Define footer – presentation title / department1 Dentistry – spring - RS/ Department of Anatomy Faculty of Medicine MU2 RESPIRATORY SYSTEM RNDr. Michaela Račanská, Ph.D. Cavum nasi Pharynx Larynx Trachea Bronchi Lungs Upper respiratory tract Lower respiratory tract Respiratory 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 Nares - Choanae Layers  skin  muscles  bones + cartilages Radix nasi Dorsum nasi Apex nasi Nares Alae nasi Cartilago septi nasi 1 Cart. nasi lat. 2 Cart. alaris major 3 Cartt. alares minores1 2 3 crus mediale crus laterale Cartt. nasales accessoriae 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  Vestibulum  Cavum nasi propr. - regio olfactoria, respiratoria Cavum nasi Limen nasi Vibrissae Recessus apicis nasi CAVITAS NASI - cavitas nasi propria – meatus nasi sup., medius, inf. meatus nasi communis, meatus nasopharyngeus, choanae 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 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 14 Lateral wall: proc. frontalis and corpus maxillae, os lacrimale, os ethmoidale, lamina perpendicularis ossis palatini, sphenoid Concha nasalis superior (os ethmoidale) Concha nasalis media (os ethmoidale) Concha nasalis inferior Enlarge the surface of nasal cavity NASAL MUCOSA Regio respiratoria plexus cavernosi - epistaxis Regio olfactoria Locus Kiesselbachi Epistaxis SINUS PARANASALES Sinus maxillaris Sinus frontalis Sinus ethmoidales Sinus sphenoidalis Hiatus semilunaris > infundibulum ethmoidale hiatus sinus maxillaris (Antrum of Highmore) Maxillary sinus puncture (Antral washout) SINUS FRONTALIS Septum sinuum frontalium Hiatus semilunaris CELLULAE ETHMOIDALES SINUS SPHENOIDALIS Septum sinuum sphenoidalium Apertura 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 (C4- C6 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 C4-C6 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) Cartilages 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 JOINTS: 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 (abduction) 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 Vocal cords in adduktion Submucous layer– oedema 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. cricoarytaenoide us posterior m. cricoarytaenoide us 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 interarytenoidea plicae vestibulares plicae vocales LARYNGOSCOPY indirect direct Vocal Cords up close while singing https://www.youtube.com/watch?v=- XGds2GAvGQ Trachea Bifurcatio Th4-5 C6 12-16cm Bronchus principalis  dexter  sinister Carina tracheae Pars thoracicaPars cervicalis Paries membranaceus glands, m. trachealis Cartilagines tracheales  number (12-15)  shape  ligg. anularia Stavba M. sternohyoideus M. sternothyroideus Lamina pretrachealis fasciae colli TOPOGRAPHY OF THE TRACHEA 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 Coniotomy, Tracheotomy coniotomia (lig. crycothyroideum) Tracheotomia coniotomy Tracheotomy superior Tracheotomy inferior - principales - lobares - segmentales ... (arbor bronchialis) … bronchioli …………………ALVEOLI Bronchi Structure as trachea Basis, apex Facies  costalis  medialis  diaphragmatica Margines  anterior  inferior  posterior Fissurae  obligua  horizontalis Pulmo L. sup. L. med. L. inf. L. inf. L. sup. Pulmo dx. Pulmo sin. 20-25cm fissura horizontalis (IV. rib) fissura obliqua (Th4 – VI.rib) Hilum pulmonis  bronchus principalis  a., v. pulmonalis  aa. bronchiales  Lymph vessels  nerves Pulmo sin. HeartA E ASC VBC Incisura cardiaca Lingula pulmonis A B V VCS ASC VAZ E HEART Pulmo dx. B A V segmenta bronchopulmonalia Dextra - 10 Sinistra -10 (8) I. and II. fused VII. in 90% mising Nutritive circulation Aorta thoracica (+ intercostal arteries)  rami bronchiales (1 on the right – usually from a. intercostalis tertia, 2 on the left directly from aorta thoracica) along bronchi until bronchioli respiratorii  venae bronchiales to v. azygos,v. hemiazygos accessoria,vv. intercostales Nutritive and functional circulation Right heart ventricle truncus pulmonalis arteriae pulmonales dx.+ sin.(low oxygen) capilaries 4 venae pulmonales (2 dx., 2 sin.) (rich on oxygen) left heart ventriclr. Functional circulation – small blood circulation • branching of the arteries = branching of the bronchi On the left: hyparterial bronchus (below artery) ABV On the right: eparterial bronchus (above artery) BAV • venules not accompanying arteries , passing in septas between lobuli • elastic, low pressure, muscular layer only in fetuses, in adults from < 1mm Pleura Parietalis lig. pulmonale Cupula pleurae Pleura: costalis diaphragmatica mediastinalis Visceralis surfactant Cavitas pleuralis Recessus pleurae Pneumothorax  costo-diaphragmaticus  phrenico-mediastinalis  costo-mediastinalis Recessus pleurae 65 Pleural borders Lines for orientation on the thorax: linea mediana ant. linea sternalis linea parasternalis linea medioclavicularis linea axillaris ant., med., post. linea scapularis linea paravertebralis linea mediana post. Pleural borders Cupula pleurae: 2 cm above clavicle Ventral border mediocaudaly Co 2 caudaly Co 6 Caudal border medioclavicul. Co 7 anterior axillary line Co 8 Middle axilary Co 9 posterir axilary Co 10 scapular Co 11 Posterior border from Th12 to cupula pl. (dx: > recessus retrooesophageus) Differs during breathing Apex in cupula pleurae Anterior border – inspiration same with pleura Lower border - 1- 2 ribs higher (normal breathing rate) Hranice plicBorders of the lung Borders of the lung and pleura EXPIRATION INSPIRATION Area interpleuralis sup. (thymica) Area interpleuralis inf. (pericardiaca) MEDIASTINUM - superius - inferius - anterius - medium - posterius Glandula thyroidea Endocrine gland  Lokalization, topography, 5. 2.- 4. Lobus dexter Lobus sinister Isthmus (lobus pyramidalis)  description  structure Capsula fibrosa - f. externa - Arterial network fibrous capsule (capsula propria) septa - lobuli - folicules Gll. parathyroideae  number  structur: Fibrous capsule - septa - gland. parenchym In the height of the lower margin of cartilago cricoidea At the lower margin of the lobe of thyroid gland  syntopy  supply A. et v. thyroidea sup. et inf., a. thyroidea ima, nll. cervicales prof., nll. paratracheales Clinical note Hyper i hypofunction of the gland results in an enlargement of the gland- struma During surgery need to respect n. laryngeus inf. (n. X) Thymus Lymphatic system  syntopy  description Capsula thymi – septa – lobuli (cortex, medulla)  structure Lobus dexter Lobus sinister newborn: 16 g 2 years: 30 - 40 g Puberty + – involution adulthood: 10 g Old age – atrofy, corpus adiposum thymi Breathing muscles • Inspiration – Main: mm. intercostales externi, diaphragma (mm. scaleni, mm. levatores costarum) – Auxilary: m. pectoralis major + minor, m. latissimus dorsi, m. serratus anterior + post. sup., m. sternocleidomastoideus, m. subclavius, (m. sternothyroideus, m. sternohyoideus) – orthopnotická position (expiration) • Expiration – main: mm. intercostales interni (+ intimi, m. subcostales) – auxilary: m. rectus abd., m. obliquus abd. ext. + int., m. trasnversus abd., m. serratus post. inf., m. transversus thoracis, (m. quadratus lumborum) 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