RESPIRATORY SYSTEM Cavum nasi Pharynx Larynx Trachea Bronchi Lungs Upper respiratory tract Lower respiratory tract Repiratory organ Upper respiratory tract Nasal cavity epiglotis laryngopharynx nasopharynxOral cavity Tongue - Prevents enter of the food to the trachea http://commons.wikimedia.org/wiki/File:Head_lateral_mouth_anatomy.jpg oropharynx pharynx NASUS EXTERNUS Radix nasi Dorsum nasi Apex nasi Nares Alae nasi Cartilago nasi lateralis Cartilago septi nasi Cartilago alaris major - crus laterale - crus mediale Cartilagines alares minores Septum nasi - pars membranacea - pars cartilaginea - pars ossea SEPTUM NASI Cartilagines alares majores – crura medialia Cartilago septi nasi – processus posterior Lamina perpendicularis ossis ethmoidalis Vomer CAVITAS NASI - vestibulum – limen, vibrisae, recessus apicis nasi - cavitas nasi propria – meatus nasi sup., medius, inf. meatus nasi communis, meatus nasopharyngeus, choanae Superior wall: cartilago nasi lateralis, os nasale, pars nasalis ossis frontalis, lamina cribrosa ossis ethmoidalis, corpus ossis sphenoidalis Inferior wall: processus palatinus maxillae, lamina horizontalis ossis palatini canalis incisivus NASAL MUCOSA Regio respiratoria plexus cavernosi - epistaxis Regio olfactoria SINUS PARANASALES Sinus maxillaris Sinus frontalis Sinus ethmoidales Sinus sphenoidalis SINUS MAXILLARIS – hiatus sinus maxillaris (Antrum of Highmore) SINUS FRONTALIS Septum sinuum frontalium Hiatus semilunaris CELLULAE ETHMOIDALES SINUS SPHENOIDALIS Septum sinuum sphenoidalium Apertura sinus sphenoidalis Meatus nasi inf. – ductus nasolacrimalis Meatus nasi medius – hiatus semilunaris – sinus maxillaris, sinus frontalis, cellulae ethmoidales anteriores Meatus nasi sup. – cellulae ethmoidales posteriores, sinus sphenoidalis Waters' (Occipitomental) view Nasopharynx base – soft palate (tuba auditiva, tonsilla pharyngea) Oropharynx (C2-4) - isthmus faucium with oral cavity (Waldeyer´s lympoepithelial ring) Pars laryngea pharyngis (C4C6 -oesophagus) in anterior wall aditus laryngis PHARYNX NASOPHARYNX Ostium pharyngeum tubae auditivae: Torus tubarius Plica salpingopharyngea Torus levatorius Plica salpingopalatina Cartilago tubae auditivae M. salpingopharyngeus M. levator veli palatini LARYNX ADULT NEONATE Prominentia laryngis CARTILAGINES LARYNGIS: Cartilago thyroidea Cartilago cricoidea Cartilago arytenoidea Cartilago epiglottica Cartilago corniculata Cartilago cuneiformis Cart. thyroidea (laminae, cornua, linea obliqua) Cart. cricoidea (arcus, lamina) Cart. epiglottica (petiolus) Cartt. arytenoideae (proc.muscularis a vocalis) Cartt. cuneiformes Cartt. corniculatae Anterior view M V Anterior view posterior view Membrana quadrangularis (from epiglottis to the aerytaenoid cartilage, ligg. vestibularia, plica vestibularis) Conus elasticus (between ligg.vocalia and arcus cartilaginis cricoideae) Membrana fibrocartilaginea laryngis conus elasticus + membrana quadrangularis Ligg. vestibularia (reinforced margine of membrana quandrangularis) Ligg. vocalia (reinforced margine of conus elasticus) • squamous epithelium („work“) Lig. cricotracheale Membrana thyrohyoidea Lig. cricothyroideum (coniotomy) Connections of laryngeal cartilages MEMBRANA THYROIDEA lig. thyroideum laterale lig. thyroideum medianum Lig thyroepiglotticum Lig. hyoepiglotticum Spatium praeepiglotticum Klouby: Art. cricothyroidea (rocking movements) Art. cricoarytenoidea (rotation and translation movements– abduction and adduction of vocal cords) ARTICULATIO CRICOARYTENOIDEA -lig. cricoarytaenoideum post. ARTICULATIO CRICOTHYROIDEA Laryngeal muscles • muscles of the larynx affect lenght, tension and position of the vocal cords and position of the epiglottis affect 1) Muscles that moves with epiglotis a) Musculus thyroepiglotticus opens aditus laryngis b) Musculus aryepiglotticus closes aditus laryngis M. thyroarytenoideus (thyroepiglotticus) M. vocalis Rima glottidis – pars intermembranacea – pars intercartilaginea 2) Muscles responsible for respiration (abdukction) and phonation (adduction) position of vocal cords: a) Musculus cricoarytaenoideus lateralis closes rima glottis (adduction of vocal cords) - phonation b) Musculus cricoarytaenoideus posterior (musculus posticus) opens rima glottis – abduktion of vocal cords (ligg. vocalia) – respiration position c) Musculus arytaenoideus the strongest adductor m. cricoarytaenoideus lateralis m. cricoarytaenoideus posterior m. arytaenoideus L P 3) Muscles responsible for tension of vocal cords: a) Musculus cricothyroideus tenses vocal cords(tensor) b) Musculus thyroarytaenoideus relaxation of vocal cords c) Musculus vocalis Fine tension TA Muscles of the larynx innervated via nervus vagus : nervus laryngeus superior (musculus cricothyroideus) nervus laryngeus inferior (branch of nervus laryngeus reccurens, all others laryngeal muscles) Respiration position Vocal cords in abduktion Phonation position vazy hlasové in adduktion Submucous layer– ema Folliculi lymph. laryngei Tonsilla laryngea Posterior side of epiglotis- taste buds Relaxation of vocal cords- m. thyroarytenoideus Tesnion of vocal cords - m. cricothyroideus m. cricothyroideus m. cricoarytaenoideus posterior m. cricoarytaenoideus lateralis m. arytaenoideus m. thyroarytaenoideus CAVITAS LARYNGIS -vestibulum laryngis -plicae vestibulares -rima vestibuli -plicae vocales -rima glottidis -glottis -ventriculus laryngis -cavitas infraglottica Vestibular folds True vocal cords Arytaenoid cartilage CAVITAS LARYNGIS -aditus laryngis-plicae aryepiglotticae (tuberculum cuneiforme et corniculatum), plica interarytenoidea,incisura inter- arytenoidea plicae vestibulares plicae vocales LARYNGOSCOPY indirect direct Vocal Cords up close while singing https://www.youtube.com/watch?v=-XGds2GAvGQ TRACHEA -pars cervicalis (C6- C7) -pars thoracica (Th1-Th4) -bifurcatio tracheae - carina tracheae -15-20 cartilagines tracheales -ligg. anularia -paries membranaceus (m. trachealis) - glandulae tracheales M. sternohyoideus M. sternothyroideus Lamina pretrachealis fasciae colli TOPOGRAPHY OF THE TRACHEA -isthmus glandulae thyroideae -vv. thyroideae inferiores -truncus brachiocephalicus -arcus aortae -v. brachiocephalica sinistra -v. cava sup. -a. carotis communis -v. jugularis int. -n. vagus -oesophagus -n. laryngeus recurrens -nodi lymph. paratracheales Syntopy: thyroid gland anteriorly, oesophagus posteriorly Infrahyoid muscles Lobe of the thyroid gland Cervical vertebraPrevertebral muscles oesophagus Coniotomy, Tracheotomy Coniotomia (cricothyrotomia) (lig. crycothyroideum) Tracheotomia coniotomy Tracheotomy superior Tracheotomy inferior BRONCHI - principales - lobares - segmentales BRONCHIOLI ALVEOLI Arbor bronchialis PULMO DEXTER Lobus superior, medius et inferior Fissura obliqua et horizontalis PULMO SINISTER Lobus superior et inferior Fissura obliqua Incisura cardiaca Lingula Apex pulmonis Basis pulmonis (facies diaphragmatica) Facies costalis Facies mediastinalis Margo anterior inferior posterior FACIES MEDIASTINALIS hillum pulmonis radix pulmonis lig. pulmonale impressio cardiaca SEGMENTA BRONCHOPULMONALIA DEXTRA 1. s. apicale 4. s. laterale 6. s. apicale 2. s. posterius 5. s. mediale 7. s. basale mediale 3. s. anterius 8. s. basale anterius 9. s. basale laterale 10. s. basale posterius SEGMENTA BRONCHOPULMONALIA SINISTRA 1+2. s. apicoposterius 6. s. apicale 3. s. anterius (7. s. basale mediale) 4. s. lingulare superius 8. s. basale anterius 5. s. lingulare inferius 9. s. basale laterale 10. s. basale posterius PLEURA - visceralis - parietalis - costalis - diaphragmatica - mediastinalis Cavitas pleuralis Cupula pleurae Recessus pleurae: r. costodiaphragmaticus r. costomediastinalis r. phrenicomediastinalis Pneumothorax Area interpleuralis sup. (thymica) Area interpleuralis inf. (pericardiaca) EXPIRATION INSPIRATION GLANDULA THYROIDEA – lobus dexter - lobus sinister - isthmus - lobus pyramidalis Capsula propria, folliculi, colloid – thyroid hormone, calcitonin Fascia externa s. perithyroidea A. et v. thyroidea sup. et inf., a. thyroidea ima, nll. cervicales prof., nll. paratracheales GLANDULAE PARATHYROIDEAE –sup. et inf. Parathormone (parathyroid hormone; PTH) THYMUS MEDIASTINUM - superius - inferius - anterius - medium - posterius MUSCULI THORACIS EXTRINSIC MUSCLES M. pectoralis major M.pectoralis minor M. subclavius M. serratus ant. INTRINSIC MUSCLES M. intercostales externi M. intercostales interni M. intercostales intimi M. subcostales M. transversus thoracis DIAPHRAGM Centrum tendineum - foramen VCI Pars sternalis Pars costalis Pars lumbalis - crus dextrum - crus sinistrum - lig. arcuatum medianum - lig. arcuatum mediale - lig. arcuatum lat. Hiatus esophageus Hiatus aorticus Illustrations and photographs were copied from: Atlas der Anatomie des Menschen/Sobotta. Putz,R., und Pabst,R. 20. Auflage. München: Urban & Schwarzenberg, 1993 Netter: Interactive Atlas of Human Anatomy. Windows Version 2.0