ANATOMY OF AIRWAY

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 INTRODUCTION

in the initial assessment and management of any

critically ill patient the ABC’s (Airway ,Breathing
and Circulation)are the first priority.
Hypoxia will begin to cause irreversible brain
injury within approximately 5 minutes and so
airway management must precede any other
treatment.
Because if airway is lost life is lost. So airway is
most important part in our life.
 DEFINITION OF AIRWAY

Anatomically airway is a passage through

which air/gas passes during respiration.

It can be divided into:-

1) UPPER AIRWAY
2)LOWER AIRWAY
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AIRWAY ANATOMY

UPPER AIRWAY LOWER AIRWAY

Pharynx Trachea
Epiglottis Bronchi
Glottis Alveoli
Vocal cords Lung tissue, consisting
Larynx of lobes and lobules (3
on the right and 2 on
the left)
pleura
 function of airway
 1) Upper Airway
• Humidification, filtration and warming of the air
• Filtration of bacteria (Tonsils/Adenoids)
• Phonation

 2)LOWER AIRWAY
• Exchange of oxygen and carbon dioxide with
blood
The upper airway starts :
 At the nostrils, extends

through the nasal conchae to

the nasopharynx, over the
uvula to the hypo pharynx
and larynx
 At the lips, extends through

the oral cavity, over the

tongue and below the hard
and soft palates, to the hypo
pharynx and larynx.
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 Nose
 Pharynx
 Larynx

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 Airway functionally begins at the nares , where air
first enters the body.
 Septal cartilage divides nasal cavity into two nasal
fossae
 ROOF-cribriform plate of the ethmoid
 FLOOR-perpendicular to the face
 LATERAL-3 turbinates
 Little’s area on anterior & inferior part of septum; may
bleed during nasal intubation or introducing nasal
airway.
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 Nasal septum is often deviated from the midline
causing one cavity to be larger than the other .
 It is therefore essential for anaesthetist
to visualize the nasal cavity before
attempting nasal intubation

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 FUNCTION OF NOSE

• Inspired air is:

– Humidified by the high water content in the
nasal cavity
– Warmed by rich plexuses of capillaries
• Ciliated mucosal cells remove
contaminated mucus
• Turbinates increase mucosal area(166cm2) for
humidification & enhance air turbulence &
help filter air
• During exhalation these structures:
– Reclaim heat and moisture
– Minimize heat and moisture loss
 Alternate respiratory passage
 Extends from mouth opening to anterior

tonsillar pillars.
 Contracture of mouth & lips-difficult

laryngoscopy.
 Teeth loose or buck-difficult intubation

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 Function of oral cavity

– 1) Inlet for the digestive system

– 2) Manipulates sounds produced by the larynx and
one outcome of this is speech
– 3) Can be used for breathing because it opens into the
pharynx, which is A common pathway for food and air.
– 4)Due to relatively small size of nasal passage and
significant risk of trauma mouth is often used as conduit
for airway devices
 PHARYNX

 Extends from base of skull to lower border

of cricoid cartilage.
 Subdivided into:
nasopharynx, oropharynx,
laryngopharynx

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3
 Extends from posterior end of
turbinates to posterior pharyngeal
wall above soft palate.
 Filters bacteria and foreign particles from
inspired air
 Eustachian tube open into lateral surfaces,
and connect nasopharynx to middle ear,
each equalizes pressure of middle ear

1
4
 Extends from soft palate above to
epiglottis below& anteriorly from anterior
tonsillar pillar to posterior pharyngeal wall.
 Mainly has a digestive function
 Ring of waldeyer

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 Lies between the fourth and sixth cervical
vertebrae.
 Starts at the superior border of the epiglottis,
and extends to the inferior border of the cricoid
cartilage, where it narrows and becomes
continuous with the oesophagus .
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 Lies between base of tongue and trachea

 Primary function is to serve as the
“watchdog” of the respiratory tract,
allowing passage only to air
 Houses the vocal cords, and helps in
vocalization
 Connection point-upper and lower
airways
 Extends from C3 to C6
 Composed of 3
single cartilaginous
structures:
 Epiglottis-flap,
swings down to
meet larynx during
swallowing
 Thyroid-bulk of this
forms larynx
 Cricoid-circular
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 Covers the rima glottidis during

swallowing (glottis=cords &
space)
 During Deglutition
closure of the laryngeal inlet during deglutition takes place by the
apposition of the aryepiglottic folds due to contraction of aryepiglotticus
musle.the epiglottis does not fall back to close the inlet like a lid, instead it
moves upward and comes in contact with the dorsal surface of the posterior
third of tongue.

 Assist in phonation

 Prevent aspiration of food into the trachea

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 Largest of the laryngeal cartilages

 Inner side are attached the vocal cords
 Its two alae meet ant.
 at 900angle in males
 1200angle in females
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 A complete cartilaginous ring

 Narrowest portion of the lower airway in
neonate and infant
 Actual start of the lower airway
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 The thyrohyoid
membrane forms a C-
shaped barrier around the
anterior and lateral walls
of the supraglottis
 Cricothyroid membrane-
easily
palpable,avascular,site for
surgical cricothyrotomy.
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 The six smaller cartilages of the larynx (3 pairs)

are functionally involved with the movements of
the vocal cords.These are:
 The Arytenoids
 The Corniculates
 The Cuneiforms
 The arytenoid cartilages are pyramid-
shaped and articulate with the superior
margin of the cricoid lamina. On their
summit, are the corniculate cartilages; on
their anterior aspect, are the cuneiform
cartilages

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 The vocal ligaments, are

attached posteriorly to the
apex of the arytenoids
and corniculates.

The cuneiforms extend
laterally, between the layers
of the vocal cords, from the
anterior aspect of the
arytenocorniculate complex.
View of the larynx at laryngoscopy.
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Posterior Abductor of vocal Recurrent laryngeal

cricoarytenoid cords

Lateral cricoarytenoid Adducts arytenoids Recurrent laryngeal

closing glottis

Transverse arytenoid/ Adducts arytenoids Recurrent laryngeal

posterior cricoarytenoid

Oblique arytenoid Closes glottis Recurrent laryngeal

Thyroarytenoid Relaxes cords Recurrent laryngeal

Cricothyroid Tensor of the cords External laryngeal

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 SENSORY:
 Above vocal cords- internal laryngeal nerve (b. of

superior laryngeal n.)

 Below vocal cords-recurrent laryngeal nerve

 MOTOR:
 All muscles which move the larynx are
supplied by recurrent laryngeal n.except the
cricothyroid.
 Cricothyroid:supplied by external laryngeal n. (b. of

superior laryngeal n.)

Superior Laryngeal nerve Paralysis
Unilateral:
Voice weak,Pitch can not raised,
Anaesthesia of larynx on side may cause
aspiration
Bilateral:
Voice weak ,husky
Inhalation of food and Pharyngeal secretions
lead to cough & choking .

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 Superior and Recurrent laryngeal nerve
paralysis
Unilateral:
Hoarsness of voice and aspiration of liquid,
cough is ineffective
Bilateral:
Aphonia, Aspiration,Inability to cough

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Larygeal function: Airwa Protection
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The glottis: open for inspiration and closed for swallowing

Open Closed
 Laryngeal function: Phonation
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The vocal cords: Adducted for phonation; abducted for

inspiration

Adducted: Talking Abducted: Breathing

 LOWER AIRWAY
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 Trachea  Bronchioles
 Main stem bronchi  Terminal bronchioles
 Segmental bronchi  Respiratory
 Subsegmental bronchi
bronchioles
 Alveolar
ducts
 Alveolar
sacs
 alveoli
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 10-13 cm long
 Mean distance lips to carina male-28.5cm;
female- 25.2cm-----ETT fixation
 Mean distance base of nose to carina male
31cm; female 28.4cm-----ETT fixation
 1.5-2.5 cm wide
 Extends from lower border of cricoid
cartilage(C6) to carina(T5) where it
bifurcates into right & left main bronchus
 15-20 C shaped rings
 Tracheostomy done at 2-3 tracheal ring.
 ETT is placed above the carina.

 In Pregnancy due to airway oedema

1cm smaller diameter ETT used.

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 Tracheobronchial Tree
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 Series of branching airways commonly referred to

a “generations” or “orders”
 The first generation or order is zero (0), the
trachea itself.
 Bifucrates at the carina
 Touching of carina during intubation may lead to
vagal stimulation.
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 Main Stem Bronchi
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 Right bronchus  Left bronchus

 Wider  Narrower
 More vertical  More angular
 5 cm long  5.5 cm Long
 Supported by C  Supported by C
 shaped cartilages shaped cartilages
 20-30 degree angle  40-60 degree angle
 First generation  First generation
 Usually bronchial

intubation, secretion &

foreign bodies lodged
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 Lobar Bronchi
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 R main stem divides  L main stem divides

into: into:
 Upper lobar  Upper lobar
bronchus bronchus
 Middle lobar
bronchus  Lower lobar
 Lower lobar bronchus
bronchus
 Segmental Bronchi 3rd
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generation

 R lobar divides into  L lobar divides into

 Segmental bronchi
 Segmental bronchi
 10 segments on right
 10 segments on
left
 Subsegmental Bronchi
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 4th to 9th generations

 Progressively smaller airways
 1-4 mm diameter
 Noncartilagenous Airways
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 Bronchioles
 10-th to 15th

generation
 Cartilage is

absent
 Surrounded by spiral
muscle fiber
 With no cartilage, airway
remains open due to
pressure gradients
 Terminal Bronchioles
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 16th to 19th generation

 Average diameter is 0.5 mm
 Cilia and mucous glands begin to
disappear totally
 End of the conducting airway
 Gas exchange zone
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 Respiratory bronchioles
 Acinus -respiratory bronchioles to the
alveoli
 Ducts, sacs, alveoli
 Alveoli
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 300 million alveoli

 Between 75 µ to 300 µ in diameter
 Most gas exchange takes place at
alveolar-capillary membrane
 85-95% of alveoli covered by small
pulmonary capillaires
 The cross-sectional area or surface area is
approximately 70m2
 Intersitium/interstial space
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 Surround, supports, and shapes the alveoli

and capillaries
 Composed of a gel like substance and
collagen fibers
 Contains tight space and loose space
areas