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1 Anatomy Of Tracheo-Bronchial Tree Dr. Supreet Singh Nayyar, AFMC www.nayyarENT.com 17-07-2012 for more presentations, visit www.nayyarENT.com 2 www.nayyarENT.com 17-07-2012 Layout • Embryology • Respiratory Tree ▫ Trachea and main bronchi ▫ Segmental Bronchi ▫ Bronchopulmonary Segments • Structure • Vasculature , Lymphatic and Nerve Supply • Applied Anatomy 3 www.nayyarENT.com 17-07-2012 EMBRYOLOGY • Tracheobronchial Diverticulum below Hypobranchial Eminence – 4th wk IUL • edges – oesophagotracheal septum • fuses caudally • endoderm lining • cranial – Trachea / Larynx • caudal – Bronchi / Lungs 4 www.nayyarENT.com EMBRYOLOGY 17-07-2012 5 www.nayyarENT.com EMBRYOLOGY 17-07-2012 6 www.nayyarENT.com 17-07-2012 7 www.nayyarENT.com The Trachea • Cartilaginous and Membranous tube • Dimensions ▫ Length -10- 12 cm ▫ Ext Dia – 2.0 cm ( 1.5 cm) • Extent – C6 – T4 • Incomplete rings 17-07-2012 8 www.nayyarENT.com 17-07-2012 9 www.nayyarENT.com 17-07-2012 Relations • Cervical ▫ Anteriorly Isthmus of thyroid with inf thyroid vessels Pretracheal fascia Sternothyroid & Sternohyoid Investing layer of Deep Cervical Fascia Skin & superficial fascia ▫ Posteriorly Oesophagus; longus colli; RLN ▫ On each side Thyroid Common Carotid Artery 10 www.nayyarENT.com 17-07-2012 Relation o cervical trachea at C 7 www.nayyarENT.com 17-07-2012 11 12 www.nayyarENT.com 17-07-2012 Relations • Thoracic ▫ Anterior Manubrium Sterni Sternothyroid Thymus Lt Brachiocephalic V Aorta & Lt CCA Deep Cardiac Plexus ▫ Posterior Oesophagus Vertebral Column ▫ Rt Side Right Lung & Pleura Rt Vagus Azygous V ▫ Lt Side Arch of Aorta Lt Common Carotid Lt Subclavian A Lt RLN 13 www.nayyarENT.com 17-07-2012 14 www.nayyarENT.com 17-07-2012 15 www.nayyarENT.com 17-07-2012 The main Bronchi and Branches • Rt and Lt Main Bronchi – T4 level • Carina • The Right Bronchus (bronchus dexter), wider, shorter, and more vertical ▫ ▫ ▫ ▫ 5 cm. long Enters right lung opposite fifth thoracic vertebra Azygos vein arches over it from behind Right pulmonary artery lies at first below and then in front ▫ 2.5 cm along course- Rt Upper Lobe Bronchus ▫ At Hilum of Lung – Middle & Lower Lobe Bronchi 16 Bronchi, Bronchioles, & Alveoli www.nayyarENT.com • Trachea divides into • Primary bronchii divide into • Secondary bronchi divide into • Tertiary bronchi divide into • Bronchioles divide into • Terminal bronchioles divide into • Respiratory bronchioles divide into • Alveolar ducts end in • Alveoli 17-07-2012 17 www.nayyarENT.com 17-07-2012 The Respiratory Tree 18 www.nayyarENT.com 17-07-2012 The Respiratory Tree Structure through the airways 1.Trachea 2. Bronchus (Right- or Left- Primary Bronchus) 3. Lobar Bronchus 4. Segmental Bronchus 5. Bronchus 6. Bronchiole 7. Terminal Bronchiole 8. Respiratory Bronchiole 9. Alveolar Duct 10. Alveolar Sac / Alveolus 19 www.nayyarENT.com 17-07-2012 20 www.nayyarENT.com 17-07-2012 The Respiratory Tree • Rt Upper Lobe Bronchus ▫ ▫ ▫ ▫ ▫ ▫ Rt lat aspect of bronchus Superolaterally 3 segmental Bronchi ( Apical; Post; Ant ) Apical Segmental – Apical & Ant. Subsegmental Br Post Segmental – Lateral & Ant. Subsegmental Br Ant. Segmental – Lateral & Ant. Subsegmental Br • Rt Middle Lobe Bronchus ▫ ▫ ▫ ▫ 2.5 cm beyond Rt Upper Lobe Bronchus Ant aspect Forwards Downwards and Laterally Lateral and Medial Subsegments 21 www.nayyarENT.com 17-07-2012 The Respiratory Tree • Rt lower lobe bronchus ▫ Apical Segmental – post aspect Medial ; Sup ; Lat subsegmental br ▫ Medial Basal ( Cardiac ) – Rt Border of heart ▫ Ant Basal ▫ Lateral Basal ▫ Post Basal 22 www.nayyarENT.com 17-07-2012 23 www.nayyarENT.com 17-07-2012 The Respiratory Tree 24 www.nayyarENT.com 17-07-2012 The Respiratory Tree 25 www.nayyarENT.com 17-07-2012 The Respiratory Tree • Left Bronchus (bronchus sinister) smaller in calibre but longer than the right ▫ 5.5 cm long ▫ Enters root of the left lung opposite sixth thoracic vertebra ▫ Passes beneath Aortic arch, ▫ crosses in front of oesophagus, thoracic duct, descending aorta ▫ Left pulmonary artery lies at first above then in front 26 www.nayyarENT.com 17-07-2012 The Respiratory Tree • Lt upper Lobe Bronchus ▫ Anterolateral aspect 5.5cm from carina ▫ Curves laterally then divides Cranial divisions: Apico posterior and Anterior Caudal divisions : anterolaterally Lingular area of lung Sup and Inf segmental • Lt Lower Lobe Bronchus ▫ Apical segmental Originates posteriorly 1cm below upper lobe orifice ▫ Anteromedial (Anterior Basal and Medial Basal ) ▫ PosterolateralLateral Basal and Post Basal) 27 www.nayyarENT.com 17-07-2012 28 The Lungs • Soft, spongy, coneshaped • Right lung ▫ 3 lobes • Left lung ▫ 2 lobes www.nayyarENT.com 17-07-2012 29 www.nayyarENT.com 17-07-2012 Bronchopulmonary segments • Independent respiratory units • Sectors of lung with tertiary/ segmental bronchus ;separate Br of Pulmonary A • Pyramidal with apex to root of lung • Clinical Significance ▫ Restriction of infections ▫ Segmental resection ▫ Bronchoscopy 30 www.nayyarENT.com 17-07-2012 31 www.nayyarENT.com 17-07-2012 Structure of Trachea and Major Bronchi • Cartilages ▫ 16-20 ▫ Incomplete Rings (4 mm vertically and 1 mm thick) ▫ Union of 2 or more rings partially or completely ▫ Highly elastic ▫ 1st Tracheal Cartilage • Fibrous Membrane ▫ Perichondrium of cartilages ▫ Collgen with elastic fibres ▫ Non striated mus fibres 32 www.nayyarENT.com 17-07-2012 33 www.nayyarENT.com 17-07-2012 Changes as the Respiratory Tree Branches • As branching of bronchi becomes more extensive ▫ Rings of cartilage become plates ▫ Smooth muscle increases ▫ Columnar epithelium becomes cuboidal, then squamous (in alveoli 34 www.nayyarENT.com 17-07-2012 35 www.nayyarENT.com 17-07-2012 • Mucous Membrane ▫ Epith lining – thins and single layered ▫ Tubulo-racemose glands ▫ Not present in bronchioles 36 www.nayyarENT.com 17-07-2012 Vasculature and lymphatics • Blood Supply ▫ ▫ ▫ ▫ Inf Thyroid A Bronchial A – 1 for Rt lung ;2 for Lt Lie against post wall of Bronchi 2 Bronchial Veins Rt – Azygous V Lt – Lt Sup Intercostal V or HemiazygousV ▫ Pulmonary V 37 www.nayyarENT.com 17-07-2012 Vasculature and lymphatics • Lymphatic Drainage ▫ Pretracheal and Paratracheal groups ▫ Superficial System- Tissue beneath pleura vessels round lung borders and fissures to reach hilum numerous Valves ▫ Deep System- Bronchial Tree; Pulm Vessels hilum- drain into Bronchopulmonary Nodes less no. of Valves ▫ Rt and Lt Paratracheal LN unite with Internal Thoracic and Brachiocephalic LN 38 www.nayyarENT.com 17-07-2012 39 www.nayyarENT.com 17-07-2012 Nerve Supply ▫ Parasympathetic ( Vagus) Motor to bronchial muscle – bronchospasm Secretomotor to mucous gland Sensory- stretch and Cough Reflex ▫ Sympathetic Cervical Ganglion and Spinal N. T2 – T5 Inhibitory to smooth muscle and glands 40 www.nayyarENT.com Applied Anatomy • Tracheostomy • Bronchoscopy • Foreign Body In Respi Tract 17-07-2012 41 www.nayyarENT.com 17-07-2012 42 www.nayyarENT.com 17-07-2012 43 www.nayyarENT.com 17-07-2012