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 APPLIED ANATOMY

3. Muscle tissue:
comprises a numerous
VIJAYAM'S

Pharynx has three

divisions:
* This layersmuscles,
contractile
involunlan
these muscles play vita|
in mechanismoffdeglutination (swallowing).
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2. Oropharynx,
Thelower constrictor muscles,
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opens only by
3. Laryngopharynx. Swallowing. uring
Parts of pharynx: Muscles of Pharynx:
1. The nasopharynx: located on the pharynx are:
portion of the pharynx soft The muscles of Constrictor: It is
The nasal
posterior part of the nose at the level of the quadrangular, thin and
a. Superiorfibers run upwards andl backwards
palate. nasopharynx, there are
pale. The and wallt
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2. mouth passing border
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to superior part ofthe musc
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body of the 3rd cervical
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3. The laryngopharynx: The laryngeal part of c. Inferior Constrictor: It is the thickest of the thre
oropharynx above and
pharynx extends from the the larynx constrictors and consists of a thyropharyngeal n
continues as the oesophagus below, with and a cricopharyngeal part. The fibers run backwar
lying anteriorly. to insert into the median fibrous raphe.

Layers of the pharynx: Pharyngeal / Blood, Nerve Supply, Lymp

Pharynx contains three layers of tissue: Drainage:
1. Mucous membrane lining: Arterial Supply: The ascending pharyngeal artery, lingu
artery, facial artery and maxillary artery are responsit
The nasopharynx is lined by the ciliated columnar to supply the arterial blood to the pharyngeal area.
epithelium. Venous drainage: Venous pharyngeal plexus
The oropharynx and laryngopharynx are covered responsible to drain the venous blood into the inte
with stratifiedsquamous epithelium, which is jugular vein.
connected to the esophagus lining. Lymphatic Drainage: It occurs by retropharyngeal a
2. Fibrous tissue: This is an intermediate layer. It is the deep cervical nodes.
thickest portion in the nasopharynx.
Nerve Supply: Pharynx is supplied by pharyngeal ple=
of nerves formed by motor fibers of cranial access
Entrance to
Paranasal the Eustachian nerve and branches from sympathetic chain.
Sinuses
tube
Application and Nursing care
the
Nasal cavity Nurses deal with the patients with some of
Nasopharynx disease conditions associated with Pharynx.
Soft Palate
disease
Hard Palate Pharyngitis: It is the inflammatory
readness anc
condition, causes the swelling,
Oropharynx Oral cavity white patches in the throat.
bacteria
Tongue Tonsillopharyngitis isa viral or pain anC
-Epiglottis infection, which causes the throat
ngopharynx difficult swallowing. result a
Larynx
Throat with the
diphtheria,paralyses
Occur
Esophagus Trachea rabies, and polio. physiolog
Note: Nurses study the anatomy andrespirato
Fig. 2.4:Structure of the pharynx of pharynx before conduct of patients
assessment and providing caretothe
2.6
 Iinit-2 :The Respiratory System VIJAYAM'S
2.1.3. LARYNX

.The larynx 1s alsO called the*Voice box" that connects the

laryngopharynx and trachea.
* Itis situated in the anterior side of the neck andextends from the
tn the lower border of the cricoid upper border of epiglottis, at the laryngeal inlet,
cartilage, at the level of C, vertebra.
It opens into the laryngeal portion of the
pharynx.
With the onset of puberty, the size of the larvnx increases, which indicates the
of the Adam's apple". deeper and more prominent voice

Epiglotis
Hyoid bone
Epiglottist
Thyrohyoid False vocal cord
membrane
Thyrohyoid
-Laryngeal Prominence cartilage Thyroid
(Adam's apple) True vocalcord cartilage

Thyroid cartilage Arytenoid

cartilages
-Cricoid
Cricoid cartilage cartilage
Tracheal
Tracheal cartilages cartilages

Anterior View Side View Posterior View

Fig. 2.5: Structure of the larynx

Relations:
Anteriorly:The muscles attached to the hyoid bone and the muscles of the neck.
Posteriorly:The laryngopharynx and 3rd to 6th cervical verte brae.
Superiorly: The hyoid bone and the root of the tongue.
Inferiorly: It is continuous with the trachea.
Laterally:The lobes of the thyroid gland.
Cartilages:
The larynx is composed ofseveral irregularly shaped cartilage, which is held together by ligaments and membranes.
The primary cartilages are:
1thyroid cartilage, 2. Icricoid cartilage,
3. 2arytenoid cartilages, 4. 1epiglottis.
. Thyroid cartilage:This cartilage is also called hyaline cartilage, which is lined with non-keratinized stratified
Squamous epithelium. It attached with hyoid bone, which is ashield shaped structure and protruded in front of
Deck called Adam'a apple, which is more prominent in males. This cartilage is articulated with ring like cricotd
cartilage.
2.7
 APPLIED ANATOMY
VIJAYAM'S LARYNX -POSTERIOR VIEW
LARYNX- ANTERIORVIEW
Epiglottic cartilage
Hyoid bone
Epiglottic cartilage

Corniculate cartilage

Thyroid cartilage Arytenoid cartilage

Cricoid cartilage

Trachea
-Trachea

posterior view
Fig. 2.6 :Structure of larynx anteriorand

below the thyroid cartilage. It is also composed with

2. Cricoid cartilage: It is the second largest cartilage. It lies with narrow part anteriorly and
hyaline cartilage. t has signet ring shape and completely encircle the larynx
tracheal ring is present , there is the
broad part posteriorly. Neighbouring to the cricoid cartilage and the first
membrane called cricothyroid membrane. This site is used for emergency airway access.
cord
3. Arytenoid Cartilage: It is a pair of small pyramidal cartilage which join with the cricoid cartilage. The vocal
and several muscles are attached to them, the movement in the muscles produces tension and relaxation in the
vocal cords and there by which produces the variety of sound pitches.
4. Epiglottis: It is an elastic cartilaginous lid-like structure situated at the root of thetongue. Posteriorly at the end of
this cartilage folds close to the glottis to prevent the food particles enter into the larynx during the act of swallowing,
coughing, or sneezing, thereby which prevents the aspiration. This moment is controlled by Autonomic Nervous
System.
Glottis: It is the opening between the vocal cords in the upper part of the larynx and the sound generator of the
larynx; it is protected by the epiglottis.

Interior of the larynx:

Vestibular folds:
* These are the pair ridges of the folds. The mucous membrane is lined all over the
laryngeal cavity. These folds
begin from the angle of the thyroid cartilage to the arytenoid cartilage. There is an enclosed space called
pseudoglottis, which protects the vocal folds from inhaling food material.
These folds are useful for the closure of the glottisduring swallowing or cough or sneeze. They
are also caod
false vocal cords.
Vocal folds:
These are the sharp edges of a pair of ridges of the mucous membrane which is lined over the
Vocal folds begins from the angle of the thyroid cartilage to the vocal process of the
vocal ligament.
arytenoid cartilage.
Skeletal muscles are attached to the dipper cartilage called arytenoid and produce on tension, or
edges of these tissues. They vibrate in the discharged air stream to produce various tomsTheir
controlled by the somatic nervous system , especially the voice center. This is also called'a: true
relamovement
xation at theis
v0cal cord.
2,8
 Unit-2 :: The Respiratory System VIJAYAM'S

BACK

Arytenoid cartilage

RIGHT LEFT
True vocal folds
False vocal folds
Epiglottis

FRONT
Fig. 2.7:Vocal folds Right- left and front- back
MUSCLES OF LARYNX
a. Intrinsic Muscles: They are involved in the movements of the vocal cords and hence, associated with the
production of voice. They are:
Cricothyroid Thyroarytenoideus or thyroarytenoid
Vocalis * Posterior cricoarytenoid the only abductor of vocal cords
* Lateral cricoarytenoid Transverse arytenoid
* Oblique arytenoid Aryepiglotticus
Thyroepiglotticus.
b. Extrinsic Muscles:The extrinsic muscles include the digastric, the stylohyoid, the mylohyoid and the geniohyoid
muscles.

Blood, Nerve Supply, Lymph Drainage:

Arterial blood supply:
Superior thyroid artery is responsible to supply the blood to the laryngeal glands, muscles, and mucous membrane.
Inferior laryngeal artery is responsible to supply the blood to the larynx, which nornmally originates from thyrocervical
trunk.
Venous supply:
Superior laryngeal vein empties into the superior thyroid veins, which then drain into the internal jugular vein.
* Inferior laryngeal vein empties into the left brachiocephalic vein, through the inferior thyroid veins.
Lymphatic Drainage: The lymphatics into superior thyroid vessels, prelaryngeal and pretracheal nodes.
Nerve Supply: The mucosa above the vocal cords is supplied by the interlaryngeal nerve; below the vocal cords by
recurrent laryngeal nerve.
Application and Nursing care
Nurses provide care tothe patients with some of the following laryngeal disease conditions;
Laryngitis: It occurs due to the inflammation to vocal cards. It is caused by excessive use of the voice,
infections, inhaled irritants etc.
Vocal nodules: These nodules are the noncancerous nodules, usually occur on the vocal cords. These
nodules are caused when the vocal is abused, especially in case of professional singers as they do frequent
modulation in their voice. These Vocal nodules cause the voice hoarse, low, and breathy.
Vocal polyp: Vocal polyp is the noncancerous growth occur on vocal cord. These polyps cause the cause
the voice hoarse, low, and breathy
Note: Nurses studypthe anatomy and physiology of larynx before the conduct of respiratory assessment and
providing care to:the patients

2.9
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BRONCHIOLES
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tSMALLER
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ng by
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The case normal respiratory Note: (thepertussis,
Pneumothorax: Pertussis Influenza serious
illness.
Acute Bronchiectasis:
this Lung
Tuberculosis: mucouS.Pleurisy:breath. theof Pneumonia: Unit-2
MusclesunderstandingThe MUSCLES PleuralAcute
Asthma:
bronchitis:
Chronic It Chronic
Emphysema: the
external are Muscles pleural condition, breathing Application
by of Nurses ::
breathing occurs respiratory cancer: bronchitis: The
called neck,
difficult causing (flu): effusion:
assessment space)(whooping In The obstructive
intercostal function
Expiration.
function in shoulder
function ofrespiration,
activityisduring this Respiratory
inspiratory with OF study It An patient Cancer In airway An difficulty In
muscle mainly persistent this condition,
The infection this and
breathing abnormally. is infection
distress More It
RESPIRATION
the the the
in complains
condition, may aiways is of condition Nursing
muscle, in and voluntary
partlyandresult and
anatomycollectioncough): amount anthe is and
pulmonary System
Inspiration. of intercostal the
Inspiration: abdominal
muscles. providing affect the infection lungs that shortness
muscles. respiration of
cough. syndrome by
these (bronchi)pleura inflammation
inflames
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are sacs
of
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muscles muscles care lungs of
Inspiratory
is physiology
air more
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the th e ofthe
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These divided activity. to contagious are lungs t
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and the part causesthe lungs associated
(COPD): deal
are chest: viruses effected which sacs
2.17 patients. fever, and
of It
of
inflamed, arecollected with
is the largecauses in are
a. bronchi, it causes weight infected. one In the
occursinfection a and lung. damaged, disease
* * Diaphragm: severe airwaysin (or) this
the levelthe Segments it which patients
isthe nerve, sternum
When The fibres Itroofseparates byprojects
the It The iscontract
diaphragm.
inspiration The During loss, is the the condition
pulled consists bronchioles, when fever, both
thoracic forming caused pleural
shortness
diaphragm radiate of diaphragm major of sudden causes (bronchi). lungs. whichconditions:
the the body and with
vertebrae,
thoracic
of9h which and in inspiration, to
downward
diaphragm 3, abdominal of the
ai r
night
productive
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and
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be floor
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length. is
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thoracic a cough which breath are
of
to the
into innervated attached cavity. dome-shaped
contracts, of the
the
the
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tendon actively before breathing
the area and
the originate abdominalandcavity.
thoracic
muscles coughing. lungs with causes
following
to thoracic wheezing.
abdominal the from the around
lung
th e large
the by
which by structure, functionvolume. caused
the difficulty. which
central from the lowerwhich cavity of conduct Bordetella amount shortness VIJAYAM'S
lungs,
increasescavity cervical respiration causes
phrenic ribs cavities by
tendon muscle and which during of a of
and the
at
 APPLIED ANATOMY

Accessory muscles:
VIJAYAM'S the diaphragmandi external intercostthea
75% of air
C
Augmenting inhalation. including
responsible for reduces the muscles to aid
diaphragm is process sternocleidomastoid, scalene, serratus
Ihe lungs.This increases in
movementintothe cavityand anterior, pectoralis minor, pectoralis major,
thoracic
pressure in the cavities. and upper trapezius.
the abdominal and pelvic
externalintercostal muscle: 11 pairs sternocleidomastoid muscles helpin raisingtthe
b. The Intercostal muscles arethe ribs.
muscles:
sternum,
The and the scalene muscles raise the upper
Intercostal in-between the 12 pairs of
increase the anteroposterior diameter
that are located into twolayers, named as the few ribs to anterior, pectorali
divided internal serratus
They are intercostal muscles and the Muscles, such as the
muscle assistt in inspiration
intercostal
external
intercostal muscles.
The External major and minor towards the a
raising the ribsor pulling the ribs
involved in inspiration. and
muscles are actively ribs action when the upper limb is
These muscles originate from the superior pass by reverse
muscle
* fibers
are inserted into the inferior ribs. The fixed in position. difficulty in
to lift the ribs when When the asthma sufferers have work.
forward and down, helping will
inhaling fromlto 12 ofthe
breathing, the accessary muscles
are innervated by nerves come into action when
Thev * The accessory muscles asthma
thoracic segment
the vertebrae and
respiration becomes difficultin case of
The ribs are connected to Expiration: These muscle
this muscle, 2. The Muscles function in
sternum and when they are raised by diameter muscle are,
both the anteroposterior (AP) and lateral are called expiratory muscles. ExpiratoryTransversus
Increase. a. Internal intercostal muscles and
muscles is
* The activity of the external intercostal thoracic muscles.
responsible for carrying around 25% of the capacity b. The abdominal muscles
of air to the lungs. c. Other muscles

Stemodeidomastoid -=
Scalenes
Intermal oblique
Pectoralis minor

Pedoralis major

Serratus anterDor

External intercostals
Extemal oblique

sL Internal oblique

Transversus abdominis

Rectus abdominis
Fig. 2.17:
Muscles of respiration
2.18
 Unit-2: The Respiratory System VIJAYAM'S

Internal intercostal muscles and Transvers us the abdomen and force the diaphragm upward during
thoracic muscles: respiration.
During normal respiration, the expiration phase is c. Other muscles:
passive which is caused by the relaxation of the * Other muscle contains the abductor muscles in
inspiratory muscles. the larynx contract early in inspiration, pulling the
* In case of difficult respiration, expiration becomes Vocal cords apart.
more active and assisted by the internal The adductor muscles contract reflexively and
intercostal and transversus thoracic muscle,
by depressing the ribs. close the glottis during swallowing or gagging,
h. The abdominal muscles: These muscles contain the which prevent the food from entering the larynx.
external obliques, internal obliques, transversus Nerve supply: All the intercostal muscles are supplied
abdominis, and the rectus abdominis, which compress by their respective intercostal nerves.

(oVERVIEW
The respiratory system are nose, nasopharynx, larynx, trachea, bronchi and lungs.
The nasal cavity is the main route of air entry and consists of large irregular cavity divided into equal
passage by a septum.
The nose is lined with ciliated columnar epithelium which consists of mucus secreting goblet cells.
The two openings into the nasal cavity, anterior nares and posterior nares.
The pharynx isl2 to 14 cm long extends from base of skull to the level of 6h cervical vertebra. It is
divided into three parts nasopharynx, laryngopharynx, oropharynx.
The walls of the pharynx contains several layers of tissue i.e. mucous membrane lining submucosaand
smooth muscle blood supply is by facial artery and venous drainage by internal jugular veins.
Larynx is also called voice box and lies at the level of 3rd 4h and 5h and 6h cervical vertebra. It is made
up of cartilages, they are cricoid, arytenoid, cuneiform, thyroid and epiglottis.
Blood supply to the larynx is by superior and inferior laryngeal arteries.
The trachea is of llcm long and also called wind pipe and it is present in front of the esophagus.
It is composed of 3 layers of tissue, middle layer and inner epithelium, blood supply is by inferior
thyroid arteries.
Human trachea divides into two right primary bronchus, and left primary bronchus at the level of the
sternal angle and of the fifth thoracia vertebrae.
The segmental bronchi divided into many primary bronchioles which divided further into terminal
bronchioles.
Lungs are lying on each side of thémidline in the thoracic cavity. They are cone shaped and have an
apex and base.
Apex is blunt and extends into the root of neck base and is semilunar in shape and lies on the diaphragm.
It has tw0 Surfaces; one is costal surface which is attached to the ribs, other one is medial surface in
which hilum is present.
Hilum is triangular shaped into whieh the pulmonary arteries, pulmonary veins, bronchial arteries,
bronchi enter and leave the hilum.
Pleura is a closed sac of serous membrane which contains small amount of serous fluid. The pleura
consist of two layers, the visceral pleura which is adherent to the Iungs. The perital pleura which is
adherent to the chest wall.
The pleural cavity is a potential space which contains pleural fluid which prevents friction during
breathing.
2.19
 APPLIED ANATOMV
REVIEW QUESTIONS 3
Difficulty
a. Apnoea
C. Dyspnoea
in breathing is
called
b. Eupnoea
LONG ANSWER QUESTIONS 4 d. Hiccups
1. Normalbreathing is called
Describe the structure of Lung and
a. Eupnoea
b. Apnoea
2. Bronchopulmonary Segments.
Name the organs of
Respiratory 5.
c. Hiccups
Increased rate and
d. Dyspnoea
the external
a note on features, relations
System. Describe
of right lung. a. Hyperventilation depth of respiration is [
b. Tachypnoea
1
Pleura. Add C. Dyspnoea
d. Asphyxia
3. SHORTANSWER
What are the QUESTIONS MATCH THE FOLLoWING
Describe partsmuscles
of
4.
5.
Respiration?
of Respiratory Tract.
1. List -1
List-2
Wite about Paranasal
6
Describe the sinuses. a)Exchange of gases in
Write a short structure lungs i) Pulmonary vein
7. and functions of
note onNasal Cavity. Pharynx. b) C-shaped cartilages
ii) Alveoli
c) Oxygenated blood
VERY SHORT ANSWER d) Pleura iii) Trachea
8. What is Hilum? QUESTIONS e) Voice box iv) Larynx
9.
Write about Pleural v) Closed sac of
10. Write the effusion. The Correct Match is serous membrane
differences
11. Write about between right and left lungs.
Voice box. a. a-v, b-i, c-ii, d-i,e-vi b. a-i, b-iii, c-i, d-v, e-iv
12. What are the parts of C. a-v, b-ii, c-i, e-a, e-iv d. a-iy, b-i,c-ii, d-i, e-v
lower Respiratory Tract?
FILL IN THE BLANKS TRUE OR FALSE
1. 1.
Exchange of gases between blood and Posterior wall of nasal cavity is formed by
called tissues is pharynx.
2. 2.
3.
is common passage for air
and food. Nasopharynx lies behind nose above the level of
soft palate.
is the organ for
4. production of voice.
protects lower respiratory
3
Bronchi are lined by
Swallowing. tract during epithelium. non-ciliated columnar
4.
5. Trachea is also known as Trachea is divided
the site of carina. into two principle bronchi at
6.
Trachea extends downward upto level of 5.
thoracic vertebrae. Anterior border of right lung is
7. Right lung has fissures and
cardiaC notch. interrupted by
lobes.
8.

9.
Dome-shaped
duct extends
to conjuctival sacof eye.from lateral walls of nose
part of respiratory system is
Fill in the Blanks:
1. Internal
(ANSWERS))
10. and 3. Larynx respiration 4.
2. Pharynx
11. Space between lungs muscles
is called
help in respiration. 5. Wind pipe
Vocal cords
6. 5th
7. Two, three 8. Nasolacrimal
MULTIPLE CHOICE QUESTIONS 9. Diaphragm
1. Muscles of inspiration include all except 10.Intercostal, diaphrag
a. Diaphragm
[
b. External intercostals
11.Mediastinum
Multiple Choice Questions:
c. Sternocleidomastoid d. Internal intercostals 1.d 2.b 3. c 4. a 5. a
2. Muscles of expiration include Match the Following:
1.b o
a. Diaphragm True or False
b. Abdominal wall muscles 1. True 2. True 3. False 4. True 5. False
c. Serratus anterior d. Sternocleidomastoid