1. ANATOMY OF THE RESPIRATORY SYSTEM 8.10.2013 Kaan Yücel M.D., Ph.D.
Vincent Van Gogh – Skull with Cigarette (1886)
Kaan Yücel M.D., Ph.D.

2. MEDIASTINUM
Mod. L. middle septum, L, mediastinus, midway

3. MEDIASTINUM

4. MEDIASTINUM

5. MEDIASTINUM

6. SUPERIOR MEDIASTINUM

7. ANTERIOR MEDIASTINUM

8. POSTERIOR MEDIASTINUM

9. Nose is divisible into :
External nose
Nasal cavity

10. External Nose Extends the nasal cavities onto the front of the face
Pyramidal in shape

11. External nose has bony & cartilaginous parts.
Bones Cartilages
Nasal bones Lateral cartilages (paired)
Frontal process of maxilla Alar cartilages (paired)
Nasal part of frontal bone Septal cartilage (single)

12. Nasal cavITIES olfactory receptors separated from:
uppermost parts of the respiratory tract
olfactory receptors
separated from:
each other by a midline nasal septum
oral cavity below by the hard palate
cranial cavity above by parts of the frontal, ethmoid, &sphenoid bones.
Posteriorly, each nasal cavity communicates with the nasopharynx through two openings choana.

13. Each nasal cavity consists of 3 regions.
nasal vestibule internal to the naris
respiratory region largest , rich neurovascular supply
olfactory apex of each nasal cavity, olfactory receptors 3 2 1

14. the most anterior part of the nasal cavity.

15. Functions of the nose & nasal cavities
Olfaction (sense of smell)
Respiration
Filtration of the dust in the inspired air
Humidification and warming of the inspired air (cooling the internal carotid artery for brain)
Reception of the secretions from the paranasal sinuses and nasolacrimal ducts

16. 2. PARANASAL SINUSES Frontal sinuses Ethmoid sinuses Sphenoid sinuses
air filled spaces lying within the bones around the nasal cavity
lined by respiratory mucosa.
open into the nasal cavities
innervated by branches of the trigeminal nerve [V].
Frontal sinuses
Ethmoid sinuses
Sphenoid sinuses
Maxillary sinuses

17. organ of phonation (vocalization)
3. LARYNX
between C3- C6
organ of phonation (vocalization)
continuous below with the trachea
above opens into the pharynx
immediately posterior & slightly inferior to the tongue
Cartilage
Muscles
Connective tissue

18. SKELETON OF LARYNX LARYNGEAL CARTILAGES
Unpaired cartilages
Thyroid cartilage (biggest)
Cricoid cartilage
Epiglottic cartilage
Paired cartilages
Arytenoid
Corniculate
Cuneiform

19. Thyroid cartilage largest cartilage of the larynx
2 laminae which fuse anteriorly at the thyroid angle & form
laryngeal prominence (Adam’s apple)

20. Cricoid cartilage
a ring shaped cartilage, most inferior of the laryngeal cartilages
Inferiorly attaches to 1st tracheal ring via cricotracheal ligament.
Completely encircles the airway
Broad lamina of cricoid cartilage posteriorly
Narrower arch of cricoid cartilage anteriorly

21. Arytenoid cartilages pyramidal in shape 3 processes
Apex (superior) articulation w/corniculate cartilage
Vocal process (anterior) vocal ligament attaches here
Muscular process (lateral)
posterior & lateral crico-arytenoid muscles

22. Epiglottic cartilage (Epiglottis)
a leaf-shaped cartilage
attached by its stem to the posterior aspect of the thyroid cartilage
@ the angle
Most superior end is free.

23. Corniculate & cuneiform cartilages
corniculate cartilages two small conical cartilages
Located on the arytenoid cartilages
cuneiform cartilages small cartilages anterior to corniculate cartilages
lie in the posterior part of
the aryepiglottic fold.

24. EXTRINSIC LIGAMENTS OF THE LARYNX.
Thyrohyoid membrane
Below superior margin of the thyroid cartilage, above hyoid bone
lateral thyrohyoid ligament
(posterior thickening), triticeal cartilage
median thyrohyoid ligament
(midline thickening)
Hyo-epiglottic ligament
from the midline of the epiglottis to the body of hyoid bone
Cricotracheal ligament
between lower border of cricoid cartilage & upper border of 1st tracheal cartilage

25. Fibroelastic membrane of the larynx
INTRINSIC LIGAMENTS OF THE LARYNX .
Fibroelastic membrane of the larynx
lies under the mucosa of the larynx
links together the laryngeal cartilages
completes the architectural framework of the laryngeal cavity
forms some of the ligaments between the cartilages.

26. Fibroelastic membrane of the larynx
INTRINSIC LIGAMENTS OF THE LARYNX .
Fibroelastic membrane of the larynx
2 parts
lower conus elasticus
upper quadrangular membrane

27. cricothyroid ligament, cricovocal membrane, cricothyroid membrane
Conus elesticus
cricothyroid ligament, cricovocal membrane, cricothyroid membrane
Free upper margin thickens & forms vocal ligament  vocal fold
opening between the 2 vocal folds
(rima) glottis
median cricothyroid ligament anterior midline thickening of conus elasticus

28. cricothyroid ligament, cricovocal membrane, cricothyroid membrane
Conus elasticus
cricothyroid ligament, cricovocal membrane, cricothyroid membrane
Each vocal ligament free upper margin
attaches to anterior part of inner surface of thyroid cartilage
@ thyroid angle
posteriorly attach to vocal processes of the arytenoid cartilages.

29. Rima glottis Inspiration Widens Phonation
Narrows- 2 vocal fold come together
Pitch increases with tensing, decreases by relaxation.
Intensity of expiration determines the loudness of sound.

30. Quadrangular membrane.
vestibular ligament
attached
posteriorly arytenoid cartilage
anteriorly thyroid angle
superior to the attachment of the vocal ligament.
lateral margin of epiglottis
free lower margin is thickened
anterolateral surface

31. Quadrangular membrane.
vestibular ligament
attached
posteriorly arytenoid cartilage
anteriorly thyroid angle
superior to the attachment of the vocal ligament.

32. LARYNGEAL CAVITY tubular architectural support
fibro-elastic membrane of the larynx
laryngeal cartilages .

33. superior aperture (laryngeal inlet) V.S. inferior aperture1)
opens into anterior aspect of pharynx
just below and posterior to the tongue
continuous with the lumen of trachea
completely encircled by cricoid cartilage

34. superior aperture (laryngeal inlet) V.S. inferior aperture2)
oblique and points posterosuperiorly into the pharynx
horizontal in position

35. superior aperture (laryngeal inlet) V.S. inferior aperture3)
can be closed by downward movement of the epiglottis.
continuously open

36. vestibular and vocal folds divide into three major regions
LARYNGEAL CAVITY
vestibular and vocal folds divide into three major regions
Vestibule
between laryngeal inlet & vestibular folds
Middle part
between vestibular folds & vocal folds
Infraglottic space
between the vocal folds & inferior opening of the larynx

37. separates middle chamber from infraglottic cavity. base
Rima glottidis
between vocal folds
separates middle chamber from infraglottic cavity.
base
formed by interarytenoid bottom of interarytenoid notch. .

38. LARYNGEAL MUSCLES MOVE THE LARYNX AS A WHOLE
INTRINSIC LARYNGEAL MUSCLES
EXTRINSIC LARYNGEAL MUSCLES
MOVE THE LARYNX AS A WHOLE
move the laryngeal components
altering the length and tension of the vocal folds and the size and shape of the rima glottidis

39. TENSOR OF THE VOCAL LIGAMENT*
Superior laryngeal nerve .
TENSOR OF THE VOCAL LIGAMENT
Pulls the thyroid angle anteriorly/inferiorly

40. RELAXER OF THE VOCAL LIGAMENT.
RELAXER OF THE VOCAL LIGAMENT
pulls the arytenoid cartilages anteriorly, toward the thyroid angle
relaxes the vocal ligaments to lower the pitch of the voice.

41. Phonation Adductors of the vocal cords lateral crico-arytenoid muscles.
lateral crico-arytenoid muscles
muscular processes anterior
vocal processes medial
transverse and oblique arytenoid muscles
Vibration of vocal ligaments
Phonation

42. Abductors of the vocal cords
posterior crico-arytenoid muscles

43. FUNCTIONAL ANATOMY OF THE LARYNX
Respiration
Quiet: laryngeal inlet, rima glottidis open
arytenoid cartilages abducted
Forced: rima glottidis widens
arytenoid cartilages rotated laterally, vocal folds abducted

44. FUNCTIONAL ANATOMY OF THE LARYNX
Effort closure
occurs when air is retained in the thoracic cavity to stabilize the trunk
increasing intra-abdominal pressure
Rima glottidis is completely closed.
Completely and forcefully shut the airway

45. FUNCTIONAL ANATOMY OF THE LARYNX Phonation
arytenoid cartilages & vocal folds adducted
rima glottidis closed
Air is forced through the closed rima glottidis
Vocal folds vibrate against each other and produce sounds.
Tension in the vocal folds adjusted by
vocalis & cricothyroid muscles

46. FUNCTIONAL ANATOMY OF THE LARYNX
Swallowing
Rima glottidis closed.
Laryngeal inlet narrowed
Larynx moves up & forward – opens the esophagus
attached to the posterior aspect of the lamina of cricoid cartilage
Epiglottis goes down toward the arytenoid cartilages
laryngeal inlet narrowed or closed .

47. External carotid artery
Subclavian artery

48. Cricothyroid muscle
recurrent (inferior) laryngeal nerve

49. from the inferior end of larynx to the level of T5-T6.
from the inferior end of larynx to the level of T5-T6
Terminates by dividing into right & left main sternal angle.
Main bronchi give branches inside the lungs & form bronchial tree.

50. formed of tracheal rings which are incomplete posteriorly
Posterior parts of the tracheal rings closed by
smooth muscle trachealis muscle. .

51. 5. PLEURA
covers the pulmonary cavities and external surfaces of the lungs in these cavities
visceral pleura invests all surfaces of the lungs
parietal pleura lines the pulmonary cavities & thorax’s inner surface

52. Visceral pleura insensitive to pain
Parietal pleura extremely sensitive to pain
Irritation causes local pain or referred pain
projecting to the dermatomes supplied by the same spinal nerve.

53. pleural cavity contains a capillary layer of serous pleural fluid
potential space between the layers of pleura
contains a capillary layer of serous pleural fluid
lubricates the pleural surfaces
allows layers of pleura slide smoothly over each other during respiration.
lung surface in contact with thoracic wall
lung expands fills with air when thorax expands

54. 5. LUNGS organs of respiration lie on either side of the mediastinum
surrounded by right & left pleural cavities

55. 5. LUNGS Air enters and leaves the lungs via main bronchi
branches of trachea
Inspired air into close relation with venous blood
in pulmonary capillaries.

56. 5. LUNGS
Apex upper pole
3 surfaces costal, mediastinal and diaphragmatic
Root of the lung
2 lobes in the left lung oblique fissure
3 lobes in the right lung horizontal & oblique fissures

58. Tracheobronchial Tree
sublaryngeal airway
superior mediastinum TRUNK OF THE TREE
sternal angle Main bronchi
Right main bronchus & Left main bronchus enter hilum of the lung
Branches of the tracheobranchial tree

59. Tracheobronchial Tree
Main (primary) bronchus
Secondary (lobar) bronchi
2 on the left, 3 on the right
Tertiary (segmental) bronchi .

60. BRONCHOPULMONARY SEGMENTS
largest subdivisions of a lobe
Pyramidal-shaped segments of the lung
apices facing the root of the lung.
Separated from adjacent segments by connective tissue septa.

61. BRONCHOPULMONARY SEGMENTS
largest subdivisions of a lobe
Segmental bronchus & Tertiary branch of pulmonary artery
Drained by intersegmental parts of the pulmonary veins

62. BRONCHOPULMONARY SEGMENTS
largest subdivisions of a lobe
Named according to the segmental bronchi supplying them.
Usually in number
Surgically resectable.

63. tertiary segmental bronchi
conducting (lobular) bronchioles
end as terminal bronchioles
respiratory bronchioles
pulmonary alveolus
basic structural unit of gas exchange in the lung

64. Branching of the bronchial tree
Trachea
Principal bronchus
Lobar bronchi (secondary bronchi)
Segmental bronchi (tertiary bronchi)
Terminal bronchiol
Respiratory bronchiol
Alveolar duct
Alveolar sac
Alveolus

66. mediastinal pleura reflects off mediastinum
root of the lung
mediastinal pleura reflects off mediastinum
a sleeve-like covering for
airway, vessels, nerves, lymphatics which pass between the lung and mediastinum

67. hilum of lung
The root of the lung joins medial surface of the lung here!
mediastinal pleura continuous with visceral hilum of the lung.

68. Vasculature of pleaura & lungs
1 pulmonary artery (venous blood)
2 pulmonary veins (arterial blood)
Each lobe and segment its own artery
Branching of the arteries follow the bronchial tree
Terminate as capillaries around the alveols.

69. Vasculature of pleaura & lungs
Veins of the parietal pleura drain into systemic veins
mainly through the intercostal veins.

70. BRONCHIAL ARTERIES
follow bronchial tree as far as respiratory bronchioles.
Left bronchial arteries
from thoracic aorta
paired
Right bronchial artery
usually arises from 3rd posterior intercostal artery
single artery.

71. BRONCHIAL VEINS
Right bronchial vein into azygos vein
Left bronchial vein into accessory hemiazygos vein.

72. pulmonary plexuses parasympathetic innervation vagus nerve
bronchoconstrictor, vasodilator to the lung vessels, secretomotor to the glands
sympathetic sympathetic trunk
bronchodilator, vasoconstrictor to the lung vessels, inhibitor to glands
parietal pleura intercostal & phrenic nerves