30.10.2014 1 Respiratory system Cavum nasi Pharynx Larynx Trachea Bronchi Lungs Upper respiratory tract Lower respiratory tract Repiratory organ External nose Radix nasi Dorsum nasi Apex nasi Nares Alae nasi (Pars membranacea septi nasi) Cartilago septi nasi Cartilago nasi lateralis Cartilago alaris major Cartilagines alares minores Cartilagines nasales accessoriae Cartilago vomeronasalis Nasal cartilages Septal cartilage os ethmoidale vomer Lateral nasal cartilage 30.10.2014 2 Nasal cavity 1. Vestibulum nasi Skin with hairs - vibrissae 2. Cavum nasi proprium meatus nasi superior meatus nasi medius meatus nasi inferior meatus nasi communis meatus nasopharyngeus Proper nasal cavity Regio olfactoria (2,5 cm2) Regio respiratoria – plexus cavernosi concharum Mucous membrane of nasal cavity locus haemorrhagicus Kiesselbachi Sinus maxillaris Sinus frontalis Sinus ethmoidalis (cellulae ethmoidales) Sinus sphenoidalis Paranasal sinuses 25 ml, recessus (alveolaris, frontalis…) hiatus sinus maxillaris hiatus semilunaris (infundibulum ethmoidale) Maxillary sinus Frontal sinus 15 ml septum sinuum frontalium infundibulum ethmoidale (hiatus semilunaris) 30.10.2014 3 Ethmoid sinus Celullae ethmoidales (3-18) Celullae ethmoidales anteriores (hiatus semilunaris) Celullae ethmoidales mediae (meatus nasi medius) Celullae ethmoidales posteriores (meatus nasi superior) Sphenoid sinus 6 ml septum sinuum sphenoidalium recessus sphenoethmoidalis apertura sinus sphenoidalis PHARYNX Pars nasalis, oralis, laryngea Fornix pharyngis: tonsilla pharyngea Ostium pharyngeum tubae auditivae: Torus tubarius Plica salpingopharyngea Torus levatorius Plica salpingopalatina 30.10.2014 4 LARYNX Adults C4 – C6 Prominentia laryngea Newborn C2 – C4 Cartilago thyroidea Cartilago cricoidea Cartilago arytaenoidea Cartilago epiglotica Cartilago corniculata Cartilago cuneiformis Cartilago sesamoidea (triticea) Laryngeal cartilages: Thyroid cartilage Lamina dextra et sinistra Incisura thyroidea superior et inferior Cornua superiora et inferiora Facies articulares cricoidea Linea obliqua Foramen thyroideum Cricoid cartilage Arcus Lamina Facies art. thyroidea Facies art. arytaenoidea Arytenoid cartilage Basis (facies art. cricoidea) Apex (cartilago corniculata) Processus muscularis Processus vocalis (lig. vocale) Facies anterolateralis Crista arcuata Colliculus Fovea triangularis Fovea oblonga Facies medialis (rima glottidis) Facies posterior Epiglottic cartilage Tritiate cartilage 30.10.2014 5 Corniculate cartilage, cuneiform cartilage Lig. thyrohyoideum medianum Lig. thyrohyoideum laterale Thyrohyoid membrane Lig. hyoepiglotticum Lig. thyroepiglotticum Bursa hyoidea Spatium praeepiglotticum Fibroelastic membrane of larynx 1. MEMBRANA QUADRANGULARIS lig. ventriculare (vestibulare) 2. CONUS ELASTICUS lig. vocale lig. cricothyroideum ConiotomyElastic cone Cricotracheal ligament Cricopharyngeal ligament (ligamentum jugale) MUSCULUS THYROEPIGLOTTICUS opens aditus laryngis MUSCULUS ARYEPIGLOTTICUS closes aditus laryngis Muscles of epiglottis: 30.10.2014 6 Abductors of rima glottidis - respiratory position MUSCULUS CRICOARYTENOIDEUS POSTERIOR (POSTICUS) Adductors of rima glottidis – speaking position MUSCULUS CRICOARYTENOIDEUS LATERALIS MUSCULUS ARYTAENOIDEUS (TRANSVERSUS, OBLIQUUS) Tensors of vocal folds MUSCULUS CRICOTHYROIDEUS Strain the vocal folds MUSCULUS THYROARYTAENOIDEUS MUSCULUS VOCALIS Innervation of laryngeal muscles Nervus vagus 30.10.2014 7 Mucous membrane pseudostratified columnar, ciliated stratified squamous, non-keratinized (vocal folds) gll. laryngeae lymphatic tissue-tonsilla laryngea Submucous tissue Rare tissue (oedema glottidis) membrana fibroelastica laryngis Laryngeal cavity VESTIBULUM LARYNGIS GLOTTIS CAVUM INFRAGLOTTICUM (aditus laryngis – rima vestibuli) (rima vestibuli – rima glottidis) (rima glottidis - trachea) Laryngoscopy direct indirect Laryngoscopic view TRACHEA C6 (cartilago cricoidea) Th4-5 (bifurcatio tracheae) Pars cervicalis Pars thoracica (10 – 12 cm) Tracheal wall adventicia cartilago tracheae paries membranaceus musculus trachealis Mucous membrane (pseudostratified columnar, ciliated ) Submucous tissue (gl. tracheales) 30.10.2014 8 PARS CERVICALIS TRACHEAE thymus, veins, arteries, tr. symphaticus, n.vagus – n. laryngeus recurrens !!!, oesophagus, lymphatic nodes PARS THORACICA TRACHEAE BRONCHUS PRINCIPALIS DEXTER ET SINISTER 70 - 800 dx. sin. bifurcatio tracheae Th4 carina tracheae bronchoscopy Lungs apex pulmonis basis pulmonis facies costalis diaphragmatica medialis margo anterior inferior posterior fissurae interlobares PULMO DEXTER Fissura obliqua Fissura transversa Lobus superior medius inferior Th 4 Costa IV. Costa VI. Fissura obliqua Lobus superior inferior Incisura cardiaca Lingula pulmonis PULMO SINISTER 30.10.2014 9 ARBOR BRONCHIALIS Bronchus principalis dx., sin. Bronchi lobares (dx. 3, sin. 2) Bronchi segmentales (dx.10, sin. 8) 6-18 x ramified Rami bronchiales segmentorum Bronchioli terminales (until 1 mm diameter– cartilages) bronchiolus terminalis bronchiolus respiratorius ductus alveolari s antrum saccus alveolarisalveolus pulmonis (300-400 mil) Functional blood circulation (pulmonary circulation) truncus pulmonalis (a. pulmonalis dx. et sin.) Venae pulmonalesLUNGS - O2 + O2 ventriculus dexter atrium sinistrum NUTRITIVE BLOOD CIRCULATION Aorta thoracica  rr. bronchiales Vv. bronchiales  v. azygos, v. hemiazygos accessoria PLEURA pleura parietalis pleura visceralis (lig. pulmonale) cavum pleurae dextrum cavum pleurae sinistrum mediastinum RECESSUS PLEURAE r. costodiaphragmaticus r. costomediastinalis r. phrenicomediastinalis 30.10.2014 10 Projection of pleura area interpleuralis superior (thymica) area interpleuralis inferior (pericardiaca) Recessus retrooesophageus Th4 – Th12 Projection of lungs MEDIASTINUM Mediastinum superius Mediastinum inferius: anterius medium posterius Mediastinum superius Mediastinum inferius 30.10.2014 11 MECHANISM OF BREATHING INSPIRATION Diaphragmatic contraction (abdominal type) mm. intercostales externi (costal type) Capacity of thoracic cavity is increased: EXSPIRATION Capacity of thoracic cavity is decreased: • Diaphragm and mm. intercostales externi are relaxed • Contraction of mm. intercostales interni a intimi • Weight of thorax • Elasticity of rib cartilages • Elasticity of lungs • Pressure of abdominal organs