Download Lower Respiratory Tract

Lower respiratory tract
1. Larynx
2. Windpipe (trachea)
3. Bronchi
SPLANCHNOLOGY
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 – C3 (epiglottis)-C6
in women and children – higher
in babies – up to C2-C3
in older people – C4-C6:
descended larynx,
descensus laryngis
vocal folds – C5
at the front – previsceral space
at the back – attached to the pharynx
Prof. Dr. Nikolai Lazarov
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SPLANCHNOLOGY
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
Prof. Dr. Nikolai Lazarov
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SPLANCHNOLOGY
Joints of the larynx
Laryngeal articulations:
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
Prof. Dr. Nikolai Lazarov
4
SPLANCHNOLOGY
Laryngeal musculature
Extrinsic muscles:
laryngeal elevators
the stylohyoid
the geniohyoid
the digastric
laryngeal detractors
inferior pharyngeal constrictor muscle
Prof. Dr. Nikolai Lazarov
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SPLANCHNOLOGY
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
Prof. Dr. Nikolai Lazarov
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SPLANCHNOLOGY
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
Prof. Dr. Nikolai Lazarov
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SPLANCHNOLOGY
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
Prof. Dr. Nikolai Lazarov
8
SPLANCHNOLOGY
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
Prof. Dr. Nikolai Lazarov
9
SPLANCHNOLOGY
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
Prof. Dr. Nikolai Lazarov
10
SPLANCHNOLOGY
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
Prof. Dr. Nikolai Lazarov
11
SPLANCHNOLOGY
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
Prof. Dr. Nikolai Lazarov
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SPLANCHNOLOGY
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
Prof. Dr. Nikolai Lazarov
13
SPLANCHNOLOGY
The windpipe, trachea
The windpipe, trachea:
a short cartilaginous and membranous tube;
length 11-13 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
15-20 cartilage rings
Topography – relations of the trachea:
in the median plane, in front of esophagus
begin – C6-C7
bifurcatio tracheae – Th4-Th5
Prof. Dr. Nikolai Lazarov
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SPLANCHNOLOGY
Prof. Dr. Nikolai Lazarov
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SPLANCHNOLOGY
The principal bronchi,
bronchi principales
Principal bronchi, bronchi principales:
bifurcatio tracheae – Th4-Th5;
Th2 (newborns)-Th7 (elderly people)
angle – 55-65° (adults); 70-80° (children)
carina tracheales
The left principal bronchus,
bronchus principalis sinister:
more transverse
longer
length – 4-5 cm
9-12 cartilages
narrower – 10-11 mm
The right principal bronchus,
bronchus principalis dexter:
more vertical than the left
shorter
length – 3 cm
6-9 cartilages
wider – 15-16 mm
Prof. Dr. Nikolai Lazarov
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SPLANCHNOLOGY
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
Prof. Dr. Nikolai Lazarov
17
SPLANCHNOLOGY
Microscopic anatomy
tunica mucosa respiratoria:
lamina epithelialis – ciliated,
pseudostratified epithelium:
ciliated cells,
epitheliocyti ciliati – 250-300 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
Prof. Dr. Nikolai Lazarov
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SPLANCHNOLOGY
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
Prof. Dr. Nikolai Lazarov
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SPLANCHNOLOGY
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
Prof. Dr. Nikolai Lazarov
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SPLANCHNOLOGY
Lymph vessels
of tracheobronchial tree
Lymphatic drainage:
deep lateral cervical lymph nodes
pre-, paratracheal and tracheobronchial lymph nodes
Prof. Dr. Nikolai Lazarov
21
SPLANCHNOLOGY
Nerves of tracheobronchial tree
Innervation –
laryngeal recurrent nerve
and pulmonary plexus:
sympathetic
vagus nerve
sympathetic
sympathetic trunk
sensory
vagus nerve
spinal cord
Prof. Dr. Nikolai Lazarov
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SPLANCHNOLOGY
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
Prof. Dr. Nikolai Lazarov
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SPLANCHNOLOGY
Thank you ...
Prof. Dr. Nikolai Lazarov
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