Respiratory system

By:
Badria alfadol
Esraa elsiddig
Rihab jaber
Sarah siddig
Objectives
The anatomical structures of Upper respiratory tract.
The anatomical structurse of the thoracic wall and.their muscle.
The anatomical structures of the lower respiratory tract.
Important clinical aspect
Introduction
Anatomically, respiratory tract is divided into upper (organ
outside thorax - nose, pharynx and larynx) and lower
respiratory tract (organ within thorax - trachea, bronchi,
bronchioles, alveolar duct, alveoli, pleura and the lung) .
Nose

the external nose

Is part that protruding in the midline of our face, it has a
pyramidal shaped structure with two opening nares or
nostrils, surrounded laterally by adge of the nose , and
separate from one another medially by nasal septum.
The external nose has skeleton that helps supports its
structure, it is form above by bone and below by hyaline
cartilage.
The bony parts of external nose give base to the nose and
include:
• Nasal bone.
• Nasal part of the frontal bone.
• Frontal process of maxillary bone
• Perpendicular plate of ethmoid bone which form superior
part of nasal septum.
• Vomer bone form posterioinferior bony part of nasal septum.
Cartilage part of the nose
In the midline of the nasal septum, there is two lateral
cartilages extend from either side of the dorsal aspect of the
septum.
Nasal cavities
They have roof,floor and medial and lateral wall.
The roof consists of:
• the body of sphenoid
• The cribriform plate of ethmoid bone( has small perforation for for fibers of
olfactory nerve to pass trough.
• Nasal bone
The floor consists of:
• Horizontal plates of palatine bones posteriorly.
• Palatine processes of maxillary bones anteriorly
The medial wall form cartilaginous aspect of nasal septum.
The lateral wall is quite irregular consists of six bones:
• The ethmoid bone (form the majority of the upper part of
the lateral wall).
• The frontal process of maxilla .
• The lacrimal bone.
• The inferior conchce.
• The perpendicular plate of the palatine bone.
• The medial pterygoid plate of the sphenoid.
There is three bony structures extend from lateral wall known as nasal
conchae which create a greater surface area to….air.
Nasal conchaes are superior,middle and inferior conchae. The superior
and middle conchae extend from ethmoid bone, inferior conchae is
individual bone.
There spaces below each conchae called nasal meatus, which are form
lateral air passage, they are :
1. Spheno etmoidal recess above the superior conchae,receive opening of
sphenoiadl air sinus.
2. Superior meatus below superior meatus, receive opening of posterior
ethmoidal sinus.
3. Middle meatus, different from others, has structers, these
structures are:
• Bulla ethmoidal formed by middle ethmoid siuns.
• Hiatus semilunaries receive opens of maxillary sinuses.
• Infundibulum receive the opening of frontal sinuse.

4. Inferior meatus receive opening of the nasolacrimal duct.

Mucous membrane of nasal cavity
the vestibule is lined by modified skin, above the superior conchae is
lined with olfactory mucosal membrane. The lower part lined with
respiratory mucous membrane.

Blood supply to the nose

branches of the maxillary artery supply the nasal cavity. The
sphenopalatine branch anastomoses with septal branch of the facial
artery in the vestibule.
Nerve supply to the nose
Olfactory nerve innervate the olfactory mucous membrane. The
reminder is supplied by branches of the ophthalmic and the maxillary
division of the trigeminal.
Lymphatic drainage
Is drainage to the retropharyngeal lymph nodes and the cervical chain.
Paranasal sinuses
They are lined with respiratory mucosa and are named after bone they
are located .
Maxillary sinus,pyramidal in shape ,locate at the inferior part of the
lateral wall of nasal cavity and the apex project to zygomatic bone, the
floor is superior to the oral cavity and the roof share the same bony
structure from the flootr of the orbits.
Ethmoidal sinus(ethmoidal air cells), divided into anterior,middle and
posterior ethmoidal sinuses.
Sphenoidal sinus,two sphenoidal sinuses with spenoidal bone.
Frontal sinus.
Pharynx
Pharynx , is part of respiratory system and digestive system,
the respiratory parst of pharynx are:
Nasopharynx,The top part of the throat connects to the nasal
cavities (nose) and lets air pass through.it lies above the soft
palate and behind the nasal cavities.
Roof, collection of lymphoid tissue(pharyngeal tonsil)
Floor, the pharyngeal isthmus opening between the soft
palate and the posterior pharyngeal wall.
Lateral wall, the auditory tupe its open
Laryngopharynx (or hypopharynx): The bottom part of the
throat is near the larynx (or voice box). It regulates the
passage of air to the lungs and food and fluid to the
esophagus.
Blood supply of pharynx
The lower part of the pharynx receives blood supply from
inferior thyroid artery and superior thyroid artery. The rest of
the pharynx receives blood from the ascending palatine and
tonsillar branches of the facial artery as well as from the
maxillary artery.
Nerves supply of pharynx
The pharyngeal muscles receive innervation from the vagus
and glossopharyngeal nerve to work in sync to propel food
from the oral cavity into the esophagus.
Lymphatic drainage, the nasopharynx, drain into the lateral
pharyngeal and retropharyngeal lymph nodes.
Lymph from the laryngopharynx joins a lymphatic plexus that
lies in the submucosa.
Larynx
Is responsible for voice production and maintaining a potent
airway. It located at the level of the bodies of C3 to C6
vertebrae and connect s the inferior part of the pharynx with
the trachea. It contain vocal cords vocal cords responsible for
voice production.
The larynx has hardly skeleton rather it formed of nine
cartilages, three single are:
• Epiglottic.
• Thyroid.
• Cricoid.
Three paired cartilage are:
• arytenoid.
• Cornicalte.
• Cuneiform
• Thyroid cartilage, is largest cartilage of the larynx, shield
shape has superior and inferior horns from upper and lower
edges.
• The thyrohyoid membrane ia a ligament associat with
Thyroid cartilage that connect it with hyoid bone. On the
outer surface is an oblique line for the attachment of muscle.
• Cricoid cartilage,is ring shaped formed most of posterior wall
of larynx, has a shallow arch in front and a broad lamina
behind. It lies below the Thyroid cartilage, and articulates
with inferior cornu. Posteriorly the lamina articulate with
arytenoid cartilage.
Epiglottis,thin leaf_like, elastic fibro cartilage, locate posterior
to the root of tongue, connected to body of hyoid and
posterior side of Thyroid cartilage.
During swallowing the larynx elevated and the epiglottis fold
back over the glottis, preventing the entry of liquid and food
into the respiratory passage way.
Arytenoid cartilage, there are two arytenoid cartilages, each
cartilage has an apex, a base, a vocal process and amuscualr
process.
Cornicalte cartilages, they are conical in shape and they
articulate with the arytenoid cartilages.
Cuniform cartilages, the rod_shaped cuneiform cartilages,
strengthen the aryepiglottic folds.
Muscle of the larynx
There are two types of laryngeal muscles, the external
(extrinsic) ones, which move the larynx as a whole, and the
internal (intrinsic) ones, which move the vocal folds to shape
the glottis. It is helpful to remember that the anatomical
names of most such muscles are derived from their origin on
one structure to their insertion on another.
Ligaments of the larynx:
Extrinsic ligament, connects cartilage to hyoid bone and
trachea.
Intrinsic ligament, connect the cartilages to each other.
Laryngeal fold:
Vestibular fold, is a fixed fold on each side of the
larynx.covering vestibular ligament, pink in color.
Vocal fold(vocal cord), is mobile fold, covering the vocal
ligament and white in color.
Sinus of the larynx
Is a small recess on each side of the larynx between the
vestibular and vocal folds
Blood supply of larynx:
Superior laryngeal artery from the superior Thyroid artery.
Inferior laryngeal artery from the inferior Thyroid artery.
Nerves supply of larynx :
Sensory nerves, above the vocal cords by the internal
laryngeal nerve. Below the vocal cords by the recurrent
laryngeal nerve.
Motor nerves, all Intrinsic muscles except the cricothyroid
muscle are supply by the recurrent laryngeal nerve. The
cricothyroid by the external laryngeal nerve.
Lymphatic drainage :
Superior deep cervical nodes.
Inferior deep cervical nodes.
THORACIC WALL
Bones of the thoracic wall:

• Sternum
• Ribs
• Costal cartilages
Sternum:

Flat bone that is divided into

three parts : the manubrium,
the body, and the xiphoid
process.
Manubrium
• The upper part of the
sternum.
• Articulates with body of
the sternum, clavicles,
first costal cartilage and
the upper part of the
second costal cartilage.
Sternal angle
• Formed by the articulation of the manubrium
with the body of the sternum.
• Important surface landmark.
• Lies at the level of :
• 1- The second costal cartilage.
• 2- The intervertebral disc between the fourth
and the fifth thoracic vertebrae.
• 3- The arch of the aorta.
• 4- The bifurcationof of the trachea.
• 5- The junction of the superior mediastinum and the
inferior mediastinum.
Body of the
sternum :
Articulates above with the
manubrium and below with
the xiphoid process. It
articulates on each side with
the second to seventh costal
cartilages.
Xiphoid process :

• It is a thin plate of cartilage that becomes

ossified at its proximal end during adult life.
• No ribs or costal cartilages are attached to
it.
Ribs
• There are 12 pairs of ribs, all
of which are attached
posteriorly to the thoracic
vertebrae.
• Ribs are divided into three
categories :
True ribs 1-7
False ribs 8-10
Floating ribs 11-12
Typical rib
Long, twisted flat bone with a
rounded superior border and a
grooved inferior border (costal
groove). The anterior end of
each rib is attached to the
corresponding costal cartilage.
A rib has a head, neck,
tubercle, shaft and angle.
Atypical ribs
• First rib (wide and short, has two costal grooves, and
one articular facet)
• Second rib (thin, long, and has a tuberosity on its
superior surface for the attachment of the serratus
anterior muscle)
• Tenth rib (only one articular facet)
• Eleventh rib, Twelfth rib (one articular facet with no
neck)
Costal cartilages
• Bars of cartilage connecting the upper seven
ribs to the lateral edge of the sternum and
the 8th, 9th, 10th ribs to the cartilage
immediately above them. The cartilages of
the 11th and 12th ribs end in the abdominal
musculature.
Joints of the thoracic wall :
• Manubriosternal joint
• Xiphisternal joint
• Costovertebral joints
• Costochondral joints
• Joints of the costal cartilage with the sternum
Manubriosternal joint
• Cartilaginous joint.
• Bony surfaces are covered
with hyaline cartilage and
joined by a disc of
fibrocartilage
• Small amount of movement is
possible during respiration.
Xiphisternal joint
• Cartilaginous joint
• The xiphoid process
usually fuses with the
body of the sternum
during middle age.
Costovertebral joints
From the 2nd to 9th rib, the head
articulates by a synovial joint with the
corresponding vertebral body and
that of the vertebra above it.
There is a strong intra-articular
ligament that connects the head to
the intervertebral disc.
The heads of the first and the lowest
three ribs have a simple synovial joint
with the corresponding vertebral
body.
Costochondral joints

• Cartilaginous joints.
• No movement is
possible.
Sternocostal joints
Muscles of respiration
• Diaphragm
• Intercostal muscles:
1. External intercostal
2. Internal intercostal
3. Innermost intercostal
Diaphragm
• The most important muscle of respiration.
• Dome-shaped, consists of a peripheral muscular part and a
centrally placed tendon.
• The origin of the diaphragm is divided into three parts :
1. A sternal part arising from the posterior surface of the
xiphoid process.
2. A costal part arising from the deep surfaces of the lower
six ribs and their costal cartilages.
3. A vertebral part arising from the vertical columns or crura
and from the arcuate ligaments.
• The right crus arises from the sides of the
bodies of the first three lumbar vertebrae and
the intervertebral discs, and it splits to enclose
the esophagus.
• The left crus arises from the sides of the bodies
of the two lumbar vertebrae and the
intervertebral disc.
• Lateral to the crura, the diaphragm arises from
the medial and the lateral arcuate ligaments.
• The medial arcuate ligament extends from the
side of the body of the second lumbar vertebra
to the transverse process of the first lumbar
vertebra.
• The lateral arcuate ligament extends from the
transverse process of the first lumbar vertebra
to the 12th rib.
• The diaphragm is inserted into a central tendon.
As seen from the front,
the diaphragm curves
up into right and left
domes. These domes
support the right and
left lungs, whereas the
central tendon supports
the heart.
• Nerve supply : phrenic nerve.
• Action : increases vertical diameter of the thorax by
pulling down the central tendon, assists in raising
lower ribs.
Openings in the diaphragm
1- Aortic opening:
• Lies anterior to the
body of the 12th
thoracic vertebra
between the crura.
• Transmits the aorta,
the thoracic duct and
the azygos vein.
Openings in the diaphragm

2- Esophageal opening:
• Lies at the level of the 10th
thoracic vertebra in a sling of
muscle fibers derived from the
right crus.
• Transmits the esophagus, the right
and left vagus nerves, the
Esophageal branches of the left
gastric vessels, and the lymphatic
vessels, from the lower third of
the esophagus.
Openings in the diaphragm

3- Caval opening :
• Lies at the level of the
8th thoracic vertebra in
the central tendon.
• Transmits the inferior
vena cava and the
terminal branches of
the right phrenic nerve.
Openings in the diaphragm
In addition to these structures,
the splanchnic nerves pierce
the crura, the sympathetic
trunk passes posterior to the
medial arcuate ligament on
each side, and the superior
epigastric vessels pass between
the sternal and the costal
origins of the diaphragm on
each side.
Intercostal muscles
• The spaces between the ribs contain three
muscles of respiration : the external intercostal,
the internal intercostal and the innermost
intercostal.
• The innermost intercostal is lined internally by the
endothoracic fascia and parietal pleura.
• The intercostal nerves and blood vessels run
between the internal and the innermost
intercostal muscles (van).
External intercostal
• Its fibers pass downward and forward.
• Origin: inferior border of the rib above.
• Insertion : superior border of the rib below.
• Nerve supply : intercostal nerves.
• Action : with the first rib fixed, they raise ribs during
inspiration and thus increase anteroposterior and
transverse diameters of the thorax; with the last rib
fixed by abdominal muscles, they lower the ribs
during expiration.
Internal intercostal
• Fibers pass downward and backward.
• Origin: inferior border of the rib above.
• Insertion: superior border of the rib below.
• Nerve supply : intercostal nerves.
• Action: assist the external intercostal muscles.
Innermost intercostal
• Fibers pass transversly, forms incomplete layer of
muscle.
• Origin : adjacent ribs.
• Insertion : adjacent ribs.
• Nerve supply : intercostal nerves.
• Action : assist external and internal intercostal
muscles.
Trachea
Amobile cartilaginous and membranous tube It begins in the neck as
acontinuation of larynx the lower border of carotid cartilage at level
6the cervical it decends in the midline of neck and it end inthe thorax at
carina and dividing into right and left main bronchi at level of sternal
angle .
The length about 11.5 cm the diamiter about 2.5
The posterior free and of the cartilag are conacted by smooth muscle .
• Anatomical relation of trachea :
• * Anteriorly : the sternum , thyms , left branchocephalic vein , the
origan of branchocephalic artery and left common carotid artary .
• * posteriorly : esophagus and left recurent laryngeal nerve .
• * Right side : the azygos vein , right vagus nerve , pleura .
• Left side: the arch of aorta , left common carotid and left subclavin
arteries
• Blood supply of trachea :
• Upper tow third are supplied by inferior thyroid artery and lower tow
thired by bronchial arteries .
• Lymph draning :
• Into the pretracheal and paratracheal lymph nodes
• Nerve supply :vagus and recurnt laryngealnerve
Bronchi
Divide dichotomously giving rise to several milion terminal bronchioles
that terminate in one or more respiratory bronchioles each bronchiol
divided into 2 to 11 alvealar ducts that enter the alveolar sac
Right principal bronchi
• Is wider , shorter, more vertical than the left about 2.5 cm long befor
inter the hilum give superior lobar bronchus on entring the hilum it
divide s into middle and inferior lobar bronchus
Left principal bronchi
• Is narrower longer mor horizontal than the right about 5 cm long it
passes to the left below the arch of the aorta and infrontof the
esophagus on entering the hilum of the left lung divides into the
superior and inferior lobar bronchus
The blood supply of the thorathic wall
• The neurovascular bundle : VAN
• Vein is located superiorly
• Artery : between vein and artery
• Nerve : islocated inferiorly
• VAN occupies the costal grove is situated between internal intercostal
intermost intercostal muscles .
• Internal thoracic artery
• Supplies the anterior wall of the body from clavical to the umblical it
divided into superior epigastric and musclophrinic arteris
• Branches : Two anterior intercostal arteries to upper six intercostal
space .
• Perforating arteries : wich compin the terminal branches of the
corresponding intercostal neeve
• Pericardio copherinic artery: compin to phrinic
• Nerve supply percardum
• Mediastinal arteries : content of the anterior medistinum .
• The superior epigastric artery :
• Supply the rectus muscle as far as umblical
• The musclo phrinic artery run around costal margin of the diaphragm
and supply the lower intercostal space of diaphragm .
• The posterior intercostal arteries of thevfirst tow space are branch es
from the supperior intercostal artery abranch of the costocervical
trunk of the subclavin artery the posterior intercostal arteris of the
lower nine space are branches of the decending thoracic aorta
Intercostal nerve
• Ventral primaryrami give tow branches :
• 1- Lateral cutanous branch
• 2- Anterior cutanous branch
• Function :
• Sensoery and motor inervation of the thoracic wall.and upper
abdominal also lateral limb of diaphragm and perital pleura .
• Dermatomes skin and muscle inervated by single pair of spinal nerve
The internal thoracic vein
• Compin to the internal thoracic artery and drains into the
brachocephalic vein on each side .
• Tow anterior one posterior
• Posterior intercostal veins : originate from intercostal space just
inferior to posterior
• In the right side :
• The 4th to 11 the posterior intercostal veins drain into azygosvein.
• In the left 4th to 7th or 8th posterior intercostal veins drain into The
accessory hemazigous vein.
• The 8th to 11th posterior intercostal and subcostal veins drain into
the heamazaygois vein.
• Supreme intercostal vein :, 1st intercostal space posteriorly into
branchiocephali vein.
• Superior intercostal vein : posterior 2nd and 3rd are drain on superior
intercostal vein into the azygos drain into brachio cephalic vein.
Lymph nodes of the thoracic wall
• The anterior wall of the skin thorax drain on Anterior axillary nodes .
• The posterior walk of the skin drain on posterior axillary nodes .
• The deep lymph vessels of the anterior part of intercostal space drain
on the internal thoracic nodes whic dran on thorathic duct .
• The deep lymph vessels of posterior drain on posterior intercostal
nodes .
Pleura and Lungs
Development of the pleura
Pleura
• The pleura is divided into two
major types, based on location:
• 1. Parietal pleura
• 2. Visceral pleura
• Each pleural cavity is the
potential space enclosed
between the visceral and
parietal pleurae.
LUNGS
Lobes and fissures of the lungs
• The right lung is divided into three lobes by two fissures, oblique and
horizontal
• The left lung is divided into two lobes by the oblique fissure
• The hilum is where the structures enter and leave the lung. It
connects the lung to structures in the mediastinum
Cervical Rib
Inhaled Foreign Bodies
Lesions of Laryngeal Nerves