Anatomy of the Respiratory

System

Sura Sreenivasulu
Senior Lecturer
FMHS, UTAR
 Learning Objectives
1. Nasal Cavity & Paranasal air sinuses and its clinical anatomy
2. Nasopharynx , Larynx and Trachea
3. Describe the anatomy of the pleura: (subdivisions into
parietal & visceral pleurae, nerve supply).
4. List the parts of parietal pleura and its recesses.
5. Describe the anatomy of lungs : (shape, surfaces, relations,
nerve supply, blood supply and lymphatic drainage.
6. Describe the difference between right & left lungs.
7. Describe the formation of bronchopulmonary segments and
its main characteristics.
Respiratory System

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 Organization and Functions of the
Respiratory System
• Consists of an upper respiratory tract (nose to larynx) and
a lower respiratory tract ( trachea onwards) .
• Conducting portion transports air.
- includes the nose, nasal cavity, pharynx, larynx,
trachea, and progressively smaller airways, from the
primary bronchi to the terminal bronchioles
• Respiratory portion carries out gas exchange.
- composed of small airways called respiratory
bronchioles and alveolar ducts as well as air sacs called
alveoli
 Upper Respiratory Tract
• Composed of the nose and nasal cavity,
paranasal sinuses, pharynx (throat),
larynx.
• All part of the conducting portion of the
respiratory system.
 Respiratory mucosa
• A layer of pseudostratified ciliated
columnar epithelial cells that secrete
mucus
• Found in nose, sinuses, pharynx, larynx
and trachea
• Mucus can trap contaminants
– Cilia move mucus up towards mouth
Upper Respiratory Tract
 Nose
• Internal nares - opening to exterior
• External nares opening to pharynx
• Nasal conchae - folds in the mucous
membrane that increase air turbulence
and ensures that most air contacts the
mucous membranes
THE NOSE

• The external nose

has a free tip (apex)
and a root (bridge).
• The external orifices
are the two nostrils
(nares).
• Each nostril is
bounded medially
by the nasal
septum.

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THE NOSE

The nostrils are

bounded
laterally by the
alla.

14
 NOSE
The framework of the
nose is made:
• Above by :
– The nasal
bones;
– The frontal
processes of
the maxillae;
– The nasal part
of the frontal
bone
• Below by hyaline
carilages:
– Upper nasal
cartilages
– Lower nasal
cartilages
– Septal
catilage

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The lateral wall of the nose

• The lateral wall

has three
projections called
the:
– Superior
concha
– Middle concha
– Inferior concha
• The area below
each concha is
called a meatus.

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The lateral wall of the nose

• The area below

each concha is
called a meatus.
– Superior
meatus
– Middle meatus
– Inferior meatus

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 Nose
rich supply of capillaries warm the inspired air
• olfactory mucosa – mucous membranes that contain
smell receptors
• respiratory mucosa – pseudostratified ciliated
columnar epithelium containing goblet cells that
secrete mucus which traps inhaled particles,
• lysozyme kills bacteria and lymphocytes and
• IgA antibodies that protect against bacteria
 Paranasal Sinuses
• Four bones of the skull contain paired air spaces
called the paranasal sinuses - frontal,
ethmoidal, sphenoidal, maxillary
• Decrease skull bone weight
• Warm, moisten and filter incoming air
• Add resonance to voice.
• Communicate with the nasal cavity by ducts.
• Lined by pseudostratified ciliated columnar
epithelium.
Paranasal sinuses
MAXILLARY SINUS

• It is located within the

body of the maxilla
behind the skin of the
cheek.
• It has a pyramidal form:
• The roots of the:
– First premolar tooth
– Second premolar tooth
– Third molar tooth
– Canine tooth
(sometimes)
• - Project into the
maxillary sinus
• Tooth extraction can
produce a fistula.
• Tooth infection can
produce sinusitis.
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 MAXILLARY SINUS
The maxillary sinus opens in the middle meatus
through the semilunar hiatus.

Dr. Vohra 22
 FRONTAL SINUS

• The frontal sinuses (two) present within the frontal bone.

• They are separated by a bony septum (frequently deviated to one side).
• Each sinus is roughly triangular.
• It extends:
– Upward above the medial end of the eyebrow
– Backward into the medial part of the roof of the orbit.
• Each frontal sinus opens into the middle meatus
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 SPHENOIDAL SINUSES

• They are two in number

• They lie within the body of the sphenoid bone.
• Each sinus opens into the sphenoethmoidal recess above
the superior concha.
• The mucous membrane is supplied by the posterior
ethmoidal nerves.
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 ETHMOIDAL SINUSES

• They are contained within the ethmoid bone.

• Only a thin layer of bone separates these sinuses from the orbit.
• Infection can readily spread from the ethmoidal sinuses into the orbit.
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 ETHMOIDAL SINUSES

• They are divided into three groups: anterior,

middle and posterior.
• The anterior group drains in the
infundibulum.
• The middle group drains in the middle meatus
(on or above bulla ethmoidalis).
• The posterior group drains in the superior
meatus.
The mucous membrane of the
ethmoidal sinuses is supplied by
the anterior and posterior
ethmoidal nerves.
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 Pharynx
• Common space used by both the
respiratory and digestive systems.
• Commonly called the throat.
• Originates posterior to the nasal and oral
cavities and extends inferiorly near the
level of the bifurcation of the larynx and
esophagus.
• Common pathway for both air and food.
 Pharynx
• Walls are lined by a mucosa and contain skeletal
muscles that are primarily used for swallowing.
• Flexible lateral walls are distensible in order to
force swallowed food into the esophagus.
• Partitioned into three adjoining regions:
nasopharynx
oropharynx
laryngopharynx
 Nasopharynx
• Superior-most region of the pharynx. Covered with
pseudostratified ciliated columnar epithelium.
• Located directly posterior to the nasal cavity and superior
to the soft palate, which separates the oral cavity.
• Normally, only air passes through.
• Material from the oral cavity and oropharynx is typically
blocked from entering the nasopharynx by the uvula of
soft palate, which elevates when we swallow.
• In the lateral walls of the nasopharynx, paired
auditory/eustachian tubes connect the nasopharynx
to the middle ear.
• Posterior nasopharynx wall also houses a single
pharyngeal tonsil (commonly called the adenoids).
 Laryngopharynx
• Inferior, narrowed region of the pharynx.
• Extends inferiorly from the hyoid bone to the
larynx and esophagus.
• Terminates at the superior border of the
esophagus and the epiglottis of the larynx.
• Lined with a nonkeratinized stratified
squamous epithelium.
• Permits passage food.
 Lower Respiratory Tract
• Conducting airways (trachea, bronchi, up
to terminal bronchioles).
• Respiratory portion of the respiratory
system (respiratory bronchioles, alveolar
ducts, and alveoli).
 Larynx
• Voice box is a short, somewhat cylindrical airway
ends in the trachea.
• Prevents swallowed materials from entering the
lower respiratory tract.
• Conducts air into the lower respiratory tract.
• Produces sounds.
• Supported by a framework of nine pieces of
cartilage (three individual pieces and three
cartilage pairs) that are held in place by
ligaments and muscles.
 The Cartilages
• The cartilaginous
skeleton is comprised
of :
 Single Cartilages:
 Thyroid
 Cricoid
 Epiglottis
 Paired Cartilages:
 Arytenoid
 Corniculate
 Cuneiform
• All the cartilages,
except the epiglottis,
are of hyaline type.
• Epiglottis is formed of
elastic cartilage
• The cartilages are:
 Connected by joints,
membranes &
ligaments
 Moved by muscles
 Larynx
• Muscular walls aid in voice production and the
swallowing reflex
• Glottis – the superior opening of the larynx
• Epiglottis – prevents food and drink from
entering airway when swallowing
• pseudostratified ciliated columnar epithelium
 Laryngeal Cavity
• Extends from laryngeal
inlet to lower border of
the cricoid cartilage
Rima
• Narrow in the region of vestibuli

the vestibular folds

(rima vestibuli)
• Narrowest in the region
of the vocal folds (rima
glottidis) Rima
glottidis
 Laryngeal Cavity cont’d
• Divided into three parts:
Supraglottic part, the
part above the vestibular
folds, is called the
vestibule
The part between the
vestibular & the vocal A
folds, is called the
B
ventricle
C
Infraglottic part, the part
below the vocal folds
 Sound Production
• Inferior ligaments are called the vocal folds.
- are true vocal cordsﾓbecause they produce sound
when air passes between them
• Superior ligaments are called the vestibular folds.
- are false vocal cordsﾓbecause they have no
function in sound production, but protect the vocal
folds.
• The tension, length, and position of the vocal folds
determine the quality of the sound.
Conducting zone of lower respiratory
tract
 Trachea
• A flexible tube also called windpipe.
• Extends through the mediastinum and lies anterior to
the esophagus and inferior to the larynx.
• Anterior and lateral walls of the trachea supported by 15
to 20 C-shaped tracheal cartilages.
• Cartilage rings reinforce and provide rigidity to the
tracheal wall to ensure that the trachea remains open at
all times
• Posterior part of tube lined by trachealis muscle
• Lined by ciliated pseudostratified columnar
epithelium.
Trachea

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 Trachea
• At the level of the sternal angle, the trachea
bifurcates into two smaller tubes, called the
right and left primary bronchi.
• Each primary bronchus projects laterally toward
each lung.
• The most inferior tracheal cartilage separates
the primary bronchi at their origin and forms an
internal ridge called the carina.
 Bronchial tree
• A highly branched system of air-conducting passages that
originate from the left and right primary bronchi.
• Progressively branch into narrower tubes as they diverge
throughout the lungs before terminating in terminal
bronchioles.
• Incomplete rings of hyaline cartilage support the walls
of the primary bronchi to ensure that they remain open.
• Right primary bronchus is shorter, wider, and more vertically
oriented than the left primary bronchus.
• Foreign particles are more likely to lodge in the right
primary bronchus.
Respiratory Zone

48
 Bronchial tree
• The primary bronchi enter the hilus of each lung
together with the pulmonary vessels, lymphatic vessels,
and nerves.
• Each primary bronchus branches into several secondary
bronchi (or lobar bronchi).
• The left lung has two secondary bronchi.The right lung
has three secondary bronchi.
• They further divide into tertiary bronchi.
• Each tertiary bronchus is called a segmental bronchus
because it supplies a part of the lung called a
bronchopulmonary segment.
 PLEURA
• It is a closed serous sac which
surrounds the lung and
invaginated from its medial side
by the root of lung.
• It has 2 – layers: parietal pleura
which lines the thoracic cavity. &
visceral pleura which surrounds
the lung, separated by a pleural
cavity.
• Pleural cavity:
• Contains 5-10 ml. of serous fluid
which lubricates both surfaces
and allows the lungs to move
free during respiration.
Divisions of parietal pleura
• 1- Cervical pleura:
It is part of parietal
pleura which protrudes
up into the root of the
neck.
• 2-Costal pleura:
It lines inner surface of
ribs, costal cartilages,
intercostal muscles
and back of the
sternum.
• 3-Diaphragmatic
pleura:
It covers upper surface
of the diaphragm.
• 4-Mediastinal pleura:
It covers mediastinal
surface of the lung.
Visceral Pleura
 firmly covers outer
surfaces of the lung and
extends into its fissures.
 The 2- layers (mediastinal
parietal pleura & visceral
pleura) are continuous
with each other to form a
tubular sheath (pleural
cuff) that surrounding root
of lung (vessels, nerves &
bronchi) in the hilum of
the lung.
 On the lower surface of
root of the lung, pleural
cuff hangs down as a fold
called pulmonary
ligament.
Pleural Recesses
 Costodiaphragmatic
recess :
lies between costal
& diaphragmatic
parietal pleura along
the inferior border.
 Costomediastinal
recess :
lies between costal
& mediastinal
parietal pleura along
the anterior border.
 The lung reaches these
recesses only in deep
inspiration.
Pleural Effusion • It is an abnormal
accumulation of pleural fluid
about 300 ml, in the
Costodiaphragmatic recess ,
(normally 5-10 ml of clear
fluid)
• Causes:
• Inflammation, TB, malignancy,
congestive heart disease.
• The lung is compressed & the
bronchi are narrowed.
• Auscultation would reveal
only faint & decreased breath
sounds over the compressed
or collapsed lung.
• Dullness on percussion over
the effusion.
Nerve Supply of Pleura
• Parietal pleura….
• Costal P.P….by
intercostal nerves.
• Mediastinal P.P….by
phrenic nerve.
• Diaphragmatic P.P.:
1-Medially by phrenic
nerve.
2-Peripheral part.. by
lower 6 intercostal
nerves.
• Visceral pleura…
sympathetic N.S. from
pulmonary plexus.
Blood supply of Pleura

• Parietal pleura… by
intercostal, internal
thoracic &
musculophrenic
vessels.
• Visceral pleura ….by
bronchial vessles.
Lymphatic Drainage:
• Parietal pleura : into
intercostal,,
mediastinal &
diaphragmatic Lymph
Nodes.
• Visceral pleura : into
broncho-pulmonary
Lymph Nodes in the
hilum of the lung.
 LUNGS
• Each lung has the
following
features:
• It is conical in
shape.
• It has an apex, a
base and 2
surfaces.
• The costal surface
of each lung
borders the ribs
(front and back).
• On the medial
(mediastinal)
surface, the
bronchi, blood
vessels, and
lymphatic vessels
enter the lung at
the hilum.
 LUNGS
• Apex: projects into
root of the neck (one
inch above the
medial 1/3 of the
clavicle).
It is covered by
cervical pleura.
It is grooved
anteriorly by
subclavian artery.
• Base: (inferior=
diaphragmatic
surface) is concave
and sits on the
diaphragm.
Borders: Anterior & Posterior
• Anterior border : is
sharp, thin and
overlaps the heart.
• Anterior border of
left lung presents a
cardiac notch at its
lower end + thin
projection called
the lingula below
the cardiac notch.
• Posterior border : is
rounded, thick and
lies beside the
vertebral column.
 Surfaces: Costal & Mediastinal
• Costal surface:
• Convex.
• Covered by costal pleura
which separates lung from:
ribs, costal cartilages &
intercostal muscles.
• Medial surface:
• It is divided into 2 parts:
• Anterior (mediastinal) part:
• Contains a hilum in the
middle (it is a depression in
which bronchi, vessels, &
nerves forming the root of
lung).
• Posterior (vertebral) part:
• It is related to: bodies of
thoracic vertebrae,
intervertebral discs, posterior
Lateral & medial surfaces of right lung intercostal vessels &
sympathetic trunk.
 RIGHT
LUNG
ROOT

• 2 bronchi lie
posterior.
• Pulmonary
artery is
superior
• 2 Pulmonary
veins are
inferior and
anterior.
 LEFT
LUNG
ROOT

• One bronchus
lies posterior
• Pulmonary
artery is
superior
• 2 Pulmonary
veins are
inferior and
anterior.
 Right
lung
• Larger &
shorter than
left lung.
• Divided by
2 fissures
(oblique &
horizontal)
into 3 lobes
(upper,
middle and
lower lobes).
 Left Lung
• Divided by
one oblique
fissure into -2
lobes, Upper
and lower.
• There is No
horizontal
fissure.
• It has a cardiac
notch at lower
part of its
anterior
border.
Mediastinal surface of right lung
• On the mediastinal
surface of the right lung,
you find these structures:
• Azygos vein and its arch
(posterior and over the
root of the lung).
• Vagus nerve posterior to
the root.
• Esophagus above and
posterior to the root.
• Phrenic nerve anterior to
the root.
• Cardiac impression:
related to right atrium.
• Below hilum and in front
of pulmonary ligament:
• Groove for I.V.C.
Mediastinal surface of left lung
• On the mediastinal
surface of the left lung,
you will find these
structures:
• Descending aorta
posterior to the root.
• Vagus nerve posterior
to the root.
• Arch of the aorta over
the root.
• Groove for left common
carotid artery.
• Groove for left
subclavian artery.
• Phrenic nerve anterior
to the root.
• Cardiac impression :
related to left ventricle.
 Blood Supply to Lungs
• Lungs are perfused by two circulations:
pulmonary and bronchial
• Pulmonary arteries – supply systemic venous
blood to be oxygenated
– Branch profusely, along with bronchi
– Ultimately feed into the pulmonary capillary
network surrounding the alveoli
• Pulmonary veins – carry oxygenated blood
from respiratory zones to the heart
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 Blood Supply to Lungs
• Bronchial arteries – provide systemic blood to
the lung tissue
– Arise from aorta and enter the lungs at the hilus
– Supply all lung tissue except the alveoli
• Bronchial veins anastomose with pulmonary
veins
• Pulmonary veins carry most venous blood
back to the heart

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Nerve Supply of the lung
Lymph drainage of the lungs
 Bronchi
• The trachea divides
into 2 main bronchi:
• Right main bronchus:
It divides before
entering the hilum, it
gives off superior
lobar (secondary)
bronchus.
On entering hilum, it
divides into middle &
inferior lobar bronchi.
• Left main bronchus:
On entering hilum, it
divides into superior
& inferior lobar
bronchi.
 Bronchial Divisions

• Within the lung each

bronchus divides into
number of branches
that can be divided
into two groups:
II- Respiratory
I- Conduction zone zone
branches branches
Primary (main) bronchi
Secondary (lobar) bronchi
• Respiratory
Tertiary (segmental) bronchioles
bronchi (supply the • Alveolar
bronchopulmonary ducts
segment)
Smaller bronchi • Alveolar sacs
Bronchioles • Alveoli
Terminal bronchioles
Bronchopulmonary segments
• They are the anatomic,
functional, and surgical
units of the lungs.
• Each lobar (secondary)
bronchus gives off
segmental (tertiary)
bronchi.
• Each segmental
bronchus divides
repeatedly into
bronchioles.
• Bronchioles divide into
terminal bronchioles,
which show delicate
outpouchings ‘the
respiratory bronchioles’.
Bronchopulmonary segments

• The respiratory
bronchioles end by
branching into
alveolar ducts,
which lead into
alveolar sacs.
• The alveolar sacs
consist of several
alveoli, each
alveolus is
surrounded by a
network of blood
capillaries for gas
exchange.
Characteristics of Bronchopulmonary segments
• It is a subdivision of a lung
lobe.
• It is pyramidal in shaped,
its apex lies toward the
root, while its base lies on
the lung surface.
• It is surrounded by
connective tissue septa.
• It has a segmental
bronchus, a segmental
artery, lymph vessels, and
autonomic nerves.
• The segmental vein lies in
the inter- segmental C.T.
septa between the
segments.
• A diseased segment can
be removed surgically,
because it is a structural
unit.