Nasal cavity

Parts and boundaries:

• It extends from nostril anterior
to posterior nasal aperture
posterior, where it opens into
nasopharynx.
• It is divided into right and left
halves by a septum. Each half
is wedge shaped having.
Roof: formed of 3 parts.
- Middle horizontal part
(cribriform plate of ethmoid)
- Anterior sloping part (frontal
and nasal bone).
- Posterior sloping part (body of sphenoid or sphenoidal part).
Floor:
• formed by hard palate which
formed of (palatine process of
maxilla &horizontal plate of
palatine bone).
Medial wall: the nasal septum which is
formed mainly by
• Perpendicular plate of
ethmoid.
• Septal cartilage.
• vomer
Lateral wall:
• has 3 projections of bone
called superior, middle &
inferior nasal conchae.
• the space below each
concha called a meatus.
• The inferior concha is a
separate bone; other
2 conchae are projections
of ethmoid bone.

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N.b: Ethmoidal bone share in formation of roof, medial & lateral walls.
Features of (and openings in) the lateral wall: 3 conchae:
Sphenoethmoidal recess: above the superior concha and receives opening of
sphenoidal air sinus.
Superior meatus: below superior concha and receives opening of post.
Ethmoidal sinus.
Middle meatus: below the middle concha and shows.
• Bulla ethmoidalis: rounded elevation produced by middle ethmoidal
sinus which opens at the bulla.
• Hiatus semilunaris: groove below the bulla, its anterior end leads to
infundibulum. In its anterior part the opening of frontal and ant.
Ethmoidal sinuses in infundibulum, in its post part the opening of
maxillary sinus.
Inferior meatus: below the inferior concha: it shows opening of nasolacrimal duct.

Mucous membrane of nasal cavity (functional):

a- Vestibule:
- A dilated anterior part just to the
inside of nostrils. It is lined by
modified skin with coarse hairs.
b- Olfactory region:
It includes the roof, the area above the
superior concha. It's lined with Olfactory
mucous membrane& contain nerve endings
sensitive to reception of smell

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c- Respiratory region: The lower part of nasal cavity which is lined by
respiratory epithelium, containing mainly ciliated cells and mucous secreting
cells. Its submucosa contains plexus of veins to heat up the inspired air.
- The presence of mucous on the surface of the conchae trap the foreign
particles & organisms in the inspired air, which are the swallowed &
destroyed by gastric acid.

Blood supply of nasal cavity:

sphenopalatine artery: the main artery
of the nose, it arises from 3rd part of
maxillary it anastomoses with
septal branch of the superior labial
artery (of facial) in the region of vestibule
(the area of epistaxis).
The anterior and posterior
ethmoidal branch of ophthalmic artery.

Nerve supply of nasal cavity:

a- General sensation by:
- Ethmoidal branches of Ophthalmic
nerve of trigeminal & maxillary nerve
of trigeminal
b-special sense (1st cranial nerve):
olfactory nerve arises from the olfactory
mucosa, ascending through the cribriform
plate of ethmoid to end in the olfactory bulb

Lymph nodes:
- vestibule end in submandibular lymph nodes.
- remainder of the nasal cavity into upper
deep cervical lymph nodes

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 Paranasal sinuses
Definition:
are cavities found in the interior of
the maxilla, frontal, sphenoidal &
ethmoidal bones
- They are lined with
mucoperiosteum & filled with
air, they communicate with nasal
cavity through relatively small
nasal apertures.
Development:
- The maxillary & sphenoidal air
sinuses are rudimentary at birth or even absent.
- They enlarge after 8 years and become fully formed in adolescence.

Function: Resonance of voice & decrease weight of skull.

Individual Sinuses
Frontal sinus:
- Two frontal sinuses separated by bony septum. Triangle in shape
- In the frontal bone deep to superciliary arch.
It opens into infundibulum which
opens in the anterior end of the hiatus
semilunaris in the middle meatus of
nose.
Sphenoidal sinus:
- Bilateral sinus in the body of
sphenoid. Opens in
Sphenoethmoidal recess: above
the superior concha
Ethmoidal air sinus:
They are 3 sinuses (ANTERIOR,
MIDDLE & POSTERIOR) contained
inside the ethmoidal bone between the
orbit and nose
-They are separated from the orbit by thin plate of bone so the infection can
rapidly spread from sinuses to the orbit
- They vary in number from 3-18 air cells arranged into 3 groups:
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 Maxillary sinus:
- The largest and lies within body of
maxilla. and the only one present at
birth.
- It is pyramidal in shape.
Roof: it is the floor of orbit.
Floor: roots of upper molar and premolar
teeth.
- It opens in the middle meatus of the nose
at the posterior end of hiatus semilunaris
LUNGS
Position: Spongy organ lies in the thoracic
cavity on either side of the heart. Part of
respiratory system for gas exchange.
Colour: Pink in early life, but dark and
mottled in adult.
Rt lung 620 g and left lung 570 gm
Shape: half a cone having Apex, a base,
costal surface (lateral) and medial surface,
anterior and posterior borders.

* The apex of the lung:

About one inch above the medial one
third of the clavicle.
- Covered by: cervical pleura and
suprapleural membrane.
- Anterior: Subclavian artery.
- Posteriorly: it is separated from the
neck of the first rib by sympathetic
trunk, superior intercostal vessels and
the first thoracic nerve.
* The base of the lung: -
- It is concave & related to the
diaphragm. The concavity is deeper in
Rt side as the Rt cupola of diaphragm is
higher than left.
- The diaphragm separates it from the
liver, stomach and spleen

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* Borders of the lung:
1- Anterior border: -
- It is thin and sharp.
- It extends into the costo –
mediastinal pleural recess.
- It has a notch called cardiac
notch on the left lung, at the
level of the 4th and 5th
intercostal spaces. Blow
cardiac notch is the lingula
2- Posterior border: -
- It is thick and rounded. It lies
along the vertebral column.
3- Inferior border: -
- Its anterior, lateral and posterior parts are sharp and thin, extending into
the costo- diaphragmatic recess.
- Its medial part is blunt and is related to the base of pericardium.
- Separate the base from costal and medial surface.

* Surfaces of the lung:

- Three surfaces: costal, medial and diaphragmatic (base – see before).
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 1- Costal surface: -
Convex& related to the costal pleura which separates it from the ribs, costal
cartilages and intercostal muscles.
2- Medial surface: -Contain hilum that
- Divide the medial surface into ant. (mediastinal surface) and posterior
(vertebral surface).
- The vertebral surface is related to the sides of the thoracic vertebral
bodies, intervertebral discs, posterior intercostal vessels.
mediastinal surface of the right lung mediastinal surface of the left lung
1-infront of hilum 1-infront of hilum
a- Cardiac impression: related to the a. Cardiac impression: - It is related to the
pericardium and right atrium. pericardium and left ventricle.
b- Ascending aorta: area infront of SVC & b. Pulmonary trunk.
also related to the thymus gland.

2-Above hilum. 2-Above hilum.

c- The arch of azygos vein c. The arch of aorta.
d- Superior vena cava & right innominate vein d. Left common carotid artery or (left
in front of upper part of the hilum. brachiocephalic vein) forms a vertical groove
e- Trachea and right vagus nerve: behind the above arch of aorta.
SVC and above the azygos arch. e. Left subclavian artery forms a groove
f- Oesophagus: behind trachea behind the left common carotid artery.
f. Oesophagus:
3-Behind the hilum.
g- Oesophagus: vertical groove behind the 3-Behind the hilum.
hilum. g. Descending aorta: - It forms a vertical
h- Azygos vein: a vertical groove behind the groove behind the hilum
oesophagus. h. Oesophagus:

Rt phrenic nerve crosses over the right innominate The left phrenic nerve crosses the groove for arch
vein, SVC, pericardial impression and IVC of aorta and the pericardial impression.

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 Root of the lung:
- It lies opposite 5th, 6th and 7th thoracic vertebrae.
- It consists of (7 structures): bronchus, pulmonary artery, two pulmonary
veins, bronchopulmonary lymph nodes, bronchial vessels, pulmonary
plexuses and pleural covering.
Rt root Left root
bronchus: Posterior in position Main bronchus(hyparterial) & Main bronchus
Superior lobar bronchus (eparterial)
bronchus.

Pulmonary artery between the two bronchi Above & anterior to bronchus
Bronchial arteries: behind One bronchial artery arises from the Two bronchial arise from the
bronchi upper left bronchial artery or from the descending thoracic aorta.
right 3rd posterior intercostal artery.
Bronchial vein One vein end in azygos vein. End in hemi azygos vein.
Pulmonary veins The superior pulmonary vein is more anterior structure.
The inferior pulmonary vein is the lowermost structure in the root
pulmonary plexuses Anterior and posterior. Supply lung, bronchi and bronchioles

8
Bronchopulmonary lymph between the main structures of the root ,in adult are black in colors due
nodes to carbon particles.
Pleural covering Surrounds the root and form downward prolongation below the root
which is pulmonary ligament.

N.b: Hilum of lung: part of medial surface that admits the structures
forming root of lung.
* Fissures of the lung:
1- Oblique fissure: -
- It is present in the two lungs.
- It separates the upper lobe from
the lower lobe in the left lung. Or
the upper and middle lobes from
the lower lobe in the right lung.
- It begins at the posterior border of
the lung opposite T3 spine.
- It passes downwards and forwards
along the line of the 6th rib.
- It ends at the inferior border at the
6th costochondral junction.
Corresponds to medial border of scapula
during raising arm above head.
2- Horizontal fissure: -
- It is presents in the right lung
only.
- It begins at the anterior border at the 4th costal cartilage and extends
horizontally to meet the oblique fissure at the midaxillary line at 6th rib.

9
 * Lobes of the lung: -
A- Left lung: It is divided into superior and inferior lobes by an oblique
fissure.
1- the superior lobe is above & infront the oblique fissure.
It contains the apex & all the anterior border
2-the inferior lobe is below & behind the oblique fissure.
It contains the base & the greater part of posterior border

B- Right lung: It is divided into superior, middle and inferior lobes by oblique
and horizontal fissures.
The MIDDLE LOBE is wedge -shaped & is cut off from the superior lobe

Bronchial tree: trachea, 2 main bronchi-lobar bronchi-segmental bronchi-

terminal bronchioles-respiratory bronchioles-alveolar duct- alveolar sac-
alveoli.

Differences between the right and left lungs

Right lung Left lung
1- Size Larger Smaller
2- Lobes Three lobes Two lobes
3- Length Shorter Langer
4- Cardiac notch Absent Present
5- Hilum Contains two bronchi Contains on bronchus
and on bronchial artery and two bronchial
arteries
6- Fissures Oblique and transverse Only oblique fissure
fissures
7- Segments Ten Eight

Bronchopulmonary segments:
- Definition: (segments) of the lung. Each segment is supplied by
segmental bronchus, a branch of the pulmonary artery and lymphatic
vessels. The tributaries of pulmonary vein usually run in the
intersegmental planes, between the bronchopulmonary segments.
- Each segment is Pyramidal in shape with its apex directed towards the
root of the lung.
- Distribution of bronchopulmonary segments: -
A- Right lung:
1- Upper lobe: Apical segment. Anterior segment. Posterior segment.
2- Middle lobe: Lateral segment. Medial segment.

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 3- Lower lobe:
Apical segment - Medial basal segment - Anterior basal segment.
Lateral basal segment - posterior basal segment.

N.B: Each lobe contains secondary lobar bronchus which divide into segmental
bronchi, the distribution of the segmental bronchi is the same distribution of the
segments.

B- Left lung: It has two lobar bronchi, one for each lobe.
1- Upper lobe: Apical segment -
Anterior segment - posterior
segment - Superior
lingual segment -Inferior
lingual segment.
2- Lower lobe: Apical Segment-
Medial basal Segment-
Anterior basal segment-
Lateral basal segment-
Posterior basal segment.

Note: The medial basal segment is

usually absent.
- In the left lung, the apical
segment of upper lobe usually
united with the posterior segment to form apicoposterior segment.
- So, the left lung may be 8 or 9 or 10 segments.

11
The distribution of the segmental bronchi is the same distribution of the
segments.

Clinical significance of bronchopulmonary segments: -If the

bronchopulmonary segment is diseased it can be removed alone and the rest of
the healthy lung is left intact.

* Blood supply of the lungs

1- Bronchial arteries (nutrient vessels of the lung):
- They supply trachea, main bronchi-lobar bronchi-segmental bronchi-
terminal bronchioles-respiratory bronchioles.
- the alveoli supplied by capillary plexus from the pulmonary artery.
2- Bronchial veins: -
- The two right bronchial vein drains into the azygos vein.
- The two left bronchial vein drains into the superior hemiazygos vein.
3- Pulmonary artery: -
- Each lung has one pulmonary artery which gives off branches which run
alongside the divisions of the bronchi.
4- Pulmonary veins: -
- Each lung is drained by two veins that carry oxygenated blood to left
atrium.
- The superior pulmonary vein is more anterior structure infront of pulmonary
artery.
- The inferior pulmonary vein is the lowermost structure in the root, lie below
the bronchus.

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* Lymph drainage of the lungs:
- The wall of the alveoli is
devoid of lymph vessels.
- The lymph vessels drain into
intrapulmonary lymph nodes
then into bronchopulmonary
lymph nodes that lie at hilum
of lung.
- Bronchopulmonary lymph
nodes reach the
tracheobronchial lymph
nodes then to tracheal lymph
nodes & finally mediastinal
lymph nodes.
- Two Broncho mediastinal
lymph trunks drain into the thoracic duct on the left side or right
lymphatic duct on the right side.
* Nerve supply of the lungs: -
- Anterior and posterior pulmonary plexuses which lie in front and
behind the root of the lung.

* Surface anatomy of the lungs: -

1- Apex of the lung: -
- Curved line from sternoclavicular joint to a point one inch above the junction
of the medial and intermediate thirds of the clavicle.
2- Anterior border of the lung: -
a- On the right side: - It is represented by a line drawn downwards and
medially from the right sternoclavicular joint to the sternal angle near to
the midline. Then, this line extended vertically downwards to the 6th
sternocostal junction.
b- On the left side: - It is represented by a line drawn downwards and
medially from the left sternoclavicular joint to the sternal angle near to

13
 the midline. Then, this line extended vertically downwards to the 4th
costal cartilage, where it deviates to the left for 4 cm and then continues
downwards to the 6th costal cartilage, 4cm from the midline, to form the
cardiac notch. At the cardiac notch, the pericardium is covered only with
pleura but not with the lung tissue.

3- Inferior border of the lung:

- It begins at the 6th sternocostal junction, It then follow a curved line which
crosses the following points: 6th rib in the midclavicular line, 8th rib in the
midaxillary line and 10th rib, 5 cm from the midline of the back.
Note: The lung lies higher than the pleura by 2 ribs.
4- Posterior border of the lung: -
- it is represented by a vertical line drawn from the apex of the lung to the
posterior end of inferior border
The lung higher than pleura by 2 ribs.

B- Surface anatomy of the fissures of the lung:

1- Oblique fissure: -
- An oblique line drawn on the side of the chest
begins, at the level of 3rd thoracic spine. It runs
downwards and anteriorly following the 6th rib to
the 6th costochondral junction.
2- Horizontal fissure: -
- It corresponds to the right 4th costal
cartilage.
- It extends from the right 4th costal cartilage
to the midaxillary line at the 6th rib.

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* Applied anatomy of the lungs: -
1- The lung tissue and visceral pleura are devoid of pain sensitive fibers,
but once the disease crosses the visceral pleura to reach the parietal
pleura, pain becomes a prominent.

PLEURA
* Definition: It is a closed serous sac
(one on each side) which is invaginated
by the lung from its medial aspect.
* Divisions:-It is divided into visceral
pleura and parietal pleura.
1- Visceral pleura: It invests the
lung and lines the lung fissures.
2- Parietal pleura: It lines the
thoracic wall and the other
surrounding structures.

It is subdivided into 4 parts:

a- Cervical pleura. It covers the
apex of the lung. It projects
through the inlet of thorax into the root of the neck and lines the
b- Costal pleura: It lines the inner surfaces of the thoracic wall (inner
surface of ribs, costal cartilage and intercostal space, the sides of
vertebral bodies & back of sternum).
c- Diaphragmatic pleura: It covers the upper surface of the diaphragm.
d- Mediastinal pleura: It covers the side of the mediastinum.

* Pulmonary ligament:
- It is a fold of pleura below the
root of the lung. It extends from
the root of the lung to the
diaphragm.
- It allows the free movement of
the root of the lung during
respiration and gives a space for
distension of the pulmonary
veins.

* Pleural cavity:
It is a narrow space between
the parietal and visceral pleurae. It is a

15
closed cavity contains a small amount of serous fluid.
The Rt and left pleural cavity widely separated by mediastinum. The pleural
cavity contains serous fluid which covers the surfaces of the pleura as a thin
film of fluid and permits the layers to move on each other & allow lungs to
move free during respiration
* Pleural recesses:
They are parts of the pleural cavity at the lines of pleural reflection.
a- Costomediastinal recess: It lies between the Costal pleura &
Mediastinal pleura along the anterior margin of the pleura.
b- Costodiaphragmatic recess: It lies between the chest wall and
diaphragm along the inferior margin of the pleura.
N.b.:
• The anterior and inferior
margins of each lung
enter these recesses
during inspiration and
leave them during
expiration.
• The costodiaphragmatic
recess is the first part of
pleural cavity to be filled
by pleural effusion.
* Nerve supply of the pleura: -
1- Costal pleura: by the
intercostal nerves.
2- Mediastinal pleura: is supplied by the phrenic nerves.
3- Diaphragmatic pleura: - Its medial part supplied by the phrenic nerve,
while its peripheral part is supplied by the lower five intercostal nerves.
4- Visceral pleura: is supplied by autonomic nerves through the
pulmonary plexus.
* Blood supply of the pleura: -
1- Parietal pleura is supplied by intercostal, internal mammary and
musculophrenic arteries. It is drained by veins which correspond to these
arteries.
2- Visceral pleura is supplied by bronchial arteries.
* Lymphatic drainage of the pleura: -
1- Parietal pleura: - it is drained by lymph vessels which end in
intercostal, parasternal, posterior mediastinal and diaphragmatic lymph
nodes.
2- Visceral pleura: by bronchopulmonary lymph nodes.

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* Surface anatomy of pleura:
a- The apex of the pleura: as lung.
b- The anterior border of the pleura: as lung.
c- The inferior margin of the pleura: -
- The inferior margin of the pleura extends from 6th costal cartilage to 8th
costal cartilage in the midclavicular plan, then 10th rib in midaxillary
line and lastly to 12th rib at the lateral border of sacrospinalis.
d- Posterior border of the pleura: as lung.
Paracentesis:
- It is the aspiration of fluid from the pleural cavity. It occurs by inserting
a large needle through the intercostal space (usually in the posterior part
of the 7th intercostal space).
- The needle must pass along the upper border of the rib to avoid injury of
the intercostal vessels and nerves.

Pharynx
Definition: a musculo-membranous tube lying behind nasal cavity, oral cavity
and larynx.
Extent: from base of skull to 6th cervical vertebra, then becomes esophagus.
Deficient anterior & replaced by
• Opening of nose(choanae)-opening of mouth & inlet of larynx

17
Subdivision: the cavity of pharynx is divided into 3 parts:
naso-pharynx, oro-pharynx and laryngo-pharynx.
communication: with middle ear through auditory tube.
Interior of pharynx
(Cavity of pharynx)
Nasopharynx (nasal part): behind
nasal cavity and above soft palate.
Extent: from base of skull above to
level of soft palate below.
Features:
a- Pharyngeal tonsils: collection
of lymphoid tissue at the roof, in
children, if it is enlarged, it is
called adenoids that can close
nasopharynx completely leading
to oral breathing. It starts to
atrophy after puberty.
b- Opening of auditory tube: - in
the lateral wall.
c- Tubal elevation: above and posterior to opening of auditory tube in
lateral wall.
d- Salpingopharyngeal fold: Fold of mucous membrane covering
Salpingopharyngeus muscle.
- Extend from posterior part of tubal elevation to f the side of pharynx.
e- Pharyngeal recess:
- Depression just behind tubal elevation.
Pharyngeal isthmus:
- The junction between nasopharynx and oropharynx.
- It is opening between the soft palate & posterior wall of pharynx
It is closed during swallowing by soft palate.

Blood supply of pharynx:

- Ascending pharyngeal art. - Lingual artery- Tonsillar branch of facial
artery. - branches of maxillary
Veins: Pharyngeal plexus drains into internal jugular vein.
Lymphatic drainage: to
- Retropharyngeal lymph nodes or directly into deep cervical nodes
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 Nerve supply:
Motor: - all muscles of pharynx are supplied by pharyngeal plexus (pharyngeal
branch of vagus) except Stylopharyngeus which is supplied by
glossopharyngeal nerve.
Sensory:
- Nasopharynx: from maxillary nerve.
- Oropharynx: glossopharyngeal nerve.
- Laryngopharynx: - Internal laryngeal nerve of vagus.

Larynx
Definition: fibromusculocartilagenuous tube in anterior midline of neck,
concerned with voice production and conduction of air (air passage).
POSITION: It's situated below the (tongue & hyoid bone)
and between the great blood vessels of the neck
Extent: from root of tongue to trachea.
Vertebral level: opposite cervical vertebrae from C4 toC6.
Communication: It opens above into laryngeal part of pharynx and below
continuous with trachea.
Relations:
• Anterior: Infrahyoid muscles
• Sides: thyroid gland
Structure:
a- Cartilages: forms skeletal framework.
b- Joints, ligaments and membranes & connecting cartilages.
c- Muscles: moving cartilages.
d- Mucous membrane: lines the cavity.
Cartilages of larynx:
3 paired cartilages and 3 unpaired.
Unpaired (single) cartilages: thyroid,
cricoid and epiglottic cartilages.
1-Thyroid cartilage (Adam's apple):

Largest
- Formed of 2 lamina fused anteriorly
forming Laryngeal prominence
(Adam's apple).

19
2-Cricoids cartilage: it is the only complete cartilaginous ring in air passages.
- Signet – ring in shape.

3-Epiglottic cartilage:
- Leaf – shaped. Lamin

- The side of it attached to arytenoid by

aryepiglottic fold.
Paired cartilages
1-Arytenoids cartilage:
- Pyramidal in shape located in the back.
- Its Vocal process: gives attachment to vocal
ligament.
- Muscular process: for muscle
attachment.
2- Corniculate cartilage:
- articulates with apex of arytenoids.
3- Cuneiform cartilage:
- Small nodule infront of corniculate
cartilage.

Cavity of larynx
It has 2 openings: -
a- Superior opening or inlet of
larynx.
b- Inferior opening which is
continuous with trachea.

Inlet of larynx (laryngeal Inlet):

• DIRECTION: It is directed
upwards and backwards and into
the laryngopharynx.
• The opening is wide infront than
behind
It is lying in the anterior wall of
laryngopharynx; it is bounded by: -
- Epiglottis: superiorly (Anterosuperior).

20
 - Inter-arytenoid fold: inferiorly (posteroinferior).
- Aryepiglottic fold: on each side.
N.B: *corniculate & cuneiform cartilages lies within & strengthen the
aryepiglottic fold

Parts of laryngeal cavity:

a- Vestibule: the part from inlet down to vestibular fold.
b- Sinus of larynx or ventricle: the middle part between vestibular fold
and vocal fold.
c- The infraglottic part: the part below vocal cords to lower border of
cricoid cartilage.

Rima vestibuli: the (gap) between the

vestibular folds. It can be widened or
closed by intrinsic muscles.
Rima glottides(glottis): the gap between
the 2 vocal folds.
- It is narrowest part of larynx.
- In children the narrowest part is
the lower part of larynx.
- & measures about 2.5 cm from
front to back in male adult & less
in female.

LARYNGEAL FOLDS
1-vestibular folds: false vocal cords
2-vocal folds (vocal cord): mobile fold
on each side of the larynx & is concerned
with voice production. Formed of mucous membrane covering vocal cord and
is avascular. It is white in color so easily seen in laryngoscope.

Intrinsic muscles of larynx:

All muscles are intrinsic except Cricothyroid muscle.
1- Cricothyroid muscle increase tension of vocal cords.
2- Posterior cricoarytenoid only Ms abducts vocal cord & open rima glottis
3-Lateral cricoarytenoid &Transverse arytenoids muscle adducts the vocal
cord.

21
 4-Two Oblique arytenoids and Transverse
arytenoids acts as sphincter for inlet of larynx

Blood supply of larynx:

- Superior laryngeal artery of superior
thyroid. For upper 1/2 of larynx
- Inferior laryngeal artery of inferior thyroid.
for lower 1/2 of larynx
Veins: drains to
- Superior thyroid vein.
- Inferior thyroid vein.

Lymphatic drainage of larynx:

- Prelaryngeal nodes.
- Pretracheal and paratracheal nodes.
- Deep cervical lymph nodes.

Nerve supply of larynx:

Motor: all muscles of larynx are supplies by recurrent laryngeal nerve except
cricothyroid by external laryngeal nerve.
Sensory :( supply mucous membrane)
- Above vocal cords: internal laryngeal nerve.
- Below vocal cords: recurrent laryngeal nerve.
- Vocal cords by both nerves.

22
 TRACHEA
- It is about 10 cm
Beginning: -
- From cricoid cartilage of larynx,
at the level of 6th cervical
vertebra.
Termination: at the level of the
sternal angle AT carina opposite
lower border of T4 vertebra divide
into right and left main bronchi.
Movements:
During expiration the
bifurcation(end) of trachea rises by
about one vertebra, during deep
inspiration lowered to T6 vertebra.
* Course: -
- Its upper half lies in midline of
the neck and its lower half in the thoracic.
- The thoracic portion of the trachea lies within the superior
mediastinum.
- Its median axis is in the median plane except its lower part where it
deviates slightly to right.
SIZE: In the adult It is about 4.5 inches ;
- long and about 1 inch (2.5 cm)
in diameter.

* Relations of the thoracic part of

the trachea: -in superior
mediastinum.
1- Anteriorly: -
a- Arch of the aorta.
b- Origins of brachiocephalic and
left common carotid arteries
from the arch.
c- Left innominate vein.
d- Sternum & thymus.
2- Posteriorly: -
a- Esophagus.
b- Left recurrent laryngeal nerve.
3- Right side: -
a- Right vagus nerve.
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 b- Right pleura and lung.
c- Arch of azygos vein.
4- Left side: -
a- Arch of aorta.
b- Left subclavian artery.
c- Left vagus nerve.
d- Left phrenic nerve
e- left pleura and lung.

* Sites of normal constriction of the trachea: -

a- At its upper end: constricted by the thyroid.
b- At its middle part: constricted by the right innominate artery.
c- At its lower end: constricted by arch of aorta.
* Arterial supply:
1- Cervical part is supplied by inferior thyroid artery.
2- Thoracic part is supplied by the right and left bronchial arteries.
* Nerve supply: -
- Sensory from the two vagi & recurrent laryngeal nerves and from also
sympathetic chains.
* Lymphatic drainage: -
- Para tracheal and pretracheal lymph nodes. And deep cervical nodes.

BRONCHI
The bronchi divide, giving rise to millions of terminal bronchioles that
terminate in respiratory bronchiole which divides into 2 to 11 alveolar ducts
that enter the alveolar sacs. The alveoli arise from the walls of the sacs as diverticula

Right bronchus Left bronchus

1- Wider 1- Narrower.
2- Shorter (one inch)2.5 cm 2- Longer (2 inches) 5 cm
3- More vertical in line with 3- More horizontal.
trachea.
4- Usually divides before entering 4- Usually divides after entering
into the lung & gives superior into the lung & gives superior and
lobar bronchus. And after inferior lobar bronchus.
entering the lung gives middle
and inferior lobar bronchus.
5- arch of azygos curves over it 5- The arch of aorta curves over it.
Note: - The foreign body passing into the trachea usually enters into the
right bronchus because it is more vertical in line with the trachea.

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 Development of Respiratory system
Two sources:
Developmental source:
• The epithelial lining of the trachea, bronchi and as well as that of the
lung, is entirely of endodermal origin from endoderm lining cranial
part of foregut that forms the lining of laryngo-tracheal groove.
• However, the cartilages, muscles, elastic tissue, blood vessels and lymphatics
of these structures are derived from splanchnic mesoderm surrounding the
foregut.
Development of larynx and trachea
laryngo-tracheal groove
The primordium of the respiratory system appears during the fourth week of
development as respiratory diverticulum from the ventral wall of the foregut
This diverticulum; called laryngo-tracheal groove that begins behind
hypobranchial eminence. This groove deepens and converted into laryngo-
tracheal tube by fusion of its edge. This tube opens into the pharynx by
laryngeal orifice.

laryngo-tracheal tube
The cranial part of the tube becomes the larynx that opens into the pharynx by
laryngeal orifice.
. The caudal part of the tube becomes the trachea that divides into two main
bronchi. each of which becomes surrounded by a cap of mesoderm to form the
lung bud.

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 Larynx:
Developmental source:
The internal lining of the larynx is of endodermal origin.
However, the cartilages and muscles arise from the mesoderm of the fourth
and sixth pharyngeal arches.
• However, the cartilages, muscles, elastic tissue of trachea and bronchi are
derived from splanchnic mesoderm surrounding the foregut.

Lung development:
Lung bud
• During its separation from the foregut, the respiratory primordium forms
a midline structure, the trachea, and two lateral bronchi surrounded by
mesodermal cap, the lung buds.
• The left lung bud develops into two main bronchi and two lung lobes,
while the right bud forms three main bronchi and three lung lobes
• With further growth in caudal and lateral directions, the lung buds
invaginate the pericardio-peritoneal canals (pleural cavity) of the
intraembryonic coelom The mesoderm covering the outside of the lung
develops into the visceral pleura, while the somatic mesoderm covering
the body wall from inside becomes the parietal pleura and the space
between the visceral and parietal pleurae is pleural cavity.
• During further development, the main bronchi divide repeatedly in a
dichotomous fashion, and by the end of the 6th months, approximately
17 generations of subdivisions have been formed. The terminal
bronchioles give rise to passages called alveolar ducts which give rise to
the alveolar sacs. Both alveolar ducts and sacs are connected to the
alveoli.
• The alveoli start formation during last 3 months of pregnancy and
continue to appear until sometimes after birth. maturation of alveoli
only after birth.

Blood vessels of lung

• Pulmonary arteries developed from 6th aortic arch.
• Bronchial arteries developed from dorsal aorta.

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 Congenital Anomalies:
1- Esophagotracheal fistula is due to incomplete fusion of the two
laryngo-tracheal groove resulting in a communication between the
trachea and the esophagus. Oesophageal atresia is common with
oesophago – tracheal fistula.
• Types of fistula.
✓ Fistula above atretic segment: Upper segment of
esophagus connected by fistula to trachea.
✓ Fistula below atretic
segment: Upper
segment of esophagus
end blindly and The
lower segment of
esophagus connected by
fistula to trachea.
✓ H Shaped fistula
without atresia.
✓ -the upper & lower
segments of esophagus
are connected separately
to trachea

2-Ectopic lung lobes arising from the trachea or esophagus. It may be due
to additional respiratory diverticula of the foregut which develop
independently of the main respiratory system.
3-Congenital cysts of the lung are formed by over dilatation of some
bronchi which become converted into cystic cavities.
4-abnormal branching of the laryngo-tracheal tube which leads to
• Absence of one lobe(Agenesis)
• Accessory lobe
• Accessory bronchopulmonary segment.
5-respiratory distress syndrome. (no surfactant)

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