1. Unit 2: The Airways The Upper Airways
RSPT 1207
Cardio Pulmonary Anatomy & Physiology

2. The Airways
Respiratory tract : combination of organs and tissues that have one function – the transfer of gas to be used by the body.
This process exposes the respiratory tract to many environmental extremes

3. The Upper Airways Consists of: The nose Oral cavities The pharynx
The larynx

4. The Upper Airways Function: There are 4 Functions Also involved with:
Direct respiratory gases to and from the lung
Defense mechanism
Humidify inspired air
Heat inspired air
Also involved with:
Speech
Eating, drinking
Smell

5. The Nose Midline, external and internal structure
Upper third is bone and covered by skin
Lower 2/3 is cartilage

6. Functions of the Nose
Filters particles prior to entering lower airways
Humidify and heat inspired air
Provides a location for sensory receptors used in the sense of smell
Provides resonance for speech

7. Major Structures of the Nose

8. Major Structures of the Nose

9. Major Structures of the Nose

10. Nasal Cavity
Separated by the septum making it into a symmetric bilateral structure
Anterior portion formed by the septal cartilage
Posterior septum formed ethmoid and vomer bones

11. Nasal Cavity
External nares – (nostrils) the openings of the nasal passageway
Internally protected from particles by Vibrissae (nose hairs)
Immediately behind vibrissae is an open chamber called the vestibule

12. Turbinates/Conchae
As incoming gas flow enter posterior to the vestibule it is separated by the turbinates or conchae
By having the turbinates, surface area is increased for heat/moisture exchange

13. Turbinates/Conchae Lines the nasal cavity like three walls
Twisted to allow particles to be filtered and air to be heated and humidified
Mucous membranes line turbinates, Mucous glands line

14. Choandae Lumen – the space (hole) in a vessel, tube, or intestine
In the nasal passage this is call the Choandae
Choanal atresia is a common birth defect found in infants

15. Paranasal Sinuses
Consists of the: frontal, maxillary, ethmoid and posterior sphenoid Sinuses
Openings are along the nasal passage
Paired sinuses contain mucous glands and membranes
Helps strengthen the skull

16. Oral Cavity Simply known as the mouth Functions:
Alternate passageway for breathing
Start of the alimentary canal
Contains major speech structures
Facial expressions

17. Oral Cavity Anteriorly begins with lips and mouth
Follows with oral vestibule and teeth and gums
Oral cavity begins after the teeth

18. The Palate The palate is the roof of the oral cavity Consists of:
Hard palate – anterior 2/3 of the palate and is bony
Soft palate – posterior 1/3 and is made of soft tissue.

19. The Palate Protects the nasal passage from food Aids in swallowing
Hard palate and tongue are used in speech
Uvula helps protect the airway from occlusion

20. The Soft Palate Made of soft tissue
This allows for food to be passed out of the oral cavity to the pharynx
Two structures form the soft palate:
Palatoglossal arch (anterior)
Palato-pharyngeal arch (posterior)

21. The Uvula
As the arches of the soft palate come together they form the uvula
Protects the lower airways by being extremely sensitive to tactile stimulation
Can cause violent gagging and possibly vomiting

22. Palatine Tonsils Lies in palato-glossal arch
Lympathic tissue that is part of the immune system

23. The Pharynx Generally known as the throat Divided into three areas:
Nasopharynyx
Oropharynx
Laryngopharynx

24. Nasopharynx Located behind the nasal cavities Contains:
Adenoids or Pharyngeal tonsils
Eustachian tube:
Runs between the back of the throat and middle ear
Equilibrates pressure in the middle ear
Acts like a pop-ff valve to release excess gas behind eardrum

25. Oropharynx Located below soft palate down to base of tongue
Only portion that can be seen without exam tools
Contains:
Lingual tonsils: at base of the tongue, tactile stimulation will cause gagging

26. Laryngopharynx Also called the hypopharynx
Located from base of the tongue to entrance of the esophagus
Contains: Epiglottis
structure that protects the opening to the lower airways which is the glottis
Strong but flexible fibro-cartilage flap that comes out of the larynx into the laryngopharynx

27. Swallowing
The most critical moment is when the food enters the laryngopharynx.
Any mishap in coordination can lead to the food being aspirated into the lower airway
There are more than 20 muscles that are involved in the act of swallowing
The interaction of the tongue, palate and epiglottis in moving the food from the oral cavity to the oropharynx to the laryngopharynx and the esophagus

28. Swallowing Food is broken down and lubricated in the oral cavity
As one swallows the muscles of the tongue and mouth move food up and back
Soft palate protects the nasopharynx
Gravity moves food into oropharynx

29. Swallowing
When the tongue moves up & forward the epiglottis moves down and backward
Results in the glottis is covered as the food moves into esophagus
Once food is in esophagus, the epiglottis moves back in place to allow gas to enter trachea

30. The Larynx Located immediately below the pharynx Formed by:
Three large external cartilages
Epiglottis
Thyroid cartilage
Cricoid cartilage
Three pairs of internal cartilages
Arytenoid cartilage
Corniculate cartilage
Cuneiform cartilage

31. The Larynx

32. Epiglottis

33. External Cartilages All protect the airway
Thyroid cartilage is open in the posterior but it is solid in the anterior to protect the vocal cords inside them
Cricoid cartilage is rigid ring and is the only structure that encircles the airway

34. Internal Cartilages
Form a three sided pyramid of ligaments and muscles to control the movement of the vocal cords
Pitch of the voice is controlled by tightening and loosening the cords
Volume or loudness is controlled by the amount of air forced through the cords

35. Interior of Larynx
Viewing the glottis from above a clinician will see the base of the tongue on top
Below the tongue will be the epiglottis & between these two will stretch the 3 ligaments of the vallecula
Egan’s page 173, figure 7-35

36. Interior of Larynx
The base of the glottal triangle is opposite from the base of the tongue
Surrounding the true vocal cords are tissue folds that are called the vestibular fold or the false cords
Vallecula – space betweent the tongue & epiglottis
Important landmark in intubation

37. Vocal Cords
The vocal cords come together and separate during quiet breathing so that the glottis is always slightly open.
A Valsalva maneuver or laryngospasm are the only time the glottis closed completely
To close the glottis completely, not only requires bringing the vocal cords together but the person tightens all laryngeal muscles at the same time

38. Valsalva Maneuver
Purpose: When the body requires positive pressure for expulsion
Examples: urination, defecation, birth, vomiting, coughing, sneezing
Person must exhale forcefully against a closed glottis, building pressure in the abdomen and thorax
Side effects:
Increase thoracic pressure decreases output of heart
Increased pressure in head

39. Coughing
Cough reflex is triggered when there is an irritant in the tracheal bronchial tree
Deep breath: mL/kg IBW,
Inspiratory hold: 3 seconds for air to get behind irritant
Compression: Valsalva maneuver. True cords close for 0.2 seconds, resulting intrathoracic pressure is cm H2O pressure
Expulsion: Glottis opens and velocity can reach LPM