Lower respiratory tract
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1 Lower respiratory tract 1. Larynx 2. Windpipe (trachea) 3. Bronchi
2 The larynx, larynx The larynx, larynx a wind and stringed musical instrument: an air passage an organ of phonation Topography skeletotopy and syntopy: in men C 3 (epiglottis)-c 6 in women and children higher in babies up to C 2 -C 3 in older people C 4 -C 6 : descended larynx, descensus laryngis vocal folds C 5 at the front previsceral space at the back attached to the pharynx 2
3 Cartilages of the larynx Laryngeal cartilages hyaline and elastic cartilages: unpaired thyroid cartilage cricoid cartilage cartilage of epiglottis paired arytenoid cartilages corniculate cartilages cuneiform cartilages cartilago triticea cartilagines sesamoideae, anteriores et posteriores 3
4 Laryngeal articulations: Joints of the larynx laryngeal ligaments and membranes membrana thyrohyoidea o lig. thyrohyoideum medianum et laterale lig. thyroepiglotticum membrana fibroelastica conus elasticus o lig. vocale o lig. cricothyroidem (lig. conicum) lig. cricoarytenoideum membrana quadrangularis lig. ventriculare lig. cricotracheale laryngeal articulations art. cricothyroidea art. cricoarytenoidea 4
5 Laryngeal musculature Extrinsic muscles: laryngeal elevators the stylohyoid the geniohyoid the digastric laryngeal detractors inferior pharyngeal constrictor muscle 5
6 Laryngeal musculature Intrinsic muscles: paired the cricothyroid (m. anticus) the posterior crico-arytenoid (m. posticus) the lateral crico-arytenoid the oblique arytenoid and its subsidiary aryepiglotticus the thyro-arytenoid and its subsidiary part the vocalis the thyro-epiglotticus unpaired the transverse arytenoid 6
7 Laryngeal musculature Movements of the vocal folds: broadening the vocal slits the posterior crico-arytenoid narrowing the vocal slits the lateral crico-arytenoid the transverse arytenoid stretching the vocal cords the cricothyroid (m. anticus) relaxing the vocal cords the thyro-arytenoid (m. vocalis) narrowing the glottis the aryepiglottic muscle the oblique arytenoid broadening the glottis the thyro-epiglotticus 7
8 Innervation of the larynx Motor innervation vagus nerve (accessory nerve): n. laryngeus inferior (recurrens) most of the laryngeal muscles n. laryngeus superior (r. externus) m. cricothyroideus Sensory innervation vagus: n. laryngeus superior the mucosa above glottis n. laryngeus inferior the mucosa below the vocal folds 8
9 Innervation of the larynx Motor innervation vagus nerve (accessory nerve): n. laryngeus inferior (recurrens) most of the laryngeal muscles n. laryngeus superior (r. externus) m. cricothyroideus Sensory innervation vagus: n. laryngeus superior the mucosa above glottis n. laryngeus inferior the mucosa below the vocal folds 9
10 Microscopic anatomy Mucosa, tunica mucosa laryngis: lamina epithelialis multilayered columnar ciliated epithelium stratified squamous non-keratinized vocal folds, laryngeal vestibule lamina propria oedema laryngis laryngeal glands tubulo-alveolar o epiglottic glands o laryngeal ventricle glands lymphoid nodules, laryngeal tonsil Submucosa, tela submucosa: membrana fibroelastica laryngis plica aryepiglottica tuberculum cuneiforme et tuberculum corniculatum incisura interarytenoidea recessus piriformis 10
11 Microscopic anatomy Mucosa, tunica mucosa laryngis: lamina epithelialis multilayered columnar ciliated epithelium stratified squamous non-keratinized vocal folds, laryngeal vestibule lamina propria oedema laryngis laryngeal glands tubulo-alveolar o epiglottic glands o laryngeal ventricle glands lymphoid nodules, laryngeal tonsil Submucosa, tela submucosa: membrana fibroelastica laryngis plica aryepiglottica tuberculum cuneiforme et tuberculum corniculatum incisura interarytenoidea recessus piriformis 11
12 The cavity of the larynx divided into three parts hour(sand)-glass: supraglottic space, vestibule, vestibulum laryngis the inlet, aditus laryngis transglottic space ventricular folds rima vestibuli vocal folds, cords (m. vocalis) rima glottidis (glottis) o intermembranous part, pars intermembranacea o intercartilaginous part, pars intercartilaginea subglottic soace, cavitas infraglottica 12
13 Laryngeal vessels Blood suply: superior laryngeal artery ramus cricothyroideus inferior laryngeal artery Venous drainage: homonymous veins internal jugular vein, brachiocephalic vein Lymphatic drainage: the upper part deep cervical lymph nodes (along inferior thyroid artery) the middle part prelaryngeal lymph nodes the lower part paratracheal lymph nodes 13
14 The windpipe, trachea The windpipe, trachea: ashort cartilaginous andmembranous tube; length cm; diameter 2.5 cm a conduit for air; assists in conditioning inspired air in the neck and the thorax, cervical part and thoracic part cartilage rings Topography relations of the trachea: in the median plane, in front of esophagus begin C 6 -C 7 bifurcatio tracheae Th 4 -Th 5 14
15 15
16 The principal bronchi, bronchi principales Principal bronchi, bronchi principales: bifurcatio tracheae Th 4 -Th 5 ; Th 2 (newborns)-th 7 (elderly people) angle (adults); (children) carina tracheales The left principal bronchus, bronchus principalis sinister: more transverse longer length 4-5 cm 9-12 cartilages narrower mm The right principal bronchus, bronchus principalis dexter: more vertical than the left shorter length 3 cm 6-9 cartilages wider mm 16
17 The tracheal wall Mucosa, tunica mucosa respiratoria: lamina epithelialis multilayered ciliated epithelium lamina propria mucosae elastic fibers and blood vessels lymphatic nodules BALT tela submucosa seromucous tracheal glands, gll. tracheales lamina fibrarum elasticum Tunica fibromusculocartilaginea: C-shaped tracheal cartilages tracheal muscle, m. trachealis lig. anularia Tunica adventitia 17
18 Microscopic anatomy tunica mucosa respiratoria: lamina epithelialis ciliated, pseudostratified epithelium: ciliated cells, epitheliocyti ciliati kinocilia mucous (goblet) cells, exocrinocyti caliciformis basal cells reserve population of stem cells brush cells microvilli, receptor cells small granule (Kulchitsky or K-) cells neuroendocrine-like cells 18
19 Bronchial microscopic structure Mucosa, tunica mucosa respiratoria: lamina epithelialis pseudostratified columnar ciliated epithelium lamina propria elastic fiber network and blood vessels BALT tela submucosa bronchial glands, gll. bronchiales lamina fibrarum elasticum Tunica fibromusculocartilaginea: bronchial cartilages plates bronchial muscle, m. bronchialis lig. anularia Tunica adventitia 19
20 Vessels of tracheobronchial tree Blood supply: trachea tracheal branches: inferior thyroid artery internal thoracic artery thoracic aorta bronchi tracheal branches: thoracic aorta Venous drainage: paratracheal and parabronchial venous plexuses inferior thyroid vein bronchial veins 20
21 Lymph vessels of tracheobronchial tree Lymphatic drainage: deep lateral cervical lymph nodes pre-, paratracheal and tracheobronchial lymph nodes 21
22 Nerves of tracheobronchial tree Innervation laryngeal recurrent nerve and pulmonary plexus: sympathetic vagus nerve sympathetic sympathetic trunk sensory vagus nerve spinal cord 22
23 Tracheotomy vs. tracheostomy superior (coniotomy) middle, and inferior tracheotomy Acute conditions: severe facial trauma large congenital tumors of the head & neck (e.g., branchial cleft cyst) acute inflammations of head and neck Chronic setting: long-lasting mechanical ventilation (coma) sleep surgery for obstructive sleep apnea 23
24 Thank you... 24
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