1. The Respiratory System

2. The General Description
The respiratory system includes the res-
piratory tract and lungs.
The primary function of this system is to supply the body with oxygen and get rid of excess carbon dioxide resulting from cell metabolism.

3. Composition Nose Pharynx upper respiratory tract Larynx Trachea
lower respiratory tract
Bronchi
Lungs-paired organs of respiration
Function: supply the body with oxygen and to get rid of excess carbon dioxide resulting from cell metabolism

4. The Nose External nose: Root of nose Back of nose Apex of nose
Alae of nose
Nasal cavity –divided into two halves by nasal septum

5. Two parts of nasal cavity : Divided by limen nasi Nasal vestibule
Proper nasal cavity
Boundaries
Roof－cribriform plate of ethmoid , Sphenoid, Frontal bone and nasal bone
Floor－hard palate
Medial wall－nasal septum
Lateral wall
Nasal conchae: superior, middle and inferior
Nasal meatus: superior, middle and inferior
Sphenoethmoidal recess

6. Remove the middle nasal conchae
Semilunar hiatus
Ethmoidal infundibulum
Ethmoidal bulb
Nasolacrimal canal

7. The formation of the nasal septum
2 Bones,
1 Cartilage,
Nasal mucous membrane:
olfactory region
respiratory region
The longitudinal
plate of ethmoid bone
The cartilage
of nasal septum
The vomer
back

8. Mucous membrane of nose
Olfactory region: located upper nasal cavity, above superior，nasal conchae，contains olfactory cells
Respiratory region : its function is to warm, moisten, and clean the inspired air

9. The paranasal sinuses and their site of drainage into the nose
Name of sinus
Site of drainage
Frontal sinus
Middle meatus via infundibulum
Maxillary sinus
Middle meatus through semilunar hiatus
Sphenoid sinus
Sphenoethmoidal recess
Ethmoidal sinuses
anterior group
middle group
posterior group
Middle meatus
Superior nasal meatus

10. Frontal sinus
Ethmoidal sinuses
Sphenoid sinus
Maxillary sinus

11. The openings of the paranasal sinuses
frontal sinus
middle nasal meatus
maxillary sinus
sphenoidal sinus
recessus sphenoethmoidalis
ethmoidal sinus
Anterior and middle -middle nasal meatus
Posterior- superior nasal meatus
4, nasolacrimal duct
inferior nasal meatuses

12. The Larynx
Position－situated in the anterior part of the neck (below the hyoid bone), and extends from vertebral level of C4 to C6

13. Layngeal cartilages Thyroid cartilage Shield-shaped cartilage
Laryngeal prominence at base of thyroid notch
Superior thyroid notch, superior and inferior cornua
Cricoid cartilage
Complete ring of cartilage (shaped like a signet ring)
Arch of cricoid cartilage－at level of C6
Larmina of cricoid cartilage

14. Arytenoid
Paired, pyramid shaped, articulate with lamina of cricoid cartilage
Vocal process anteriorly, site of posterior attachment of vocal fold
Muscular process
Epiglottic cartilage
leaf-shaped elastic cartilage situated behind the root of the tongue

15. Thyroid cartilage Anterior view posterior view lamina sup. cornu
Laryngeal prominence
sup. thyroid notch
lamina
anterior angle
Laminae of thyroid cartilage
inf. cornu
Anterior view posterior view

16. Arytenoid cartilages Cricoid cartilage Anterior view posterior view
Muscular process
Vocal process
Muscular process
Vocal process
Cricoid arch
Cricoid cartilage
Cricoid lamina
Anterior view posterior view

17. Epiglottic cartilage
Anterior view posterior view

18. Quadrangular membrane
Between epiglottic, thyroid and arytenoid cartilages
Lower free border forms vestibular ligament
Conus elasticus
Between arytenoids, thyroid, and cricoid cartilages
Upper free border forms vocal ligament
Median cricothyroid ligment ：may be site of circothyrotomy during acute respiratory obstruction
Cricotracheal ligament －between cricoid cartilage and first ring of trachea

19. 2. cricoarytenoid joints: rotate around the vertical axis
Articulation:
1. cricothyroid joint: rotate around the coronary axis
2. cricoarytenoid joints: rotate around the vertical axis
3. conus elasticus: free and thicked upper border formed the vocal ligament
4. quadrangular membrane: free lower border formed vestibular ligament
5. thyrohyoid membrane 5 4 2 1 3

20. Laryngeal joints
cricothyroid joint
cricoarytenoid joint
Laryngeal ligaments and membrane
Thyrohyoid membrane －extending from hyoid bone to thyroid cartilage

21. Thyrohyoid membrane
Quadrangular
membrane
Conus
elasticus
Lateral view
Lateral view

22. Muscles of larynx
Increasing tension on the vocal ligament－cricothyroid
Decreasing tension on the vocal ligament－thyroarytenoid
Opening the glottis－posterior cricoarytenoid
Closing the glottis－ lateral cricoarytenoid, transverse arytenoid and oblique arytenoid.

23. 3. Laryngeal cavity 3 parts: laryngeal vestibule
intermediate cavity of larynx
infraglottic cavity
by 2 fissures— vestibular fissure
fissure of glottis
laryngeal inlet
vestibular fold
vocal fold
ventricle of larynx

24. Laryngeal cavity
Aperture of larynx －bounded by upper border epiglottic cartilage, aryepiglottic folds and interarytenoid notch

25. Two pairs of shelf like folds :
Structure features
Two pairs of shelf like folds :
Vestibular folds
Vocal folds
Two fissures
Rima vestibuli
Fissure of glottis
Inter membranous part －anterior 3/5, between vocal-folds
Inter cartilagrnous part －posterior 2/5, between arytenoids cartilages

26. Three parts Laryngeal vestibule Infraglottic cavity
Extends from the aperture of larynx to the rima vestibuli
Tubercle of epiglottis Intermedial cavity of larynx
Extends from the level of the rima vestibuli to the level of the fissure of glottis
Ventricle of larynx
－a small recess between vestibular and vocal folds on each side
Infraglottic cavity
extends from the level of the vocal folds to the lower border of the cricoid cartilage

27. The Trachea
Position: extends from the lower border of cricoid cartilage to the level of sternal angle (between T4－T5 vertebrae) where it divides into right and left principal bronchi
Structure features
Consists of about 16－20 C-shaped incomplete tracheal cartilages for patency connected by smooth muscle and connective
Carina of trachea －ridge of cartilage at bifurcation into principal bronchi

28. Bronchi Right principal bronchus Left principal bronchus
Shorter, wider, and more vertical than the left , is about 2.5cm long, Leaves the extend line of the middle line of trachea at 22～25o angle
Foreign bodies are therefore more likely to lodge in this bronchus or one of its branches
Left principal bronchus
Narrower, longer, and more horizontal than the right is about 5cm long, leaves the extend line of the middle line of trachea at about 35～36o angle

29. Ⅳ.The trachea and main bronchus:
Bifurcation of trachea

30. Ⅴ. Lung: Position: located in the thoracic cavity, both sides of the
mediastinum, above the diaphragm

31. The Lungs
Position: located in the thoracic cavity by both sides of mediastinum
General features
Cone-shaped, the right lung is shorter and broader, the left one is longer and narrower
Apex of lung－rises 2 ～3 cm above the medial third of clavicle into neck
Base－concave, related to diaphragm, also called diaphragmatic surface
Costal surface－large, convex, related to thoracic wall

32. an apex External features: a base 2 surfaces— mediastinal and
costal surfaces
3 borders–
anterior border,
inferior border,
posterior border

33. Borders Lobes and Fissure Right lung Left lung Posterior－blunt
Inferior－ sharp
Anterior－sharp
cardiac notch
lingual in left lung
Lobes and Fissure
Right lung
Two fissures : horizontal an oblique
Three lobes : superior, middle, inferior
Left lung
One fissure : oblique
Two lobes : superior and inferior

34. Fissures and lobes of the lungs:
left lung – 2 lobes ( by oblique fissure)
superior lobe (lingula)
inferior lobe
right lung – 3 lobes
(by oblique and
horizontal fissures):
superior lobe
middle lobe,

35. Hilum of lungs (medial view of the lungs)
It is the center part of mediastinal surface.
The arrangement of main structures as follows:
from anterior to posterior---
pulmonary v.,
pulmonary a.,
main bronchus
(both sides)
from superior to inferior---
right lung– bronchus of sup. lobe, left lung– pulmonary a.,
pulmonary a., main bronchus,
bronchus of inf. lobe, pulmonary v.
pulmonary v.

36. Medial surface－concave, related to mediastinum and vertebrae
Hilum of lung ：area on medial surface where structures in root enter or leave lung
Root of lung
Contents
Principal bronchus
Pulmonary artery and vein
Nerves and lymphatics
Surrounded by connective tissue
Order of structures in the root of lung
From before backward: V.A. B.
From above downward:
R.－B. A. V.
L.－A. B. V.

37. Bronchial tree
Each principal bronchus divides into lobar bronchi (two on the left, three on the right), each of which supplies a lobe of lung. Each lobar bronchus then divided into segmental bronchi, which supply specific segments of the lung.

38. The structures of the lung: two parts
--- bronchial tree:
principal bronchus---
lobar bronchi---segmental
bronchi--- bronchioles---
terminal bronchioles
--- alveoli of the lung:

39. Bronchopulmonary segments
Wedge shaped, with the base lying peripherally and the apex lying towards the root of lungs, ten in each lung
Each with a segmental bronchus and branches of pulmonary artery
The veins lie both in and between segments

40. The Segments of the lung: bronchopulmonary segments
Bronchopulmonary segments of right lung
superior lobe
apical
posterior
anterior
middle lobe
lateral
medial
inferior lobe
superior
medial-basal
anterior-basal
lateral-basal
posterior-basal
Bronchopulmonary segments of left lung
superior lobe
apico-posterior (merger of "apical" and "posterior")
anterior
lingula of superior lobe
inferior lingular
superior lingular
inferior lobe
superior
anterior medial basal (merger of "anterior basal" and "medial basal")
posterior basal
lateral basal

41. The Pleura General features Serous membranes forming closed sacs
Two layers
Visceral pleura－adheres to lung, continuous with parietal pleura at root of lung
Parietal pleura－lines the thoracic cavity

42. Two pleural layers continue with each other at root of lung forming closed potential space－pleural cavity
Contains a small amount pleural fluid
Subatmospheric pressure in it

43. Named parts of parietal pleura
Cupula of pleura －extends up into the neck, over the apex of lung, 2～3cm above the medial third of clavicle
Costal pleura －lines the inner surface of the wall of the chest
Mediastinal pleura
Lines mediastinum
Pulmonary ligament －redundant pleura at root of lung, which extends downward, allows movement of structures forming root of lung
Diaphragmatic pleura －Lines diaphragm

44. Pleural recesses －potential spaces of pleural cavity which lungs are not occupied in quiet respiration
Costodiaphragmatic recesse－are the slit-like intervals between costal and diaphragmatic pleurae on each side, the lowest point of pleural cavity
Costomediastinal recess －on the left side between the mediastinal pleura and costal pleura

45. The surface projection of lower border of lung and pleurae
Midclavicular lines
Midaxillary lines
Sides of the vertebral column
Lungs
6th rib
8th rib
10th rib
Pleura
12th rib

46. The Mediastinum
Concept－all of organs between the left and right mediastinal pleurae is called mediastinum. It extends from the sternum in front to the vertebral column behind, and from the thoracic inlet above to the diaphragm below.

47. Subdivisions of mediastinum
Superior mediastinum
sternal angle
Inferior mediastinum
heart and pericardium
Anterior mediastinum
Middle mediastinum
Posterior mediastinum

48. Left side of mediastnum
Left subclavian a.
Thoracic duct
Left vagus n.
Aortic arch
Left recurrent n.
Thoracic aorta
Phrenic n. &
pericardiacophrenic a.
Sympathetic trunk
Root of lung
Pericardium
Esophagus
Greater splanchnic n

49. Right side of mediastnum
Trachea
right vagus n.
Superior vena cava
Arch of azygos v.
Phrenic n. &
pericardiacophrenic a.
Azygos v.
Root of lung
Sympathetic trunk
Esophagus
Pericardium
Inferior vena cava

50. Superior mediastinum
Locating－from inlet of thorax to plane extending from level of sternal angle anteriorly to lower border of T4 vertebra posteriorly
Contents
Superficial layer
Thymus
Three veins
Left brachiocephelic v.
Right brachiocephelic v.
Superior vena cava

51. Middle layer Arotic arch and its three branches Phrenic n. Vagus n.
the brachiocephalic trunk, the left common carotid artery, the left subclavian artery.
Phrenic n.
Vagus n.

52. Posterior layer
Trachea
Esophagus
Thoracic duct

53. Inferior mediastinum
Anterior mediastinum Location－posterior to body of sternum and attached costal cartilages, anterior to heart and pericardium
Contents－fat, remnants of thymus gland, anterior mediastinal lymph nodes

54. Middle mediastinum
Location－between anterior mediastinum and posterior mediastinum
Contents: heart and pericardium, beginning or termination of great vessels, phrenic nerves, pericardiacophrenic vessels , lymph nodes,

55. Posterior mediastinum
Location－posterior to heart and pericardium, anterior to vertebrae T5－T12
Contents: esophagus, vagus n., thoracic aorta, azygos system of veins, thoracic duct, thoracic sympathetic trunk, posterior mediastinal lymph nodes