larynx, treachea & bronchi - wordpress.com...(relax vocal cords). o thyroarytenoid (vocalis)....
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LARYNX, TREACHEA & BRONCHI
Khaleel Alyahya, PhD, MEdwww.khaleelalyahya.net 1
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RESOURCES
RESOURCES
Gray’s Anatomy
Clinical Anatomy
www.kenhub.com
Atlas of Human Anatomy
Human Anatomy & Physiology
Mosby’s Dictionary
2Khaleel Alyahya, PhD, MEd
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OBJECTIVES
One Two Three Four Five
Describe the Extent,
structure and functions
of the larynx.
Describe the Extent,
structure and functions
of the trachea.
Describe the bronchi
and branching of the
bronchial tree.
Describe the functions
of bronchi and their
divisions
Clinical anatomy
3Khaleel Alyahya, PhD, MEd
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Larynx
4
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INTRODUCTION
Customer
Objectives
Tasks▪ The larynx is the part of the respiratory tract which contains
the vocal cords.
▪ In adult it is 2-inch-long tube.
▪ It opens above into the laryngeal part of the pharynx.
▪ Below, it is continuous with the trachea.
▪ The larynx has functions in:
• Respiration (breathing).
• Phonation (voice production).
• Deglutition (swallowing).
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RELATIONS
Customer
Objectives
▪ The larynx is related to major critical structures in the neck.
▪ Arteries
• Carotid arteries: (common, external and internal).
• Thyroid arteries: (superior & inferior thyroid arteries).
▪ Veins
• Jugular veins, (external & internal)
▪ Nerves
• Laryngeal nerves (Superior laryngeal & recurrent laryngeal).
• Vagus nerve.
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STRUCTURES
Customer
Objectives
▪ The larynx consists of four basic components:
• Cartilaginous skeleton.
• Membranes and ligaments.
• Muscles (Intrinsic & extrinsic muscles).
• Mucosal lining.
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FUNCTIONS
Customer
Objectives
▪ Protective sphincter at the air passage.
▪ Phonation.
▪ Regulates air passage in inspiration and expiration.
▪ Opens & closes during swallowing, coughing & sneezing.
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CARTILAGES
Customer
Objectives
▪ Unpaired (Single) Cartilages
• Epiglottis
• Thyroid cartilage
• Cricoid
▪ Paired Cartilages
• Arytenoid
• Corniculate
• Cuneiform
▪ All cartilages are hyaline
• Except the epiglottis
o elastic cartilage
▪ Cartilages are connected by joints, membranes and ligaments.
▪ Cartilages are moved by muscles.
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MEMBRANES & LIGAMENTS
Customer
Objectives
▪ Thyrohyoid membrane
• The thyrohyoid membrane is thickened in the median plane to form
median thyrohyoid ligament and on both sides to form lateral
thyrohyoid ligaments.
▪ Cricothyroid membrane (conus elasticus)
• Its lower margin is attached to the upper border of cricoid cartilage.
• Upper free margin forms vocal ligament which forms the true vocalcord.
▪ Cricotracheal membrane
▪ Hyoepiglottic ligament
▪ Thyroepiglottic ligament
▪ Quadrangular membrane (aryepiglottic membrane):
• It extends between the arytenoid and epiglottis.
• Its lower free margin forms the vestibular ligament which forms the vestibular fold (false vocal cord).
10Khaleel Alyahya, PhD, MEd
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LARYNGEAL INLET
Customer
Objectives
▪ It is the upper opening of the larynx.
▪ It faces upward and backward and opens into the laryngealpart of the pharynx, (laryngopharynx).
▪ Bounded:
• Anteriorly by the upper margin of epiglottis (E)
• Posteriorly & below by arytenoid cartilages (A)
• Laterally by the Aryepiglottic folds (AEF)
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LARYNGEAL CAVITY
Customer
Objectives
▪ Extends from laryngeal inlet to lower border of the cricoidcartilage
▪ Narrow in the region of the vestibular folds (rima vestibuli)
▪ Narrowest in the region of the vocal folds (rima glottidis)
▪ Divided into three parts:
• Supraglottic part or vestibule: it is the part above the vestibularfolds.
• Ventricle: it is the part between the vestibular folds & the vocal folds.
• Infraglottic part, the part below the vocal folds.
o NB. The ventricle has an upward invagination called saccule which is rich ingoblet cells.
▪ The cavity is lined with ciliated columnar epithelium except thesurface of the vocal cords.
▪ The surface of vocal folds, is covered with stratified squamousepithelium because of exposure to continuous trauma duringphonation.
▪ It contains many mucous glands, more numerous in the region ofthe saccule (for lubrication of vocal folds).
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MUSCLES
Customer
Objectives
▪ Laryngeal muscles are divided into two groups:
• Extrinsic muscles: subdivided into two groups:
o Elevators of the larynx.
o Depressors of the larynx.
• Intrinsic muscles: subdivided into two groups:
o Muscles controlling the laryngeal inlet.
o Muscles controlling the movements of the vocal cords.
13Khaleel Alyahya, PhD, MEd
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EXTRINSIC MUSCLES
Customer
Objectives
▪ Elevators of the Larynx
• The Suprahyoid Muscles (MSGD)
o Mylohyoid
o Stylohyoid
o Geniohyoid
o Digastric
• The Longitudinal Muscles of the Pharynx
o Stylopharyngeus
o Salpingopharyngeus
o Palatopharyngeus
▪ Depressors of the Larynx
• The Infrahyoid Muscles
o Sternohyoid
o Sternothyroid
o Omohyoid
14Khaleel Alyahya, PhD, MEd
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INTRINSIC MUSCLES
Customer
Objectives
▪ Muscles Controlling the Laryngeal Inlet
• Oblique arytenoid.
• Aryepiglottic muscle.
▪ Muscles controlling the vocal cords
• Muscle decreasing the Length & Tension of Vocal Cords(relax vocal cords).
o Thyroarytenoid (vocalis).
• Muscle increasing the Length & Tension of Vocal Cords.
o Cricothyroid.
• NB. It is the only intrinsic muscle which found outside the larynx.
• Adductors (close rima glottis)
o Lateral cricoarytenoid.
o Transverse arytenoid.
• Abductor (open rima glottis)
o Posterior cricoarytenoid.
15Khaleel Alyahya, PhD, MEd
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BLOOD SUPPLY
Customer
Objectives
Resources
▪ ARTERIES
• Superior Laryngeal Artery
o branch of superior thyroid artery
• Inferior Laryngeal Artery
o branch of inferior thyroid artery
▪ VIENS
• The superior and inferior laryngeal veins drain thelarynx and share the same course as the arteries.
• Superior Laryngeal Vein
o drain into the superior thyroid veins, which empty intothe internal jugular veins.
• Inferior Laryngeal Vein
o drain into the inferior thyroid veins, which empty intothe left brachiocephalic vein.
16Khaleel Alyahya, PhD, MEd
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INNERVATION
Customer
Objectives
▪ Sensory
• Above the vocal cords: Internal laryngeal nerve, branch ofthe superior laryngeal of the vagus nerve.
• Below the vocal cords: Recurrent laryngeal nerve, of thevagus nerve.
▪ Motor
• All intrinsic muscles, are supplied by the recurrent laryngealnerve except the cricothyroid.
• The cricothyroid is supplied by the external laryngeal nerveof superior laryngeal of vagus.
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SEMON’S LAW
Customer
Objectives
▪ It is the damage of the recurrent laryngeal Nerve.
▪ Semon’s Law indicates the different effect betweendamage (surgical trauma) and transection of therecurrent laryngeal nerve due to surgery in region of theneck (e.g., thyroidectomy or parathyroidectomy).
• N.B: The nerve fibers supplying the abductors of the vocalfolds lie in the periphery of the recurrent laryngeal nerveand any progressive lesion involves these fibers first beforeinvolving the deeper fibers that supply the adductors.
18Khaleel Alyahya, PhD, MEd
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Trachea
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INTRODUCTION
Customer
Objectives
▪ The windpipe.
▪ Mobile, fibrocartilaginous tube, 5 inches long, 1 inch indiameter.
▪ It begins in the neck below the cricoid cartilage of thelarynx (at lower border of cricoid cartilage at (C6).
▪ It ends in the thorax at the level of sternal angle (lowerborder of T4), by dividing into right and left principal(main, primary) bronchi.
▪ The ridge at the bifurcation from inside is called carina.
▪ It is the most sensitive part of the respiratory tract and isassociated with the cough reflex.
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RELATIONS
Customer
Objectives
Resources
▪ Anterior• Sternum.• Thymus, (remains of thymus gland).• Left brachiocephalic vein.• Arch of aorta.• Origin of:• Brachiocephalic artery.• left common carotid artery.
▪ Posterior• Esophagus.• Left recurrent laryngeal nerve.
▪ Left side• Arch of aorta.• Left common carotid artery.• left subclavian artery.• Left vagus nerve.• Left phrenic nerve.• Pleura.
▪ Right side• Azygos vein• Right vagus nerve.• Pleura
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BLOOD SUPPLY
Customer
Objectives
▪ Arteries
• Branches from the inferior thyroid and bronchialarteries (from descending thoracic aorta)
▪ Veins
• Drain to inferior thyroid veins.
▪ Lymphatic Drainage
• Into the pretracheal and paratracheal lymph nodes.
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INNERVATION
Customer
Objectives
▪ Branches of the vagus nerve and recurrent laryngealnerve give sensory fibers to supply the mucousmembrane.
▪ Branches from the sympathetic trunks supply thetrachealis muscle and the blood vessels.
23Khaleel Alyahya, PhD, MEd
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Bronchi
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BRONCHUS
Customer
Objectives
▪ Right Principal Bronchus
• About one inch long.
• Wider, shorter and more vertical than the left.
• Gives superior lobar bronchus before entering the hilum ofthe right lung.
• On entering the hilum, it divides into middle and inferiorlobar bronchi.
▪ Left Principal Bronchus
• About two inches long.
• Narrower, longer and more horizontal than the right.
• Passes to the left below the aortic arch and in front ofesophagus.
• On entering the hilum of the left lung, it divides intosuperior and inferior lobar bronchi.
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BRONCHIAL DIVISION
Customer
Objectives
▪ Within the lung, each bronchus divides and redivides intonumber of branches that can be divided into two groups:
• Conduction zone branches
o Primary (main) bronchi.
o Secondary (lobar) bronchi.
o Tertiary (segmental) bronchi. (supply the bronchopulmonarysegment).
o Smaller bronchi.
o Bronchioles.
o Terminal bronchioles.
• Respiratory zone branches
o Respiratory bronchioles.
o Alveolar ducts.
o Alveolar sacs.
o Alveoli.
26Khaleel Alyahya, PhD, MEd