The document describes the anatomy of the nose, larynx, and trachea. It discusses the external features of the nose including its pyramidal shape and openings into the nasal cavity. It also details the skeletal structure, blood supply, innervation, and contents of the nasal cavity including the nasal conchae and paranasal sinus openings. The summary describes the cartilages and functions of the larynx in regulating breathing, swallowing, and phonation. It also lists the intrinsic and extrinsic muscles that control the larynx.
The document describes the anatomy of the nose, larynx, and trachea. It discusses the external features of the nose including its pyramidal shape and openings into the nasal cavity. It also details the skeletal structure, blood supply, innervation, and contents of the nasal cavity including the nasal conchae and paranasal sinus openings. The summary describes the cartilages and functions of the larynx in regulating breathing, swallowing, and phonation. It also lists the intrinsic and extrinsic muscles that control the larynx.
The document describes the anatomy of the nose, larynx, and trachea. It discusses the external features of the nose including its pyramidal shape and openings into the nasal cavity. It also details the skeletal structure, blood supply, innervation, and contents of the nasal cavity including the nasal conchae and paranasal sinus openings. The summary describes the cartilages and functions of the larynx in regulating breathing, swallowing, and phonation. It also lists the intrinsic and extrinsic muscles that control the larynx.
The document describes the anatomy of the nose, larynx, and trachea. It discusses the external features of the nose including its pyramidal shape and openings into the nasal cavity. It also details the skeletal structure, blood supply, innervation, and contents of the nasal cavity including the nasal conchae and paranasal sinus openings. The summary describes the cartilages and functions of the larynx in regulating breathing, swallowing, and phonation. It also lists the intrinsic and extrinsic muscles that control the larynx.
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ANATOMY OF THE NOSE,
LARYNX AND TRACHEA
DR. HASSAN SHAIBAH
SURFACE APPEARANCE THE EXTERNAL NOSE
• HAVE A PYRAMIDAL SHAPE.
• NASAL ROOT LOCATED SUPERIORLY & CONTINUOUS WITH FOREHEAD. • APEX ENDS INFERIORLY IN A ROUNDED ‘TIP’. • SPANNING BETWEEN THE ROOT & APEX IS DORSUM OF THE NOSE. • INFERIORLY TO APEX THE NARES; OPENINGS INTO THE VESTIBULE OF THE NASAL CAVITY. • NARES BOUNDED MEDIALLY BY NASAL SEPTUM, & LATERALLY BY ALA NASI (THE LATERAL CARTILAGINOUS WINGS OF THE NOSE). SKELETAL STRUCTURE
MADE OF BONY & CARTILAGINOUS
COMPONENTS: • BONY COMPONENT – LOCATED SUPERIORLY, COMPRISED OF CONTRIBUTIONS FROM NASAL, & MAXILLA BONES • CARTILAGINOUS COMPONENT LOCATED INFERIORLY, COMPRISED: • 2 LATERAL CARTILAGES • 2 ALAR CARTILAGES • ONE SEPTAL CARTILAGE. • SOME SMALLER ALAR CARTILAGES VESSELS AND LYMPHATICS
• EXTERNAL NOSE RECEIVES ARTERIAL SUPPLY
FROM • BRANCHES OF THE MAXILLARY (INFRA ORBITAL) • OPHTHALMIC ARTERIES ( DORSAL & EXTERNAL )
• THE SEPTUM & ALAR CARTILAGES RECEIVE
ADDITIONAL SUPPLY FROM ANGULAR ARTERY & LATERAL NASAL ARTERY. THESE ARE BOTH BRANCHES OF FACIAL ARTERY (DERIVED FROM EXTERNAL CAROTID ARTERY). • VENOUS DRAINAGE IS INTO THE FACIAL VEIN, THEN IN TURN INTO INTERNAL JUGULAR VEIN. • LYMPHATIC DRAINAGE FROM THE EXTERNAL NOSE IS VIA SUPERFICIAL LYMPHATIC VESSELS ACCOMPANYING THE FACIAL VEIN. THESE VESSELS, LIKE ALL LYMPHATIC VESSELS OF THE HEAD AND NECK, ULTIMATELY DRAIN INTO THE DEEP CERVICAL LYMPH NODES. INNERVATION • SENSORY INNERVATION OF THE EXTERNAL NOSE IS DERIVED FROM THE TRIGEMINAL NERVE (CN V). • EXTERNAL NASAL NERVE, A BRANCH OF OPHTHALMIC NERVE (CN V1), SUPPLIES THE SKIN OF THE DORSUM OF NOSE, NASAL ALAE AND NASAL VESTIBULE. • THE LATERAL ASPECTS OF THE NOSE ARE SUPPLIED BY THE INFRORBITAL NERVE, A BRANCH OF THE MAXILLARY NERVE (CN V2). THE NASAL CAVITY
• THE MOST SUPERIOR PART
OF RESPIRATORY TRACT. • EXTENDS FROM VESTIBULE TO THE NASOPHARYNX, AND HAS THREE DIVISIONS: 1. VESTIBULE – THE AREA SURROUNDING ANTERIOR EXTERNAL OPENING TO NASAL CAVITY. 2. RESPIRATORY REGION – LINED BY CILIATED PSUDEOSTRATIFIED EPITHELIUM, WITH MUCUS-SECRETING GOBLET CELLS. 3. OLFACTORY REGION – LOCATED AT THE APEX OF THE NASAL CAVITY. LINED BY OLFACTORY CELLS & RECEPTORS. NASAL CONCHAE • LATERAL WALLS OF THE NASAL CAVITY CURVED SHELVES OF BONE. THEY ARE CALLED CONCHAE (OR TURBINATES). • 3 CONCHAE – INFERIOR, MIDDLE & SUPERIOR. • PROJECT INTO NASAL CAVITY, CREATING PATHWAYS FOR THE AIR TO FLOW. THESE PATHWAYS ARE CALLED MEATUSES: • INFERIOR MEATUS – BETWEEN THE INFERIOR CONCHA AND FLOOR OF THE NASAL CAVITY. • MIDDLE MEATUS – BETWEEN THE INFERIOR AND MIDDLE CONCHA. • SUPERIOR MEATUS – BETWEEN THE MIDDLE AND SUPERIOR CONCHA. • FUNCTION TO INCREASE THE SURFACE AREA OF THE NASAL CAVITY – THIS INCREASES THE AMOUNT OF INSPIRED AIR, SO THAT IT CAN BE HUMIDIFIED. OPENINGS INTO THE NASAL CAVITY
• ONE OF THE FUNCTIONS OF THE NOSE IS TO DRAIN A VARIETY OF
STRUCTURES. MANY OPENINGS INTO NASAL CAVITY DRAINAGE OCCURS. • FRONTAL, MAXILLARY & ANTERIOR ETHMOIDAL SINUSES OPEN INTO MIDDLE MEATUS. THE LOCATION OF THIS OPENING IS MARKED BY THE SEMILUNAR HIATUS, A CRESCENT-SHAPED GROOVE ON THE LATERAL WALLS OF THE NASAL CAVITY. • MIDDLE ETHMOIDAL SINUSES EMPTY OUT ONTO A STRUCTURE CALLED THE ETHMOIDAL BULLA. • THE POSTERIOR ETHMOIDAL SINUSES OPEN OUT AT THE LEVEL OF THE SUPERIOR MEATUS. • THE ONLY STRUCTURE NOT TO EMPTY OUT ONTO THE LATERAL WALLS OF THE NASAL CAVITY IS THE SPHENOID SINUS. IT DRAINS ONTO THE POSTERIOR ROOF. • IN ADDITION TO THE PARANASAL SINUSES, OTHER STRUCTURES OPEN INTO THE NASAL CAVITY: • NASOLACRIMAL DUCT –DRAIN TEARS FROM THE EYE. IT OPENS INTO THE INFERIOR MEATUS. • AUDITORY (EUSTACHIAN) TUBE – OPENS INTO THE NASOPHARYNX AT THE LEVEL OF THE INFERIOR MEATUS. IT ALLOWS THE MIDDLE EAR TO EQUALISE WITH THE ATMOSPHERIC AIR PRESSURE. CLINICAL RELEVANCE: SPREAD OF INFECTION
• AS THE AUDITORY TUBE CONNECTS THE MIDDLE EAR AND UPPER RESPIRATORY TRACT, IT IS A PATH BY WHICH INFECTION CAN SPREAD FROM THE UPPER RESPIRATORY TRACT TO THE EAR. INFECTION OF THE AUDITORY TUBE CAUSES SWELLING OF THE MUCOUS LININGS, AND THE TUBE BECOMES BLOCKED. THIS RESULTS IN DIMINISHED HEARING. VASCULATURE INTERNAL CAROTID BRANCHES: • ANTERIOR ETHMOIDAL ARTERY • POSTERIOR ETHMOIDAL ARTERY
THE ETHMOIDAL ARTERIES ARE BRANCH OF
THE OPHTHALMIC ARTERY. EXTERNAL CAROTID BRANCHES: • SPHENOPALATINE ARTERY • GREATER PALATINE ARTERY • SUPERIOR LABIAL ARTERY • LATERAL NASAL ARTERIES • THESE ARTERIES FORM ANASTOMOSES WITH EACH OTHER. THIS IS PARTICULARLY PREVALENT IN THE ANTERIOR PORTION OF THE NOSE • THE VEINS OF THE NOSE TEND TO FOLLOW THE ARTERIES. THEY DRAIN INTO THE PTERYGOID PLEXUS, FACIAL VEIN OR CAVERNOUS SINUS. CLINICAL RELEVANCE: EPISTAXIS
• EPISTAXIS IS A NOSEBLEED. DUE TO THE RICH BLOOD SUPPLY OF THE NOSE, THIS IS A COMMON OCCURRENCE. IT IS MOST LIKELY TO OCCUR IN THE ANTERIOR THIRD OF THE NASAL CAVITY – THIS AREA IS KNOWN AS THE KIESSELBACH AREA. • THE CAUSE CAN BE LOCAL (SUCH AS TRAUMA), OR SYSTEMIC (SUCH AS HYPERTENSION). INNERVATION
• CAN BE FUNCTIONALLY DIVIDED
INTO SPECIAL AND GENERAL INNERVATION. • SPECIAL SENSORY SMELL. BY OLFACTORY NERVES. • GENERAL SENSORY INNERVATION TO THE SEPTUM AND LATERAL WALLS IS DELIVERED BY THE NASOPALATINE NERVE (BRANCH OF MAXILLARY NERVE) & THE NASOCILIARY NERVE (BRANCH OF THE OPHTHALMIC NERVE). • INNERVATION TO THE EXTERNAL SKIN OF THE NOSE IS SUPPLIED BY THE TRIGEMINAL NERVE. THE LARYNX
CARTILAGINOUS STRUCTURE IN THE NECK THAT GUARDS THE ENTRANCE TO THE TRACHEA
HAS 3 BASIC FUNCTIONS; IN ORDER OF IMPORTANCE:
1. AIR PASSAGE: CARTILAGINOUS STRUCTURE ENSURES PATENCY OF AIRWAY
2. SPHINCTER: REGULATES AIR & FOOD PASSAGES TO ENSURE COORDINATED BREATHING & SWALLOWING. PROVIDES VALVULAR BLOCKADE FOR BUILD-UP OF INTRA-THORACIC & INTRA- ABDOMINAL PRESSURE IMPORTANT FOR FUNCTIONS SUCH A COUGHING, SNEEZING, MICTURITION, PARTURITION, ETC.
3. ORGAN OF PHONATION (VOICEBOX): PRODUCES SOUND BY INTERMITTENT RELEASE OF HIGH
PRESSURE AIR BETWEEN CLOSED VOCAL FOLDS CAUSING THEIR VIBRATION ANATOMICAL STRUCTURE • IS FORMED BY A CARTILAGINOUS SKELETON, WHICH IS HELD TOGETHER BY LIGAMENTS AND MEMBRANES. THE LARYNGEAL MUSCLES ANATOMICALLY, THE INTERNAL CAVITY OF THE LARYNX CAN BE DIVIDED INTO THREE SECTIONS: • SUPRAGLOTTIS – FROM THE INFERIOR SURFACE OF THE EPIGLOTTIS TO THE VESTIBULAR FOLDS (FALSE VOCAL CORDS). • GLOTTIS – CONTAINS VOCAL CORDS AND 1CM BELOW THEM. THE OPENING BETWEEN THE VOCAL CORDS IS KNOWN AS RIMA GLOTTIDIS, THE SIZE OF WHICH IS ALTERED BY THE MUSCLES OF PHONATION. • SUBGLOTTIS – FROM INFERIOR BORDER OF THE GLOTTIS TO THE INFERIOR BORDER OF THE CRICOID CARTILAGE. CARTILAGES
PRINCIPLE CARTILAGES (hyaline
cartilage):
• Thyroid cartilage
• Cricoid cartilage
• Arytenoid cartilages (2)
(These cartilages are made of hyaline cartilage and
may calcify with age starting with the thyroid cartilage at ~ 25 yrs.) SECONDARY CARTILAGES:
• Epiglottis
• Corniculate cartilages (2)
• Cuneiform cartilages (2)
(These cartilages are made of elastic fibrocartilage & do not usually calcify) MUSCLES OF THE LARYNX
1. EXTRINSIC MUSCLES:
Join cartilages of the larynx to neighboring structures in the neck. Divided into:
Suprahyoid muscles (elevators) & infrahyoid muscles (depressors) of the larynx
2. INTRINSIC MUSCLES:
Regulate length and tension of the vocal folds and aperture of the glottis
All intrinsics supplied by CN XI via X (vagus: external & recurrent laryngeal nerves)
The next slide is a summary of these muscles…
SUMMARY OF EXTRINSIC MUSCLES OF THE LARYNX (Nerve supply in parentheses) Digastric (ant. belly: CN V3; post. belly: CN VII)
Stylohyoid (CN VII) Suprahyoid
muscles ELEVATORS Geniohyoid (C1) OF LARYNX Stylopharyngeus (CN IX)
Palatopharyngeus (CN XI via X)
EXTRINSIC
MUSCLES Sternothyroid (ansa cervicalis)
Sternohyoid (ansa cervicalis) Infrahyoid (strap)
DEPRESSORS muscles OF LARYNX Omohyoid (ansa cervicalis)
Thyrohyoid (C1)
Inf. pharyngeal constrictor (XI via X)
SUMMARY OF INTRINSIC MUSCLES OF THE LARYNX (All intrinsics supplied by XI via X) Abductors Posterior cricoarytenoid MUSCLES VARYING Lateral cricoarytenoid APERTURE OF GLOTTIS Adductors Transverse arytenoid
Oblique arytenoid
Cricothyroid
MUSCLES REGULATING Thyroarytenoid
INTRINSIC TENSION OF VOCAL LIGAMENTS Vocali MUSCLES s Posterior cricoarytenoid
THE TRACHEA ANATOMICAL POSITION • MARKS THE BEGINNING OF THE TRACHEOBRONCHIAL TREE. IT ARISES AT THE LOWER BORDER OF CRICOID CARTILAGE IN THE NECK, AS A CONTINUATION OF THE LARYNX. • TRAVELS INFERIORLY INTO THE SUPERIOR MEDIASTINUM, BIFURCATING AT THE LEVEL OF THE STERNAL ANGLE (FORMING THE RIGHT AND LEFT MAIN BRONCHI). AS IT DESCENDS, THE TRACHEA IS LOCATED ANTERIORLY TO THE ESOPHAGUS, STRUCTURE • THE TRACHEA,, IS HELD OPEN BY CARTILAGE – HERE IN C- SHAPED RINGS. THE FREE ENDS OF THESE RINGS ARE SUPPORTED BY THE TRACHEALIS MUSCLE. • AT THE BIFURCATION OF THE PRIMARY BRONCHI, A RIDGE OF CARTILAGE CALLED THE CARINA CAN BE SEEN ON BRONCHOSCOPY. NEUROVASCULAR SUPPLY
• THE TRACHEA RECEIVES SENSORY INNERVATION FROM THE RECURRENT
LARYNGEAL NERVE. • ARTERIAL SUPPLY COMES FROM THE TRACHEAL BRANCHES OF THE INFERIOR THYROID ARTERY, WHILE VENOUS DRAINAGE IS VIA THE BRACHIOCEPHALIC, AZYGOS AND ACCESSORY HEMIAZYGOS VEINS. BRONCHI
• AT THE LEVEL OF THE STERNAL ANGLE, THE
TRACHEA BIFURCATES INTO THE RIGHT AND LEFT MAIN BRONCHI. • UNDERGO FURTHER BRANCHING TO THE SECONDARY BRONCHI. • EACH SECONDARY BRONCHI SUPPLIES A LOBE OF THE LUNG, AND GIVES RISE TO SEVERAL SEGMENTAL BRONCHI. • ALONG WITH BRANCHES OF THE PULMONARY ARTERY AND VEINS, THE MAIN BRONCHI MAKE UP THE ROOTS OF THE LUNGS. STRUCTURE
THE RIGHT PRINCIPAL BRONCHUS IS SHORTER, WIDER
AND MORE VERTICAL THAN THE LEFT; THEREFORE INHALED (ASPIRATED) OBJECTS TEND TO LODGE MORE FREQUENTLY IN THE RIGHT LUNG COMPARED TO THE LEFT. • EACH SECONDARY BRONCHI SUPPLIES A LOBE OF THE LUNG, THUS THERE ARE 3 RIGHT LOBAR BRONCHI AND 2 LEFT. • THE LOBAR BRONCHI THEN BIFURCATE INTO SEVERAL SEGMENTAL (TERTIARY) BRONCHI, EACH OF WHICH SUPPLIES A BRONCHOPULMONARY SEGMENT. Bronchopulmonary segments are subdivisions of the lung lobes, and act as the functional unit of the lungs. Bronchioles
The segmental bronchi undergo further
branching to form numerous smaller airways – the bronchioles. (The smallest airways, bronchioles do not contain any cartilage )
bronchioles then eventually end as terminal
bronchioles. These terminal bronchioles branch even further into respiratory bronchioles, which are distinguishable by the presence of alveoli extending from their lumens. Alveoli are tiny air-filled pockets with thin walls (simple squamous epithelium), and are the sites of gaseous exchange in the lungs. Altogether there are around 300 million alveoli in adult lungs, providing a large surface area for adequate gas exchange. THE TRACHEA AND BRONCHIAL TREE The right principal bronchus is shorter, wider and more vertical than the left; therefore inhaled (aspirated) objects tend to lodge more frequently in the right lung compared to the Cross section of trachea: left. Incomplete hyaline Esophagus cartilage ring
Trachealis (smooth) muscle posteriorly Trachea Related posteriorly Right Left to esophagus lung lung Left main (principal) Right main (principal) bronchus 2 lobar bronchi bronchus 3 lobar (superior & inferior) bronchi (superior, middle & inferior) Tracheal bifurcation at T4/5 vertebral level (internal aspect of bifurcation known as carina)
The lobar bronchi divide into segmental bronchi, each supplying a bronchopulmonary are 10 bronchopulmonary segments in each lung (see next slide). The segmental br divisions into progressively smaller airways called bronchioles, and terminal and resp NEUROVASCULAR SUPPLY
• THE BRONCHI DERIVE INNERVATION
FROM PULMONARY BRANCHES OF THE VAGUS NERVE (CN X). • BLOOD SUPPLY TO THE BRONCHI IS FROM BRANCHES OF THE BRONCHIAL ARTERIES, WHILE VENOUS DRAINAGE IS INTO THE BRONCHIAL VEINS.
