thorax expands
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5. LUNGS
organs of respiration
lie on either side of the mediastinum
surrounded by right & left pleural cavities
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5. LUNGS
Air enters and leaves the lungs via main bronchi
branches of trachea
Inspired air into close relation with venous blood
in pulmonary capillaries.
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5. LUNGS
Apex upper pole
3 surfaces costal, mediastinal and diaphragmatic
Root of the lung
2 lobes in the left lung oblique fissure
3 lobes in the right lung horizontal & oblique fissures
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TRACHEOBRONCHIAL TREE
sublaryngeal airway
Trachea @ superior mediastinum TRUNK OF THE TREE
Bifurcation @ sternal angle Main bronchi
Right main bronchus & Left main bronchus enter hilum of the lung
Branches of the tracheobranchial tree
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TRACHEOBRONCHIAL TREE
Main (primary) bronchus
Secondary (lobar) bronchi
2 on the left, 3 on the right
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Tertiary (segmental) bronchi
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BRONCHOPULMONARY SEGMENTS
largest subdivisions of a lobe
o Pyramidal-shaped segments of the lung
apices facing the root of the lung.
o Separated from adjacent segments by connective tissue septa.
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BRONCHOPULMONARY SEGMENTS
largest subdivisions of a lobe
o Segmental bronchus & Tertiary branch of pulmonary artery
o Drained by intersegmental parts of the pulmonary veins
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BRONCHOPULMONARY SEGMENTS
largest subdivisions of a lobe
o Named according to the segmental bronchi supplying them.
o Usually 18-20 in number
o Surgically resectable.
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tertiary segmental bronchi
conducting (lobular) bronchioles
end as terminal bronchioles
respiratory bronchioles
pulmonary alveolus
basic structural unit of gas exchange in the lung
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Branching of the bronchial tree
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Trachea
Principal bronchus
Lobar bronchi (secondary bronchi)
Segmental bronchi (tertiary bronchi)
Terminal bronchiol
Respiratory bronchiol
Alveolar duct
Alveolar sac
Alveolus
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root of the lung
mediastinal pleura reflects off mediastinum
a sleeve-like covering for
airway, vessels, nerves, lymphatics which pass between the lung and mediastinum
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hilum of lung
The root of the lung joins medial surface of the lung here!
mediastinal pleura continuous with visceral pleura @ hilum of the lung.
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VASCULATURE OF PLEAURA & LUNGS
1 LUNG
1 pulmonary artery (venous blood)
2 pulmonary veins (arterial blood)
Each lobe and segment its own artery
Branching of the arteries follow the bronchial tree
Terminate as capillaries around the alveols.
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VASCULATURE OF PLEAURA & LUNGS
Veins of the parietal pleura drain into systemic veins
mainly through the intercostal veins.
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BRONCHIAL ARTERIES
follow bronchial tree as far as respiratory bronchioles.
Left bronchial arteries
from thoracic aorta
paired
Right bronchial artery
usually arises from 3rd posterior intercostal artery
single artery.
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BRONCHIAL VEINS
Right bronchial vein into azygos vein
Left bronchial vein into accessory hemiazygos vein.
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pulmonary plexuses
parasympathetic innervation vagus nerve
bronchoconstrictor, vasodilator to the lung vessels, secretomotor to the glands
sympathetic sympathetic trunk
bronchodilator, vasoconstrictor to the lung vessels, inhibitor to glands
parietal pleura intercostal & phrenic nerves
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