Vincent Van Gogh – Skull with Cigarette (1886)

1. ANATOMY OF THE RESPIRATORY SYSTEM Vincent Van Gogh – Skull with Cigarette (1886) • 8.10.2013 Kaan Yücel M.D., Ph.D.

2. MEDIASTINUM Mod. L. middle septum, L, mediastinus, midway

3. MEDIASTINUM

4. MEDIASTINUM

5. MEDIASTINUM

6. SUPERIOR MEDIASTINUM

7. ANTERIOR MEDIASTINUM

8. POSTERIOR MEDIASTINUM

9. Nose is divisible into : Externalnose Nasal cavity

10. External Nose Extendsthe nasal cavities onto the front of the face Pyramidalin shape

11. External nose has bony &cartilaginous parts. • BonesCartilages • Nasal bonesLateral cartilages (paired) • Frontal process of maxillaAlar cartilages (paired) • Nasal part of frontal boneSeptalcartilage (single)

12. NasalcavITIES uppermost parts of the respiratory tract olfactory receptors • separatedfrom: • each other by a midline nasal septum • oral cavity below by the hard palate • cranial cavity above by parts of the frontal, ethmoid, &sphenoid bones. Posteriorly, each nasal cavity communicates with the nasopharynx through two openings choana.

13. Each nasal cavity consists of 3regions. • nasal vestibuleinternal to the naris • respiratory regionlargest , rich neurovascular supply • olfactory region @ apex of each nasal cavity, olfactory receptors 3 2 1

14. the most anterior part of the nasal cavity.

15. Functions of the nose & nasal cavities • Olfaction (sense of smell) • Respiration • Filtration of the dust in the inspired air • Humidification and warming of the inspired air (cooling the internal carotid artery for brain) • Reception of the secretions from the paranasal sinuses and nasolacrimal ducts

16. 2. PARANASAL SINUSES air filled spaces lying within the bones around the nasal cavity lined by respiratory mucosa. open into the nasal cavities innervated by branches of the trigeminal nerve [V]. • Frontal sinuses • Ethmoid sinuses • Sphenoid sinuses • Maxillary sinuses

17. 3. LARYNX between C3-C6 organ of phonation (vocalization) continuous below with the trachea above opens into the pharynx immediately posterior & slightly inferior to the tongue Cartilage Muscles Connectivetissue

18. SKELETON OF LARYNX LARYNGEAL CARTILAGES • Paired cartilages • Arytenoid • Corniculate • Cuneiform • Unpaired cartilages • Thyroid cartilage (biggest) • Cricoid cartilage • Epiglottic cartilage

19. Thyroid cartilage largest cartilage of the larynx 2 laminaewhich fuse anteriorly at the thyroid angle & form laryngeal prominence (Adam’s apple)

20. Cricoid cartilage a ring shaped cartilage, most inferior of the laryngeal cartilages Inferiorly attaches to 1st tracheal ring viacricotrachealligament. Completelyencircles the airway Broadlamina of cricoidcartilageposteriorly Narrowerarch of cricoidcartilageanteriorly

21. Arytenoid cartilages pyramidal in shape 3 processes Apex (superior) articulation w/corniculatecartilage Vocal process (anterior)vocal ligament attaches here Muscular process (lateral) posterior & lateral crico-arytenoid muscles

22. Epiglottic cartilage (Epiglottis) a leaf-shaped cartilage attached by its stem to the posterior aspect of the thyroid cartilage @the angle Most superior end is free.

23. Corniculate&cuneiform cartilages corniculatecartilagestwo small conical cartilages Located on thearytenoid cartilages cuneiform cartilagessmall cartilagesanterior to corniculatecartilages lie in the posterior part of the aryepiglottic fold.

24. EXTRINSIC LIGAMENTS OF THE LARYNX . Thyrohyoid membrane Belowsuperiormargin of thethyroidcartilage, abovehyoid bone lateralthyrohyoidligament (posteriorthickening),triticeal cartilage medianthyrohyoidligament (midlinethickening) Hyo-epiglottic ligament fromthemidline of theepiglottistothe body of hyoid bone Cricotrachealligament between lower border of cricoid cartilage & upper border of 1st tracheal cartilage

25. INTRINSIC LIGAMENTS OF THE LARYNX . Fibroelastic membrane of the larynx lies under the mucosa of the larynx links together the laryngeal cartilages completes the architectural framework of the laryngeal cavity forms some of the ligaments between the cartilages.

26. INTRINSIC LIGAMENTS OF THE LARYNX . Fibroelastic membrane of the larynx 2parts lower conuselasticus upper quadrangular membrane

27. Conuselesticus cricothyroidligament, cricovocal membrane, cricothyroidmembrane Freeuppermarginthickens & formsvocalligament vocalfold opening between the 2 vocal folds (rima) glottis median cricothyroidligamentanteriormidlinethickening of conuselasticus

28. Conus elasticus cricothyroidligament, cricovocal membrane, cricothyroidmembrane Each vocal ligamentfreeuppermargin attaches to anterior part of inner surface of thyroid cartilage @ thyroid angle posteriorly attach to vocal processes of the arytenoid cartilages.

29. Rima glottis Inspiration Widens Phonation Narrows- 2 vocalfoldcometogether Pitch increases with tensing, decreases by relaxation. Intensity of expiration determines the loudness of sound.

30. Quadrangular membrane . vestibular ligament attached posteriorly arytenoid cartilage anteriorly thyroid angle superior to the attachment of the vocal ligament. lateralmargin of epiglottis free lower margin is thickened anterolateral surface

31. Quadrangular membrane . vestibular ligament attached posteriorly arytenoid cartilage anteriorly thyroid angle superior to the attachment of the vocal ligament.

32. LARYNGEAL CAVITY tubular architectural support fibro-elastic membrane of the larynx laryngeal cartilages .

33. superior aperture (laryngeal inlet)V.S. inferioraperture 1) opens into anterior aspect of pharynx just below and posterior to the tongue continuous with the lumen of trachea completely encircled by cricoid cartilage

34. superior aperture (laryngeal inlet)V.S. inferioraperture 2) obliqueand points posterosuperiorly into the pharynx horizontal in position

35. superior aperture (laryngeal inlet)V.S. inferioraperture • 3) • can be closed by downward movement of the epiglottis. • continuouslyopen

36. LARYNGEAL CAVITY vestibular and vocal foldsdivide into three major regions Vestibule betweenlaryngeal inlet & vestibularfolds Middlepart between vestibular folds & vocal folds Infraglotticspace between the vocal folds & inferior opening of the larynx

37. Rimaglottidis between vocal folds separates middle chamber from infraglottic cavity. base formed byinterarytenoid fold @ bottom of interarytenoidnotch. .

38. LARYNGEAL MUSCLES INTRINSIC LARYNGEAL MUSCLES EXTRINSIC LARYNGEAL MUSCLES move the laryngeal components altering the length and tension of the vocal folds and the size and shape of the rimaglottidis MOVE THE LARYNX AS A WHOLE

39. * Superiorlaryngealnerve TENSOR OF THE VOCAL LIGAMENT . Pullsthethyroidangleanteriorly/inferiorly

40. RELAXER OF THE VOCAL LIGAMENT . pullsthearytenoid cartilages anteriorly, toward the thyroid angle relaxes the vocal ligaments to lower the pitch of the voice.

41. Adductors of thevocalcords . lateral crico-arytenoid muscles muscularprocessesanterior vocalprocessesmedial transverse and oblique arytenoid muscles Vibration of vocalligaments Phonation

42. Abductorsof thevocalcords posterior crico-arytenoid muscles

43. FUNCTIONAL ANATOMY OF THE LARYNX Respiration Quiet: laryngeal inlet, rimaglottidisopen arytenoidcartilagesabducted Forced: rimaglottidiswidens arytenoidcartilagesrotatedlaterally, vocalfoldsabducted

44. FUNCTIONAL ANATOMY OF THE LARYNX Effortclosure occurs when air is retained in the thoracic cavity to stabilize the trunk increasing intra-abdominal pressure Rimaglottidis is completely closed. Completelyand forcefully shut the airway

45. FUNCTIONAL ANATOMY OF THE LARYNX Phonation arytenoid cartilages & vocal folds adducted rimaglottidisclosed Air is forcedthroughtheclosedrimaglottidis Vocal folds vibrate against each other and produce sounds. • Tension in the vocal folds adjusted by • vocalis& cricothyroidmuscles

46. FUNCTIONAL ANATOMY OF THE LARYNX Swallowing Rimaglottidisclosed. Laryngeal inlet narrowed Larynxmovesup & forward – openstheesophagus attachedtotheposterioraspect of thelamina of cricoidcartilage Epiglottisgoesdowntowardthearytenoidcartilages laryngeal inlet narrowedorclosed .

47. Externalcarotidartery Subclavianartery

48. Cricothyroidmuscle recurrent (inferior) laryngeal nerve

49. . from the inferior end of larynx to the level of T5-T6 Terminatesby dividing into right &left main bronchi @ sternal angle. Mainbronchi give branches inside the lungs & form bronchial tree.

50. formed of tracheal rings which are incomplete posteriorly Posterior parts of the tracheal rings closed by smooth muscle trachealis muscle. .