Anatomy of Respiratory Sytem

Rimanda Christie 2011-060-029

Dionisius Ivan 2011-060-146
Yeodi Utomo 2011-060-173
Maria Vickyliana W. 2011-060-179
Stephen Chonardo 2011-060-182
Jesse Lesmana 2011-060-237
Heinz Purwadi G.S. 2011-060-241
 Thoracic Wall
• Introduction
– The primary function of the thorax is respiration
– The ribs and the diaphragm move so that the thoracic
cavity increases and decreases in size during the
İnspiration (inhalation) and espiration exhalation)
phases of respiration
– It also probably helps in returning venous blood back
to the heart because of the negative pressure
produced with respiratory movements
– Secondarily it serves to protect the organs located
within its cavity and some organs of the abdominal
cavity
– The main thoracic organs which you will examine in
your dissection of the thorax are the:
• lungs
• Heart

– The other structures are:

• aorta and its branches
• superior and inferior vena cavae
• trachea and primary bronchi
• sympathetic trunks and their associations
• azygos and hemiazygos venous systems
 Muscle of the Thoracic Wall
• Consist of:
– intercostals and diaphragm

Intercostals
• The intercostal muscle are arranged as three
layers (external layer, internal layer and an
incomplete innermost layer) between the ribs.
• external intercostal
• internal intercostal
• innermost intercostal (3 parts)
– transversus thoracic (anterior), innermost
(lateral) and subcostal (posterior)
• transversus thoracis
• Subcostal
Diaphragm
• closes the thoracic outlet
• separates the thoracic cavity
from the abdominal cavity.
• Innervated by right annd left
phrenic nerves
• The diaphragm is the most
important muscle of the thoracic
wall
• This muscle is the primary
component during normal
respiration.
• Attachements:
– Origin: inferior internal rib cage
– Insertion: central tendon

• Hiatus
– Hiatus vena cava  vert Th 8
– Hiatus oesophagus  vert Th 10
– Hiatus aorta  vert Th 12
 Bones of the Thorax
• Sternum
• Ribs
• Thoracic Vertebrae
• Thoracic Cavity
 Bony Boundaries of the Thorax
• sternum
– manubrium (1)
– sternal angle (2)
– body (3)
– xiphoid process (4)
• 12 pairs of ribs
– 6 or 7 pairs of true ribs
(5)
– 3 or 4 pairs of false ribs
(6)
– 2 pairs of floating ribs
(7)
• thoracic inlet (superiorly)
(8)
• thoracic outlet (inferiorly)
(9)
• thoracic vertebrae,
posteriorly
 The Sternum
• jugular notch (1)
• facet for head of first rib
• manubrium (2)
• facet for head of second rib
• manubriosternal joint (sternal angle) (3)
• body (made up of several fused sternabrae)
(4)
• xiphoid process (5)
 The Ribs
• Consist of:
– Typical Rib
– First Rib
Typical Rib

A typical rib has the following characteristics:

• head  articulates with bodies of vertebrae
• neck
• tubercle  articulates with transverse processes
• angle  a point just lateral to the
tubercle where the shaft bends forward;
• costal groove  lodges intercostal vessels and nerves
The first Rib

• short, flat and more sharply curved

than any of the others.
• has upper and lower surfaces, with
outer and inner borders, and on its
head there is one articular facet only.
• The upper surface has two grooves for
the subclavian artery and subclavian
vein
• very little movement during respiration
and serves as a base attachment for
the intercostal muscles and the ribs
below
 Thoracic Vertebrae
• There are 12 thoracic vertebrae
• The 1st and 12th are called atypical
vertebrae
– The 1st and 12th vertebrae have slightly
different characteristics than the typical ones
• the rest are typical vertebrae
– All of the typical vertebrae have the same
characteristics
 Characteristics of a typical
thoracic vertebra include:
• body (1)
• superior and inferior
demifacets (2,3)
• pedicle (4)
• superior and inferior
articular processes (5, 6)
• transverse process (with
an articular process)
(7,10)
• lamina (8)
• spinous process (9)
• superior and inferior
notches (13,12)
• vertebral canal(14)
• not a bone but an integral
part of the vertebral
column is the
intervertebral disk (11)
 Thoracic Cavity
• Kidney shaped
• Has anterior,
posterior and
lateral boundaries
 Arterial Blood Supply to the
Thoracic Wall
• he thoracic wall is supplied by
three sources of blood supply:
• axillary
– supreme thoracic (2)
– lateral thoracic (3)
• subclavian
– internal thoracic (or
mammary) artery (1)
• anterior intercostal branches
• aorta
– intercostal arteries (4)
 Nerves of the Thoracic Wall
• spinal cord (1)
• dorsal (sensory, afferent) root (3)
• ventral (motor, efferent) root (2)
• spinal nerve (4)
• dorsal primary ramus (mixed) (5)
• ventral primary ramus (mixed) (6)
• white communicating ramus (8)
• gray communicating ramus (7)
• sympathetic ganglion (9)
 The Respiratory Organs
Nose → pharynx → larynx → trachea → primary bronchi →
secondary bronchi → tertiary bronchi → bronchioles
terminal → bronchioles respiratory → bronchioles → alveoli
duct → alveoli sac → alveoli
 Nose
• Provides airway
• warms and moistures the air
• Filters air
• Olfactory receptors
 Nose
• Divided into:
– External nose
– Internal nasal cavity
• Nasal cavity is divided half by the nasal septum
External Nose
• Root
• Dorsum
• Apex (tip)
• Naris
(nostrils)
• Alae (nose
wing)
• olumnella
 Skeleton of External Nose
• Bony Parts:
– Os Nasal
– Frontal processes of maxillae
– Nasal part of the frontal bone
– Bony Parts of the nasal septum
• Cartilaginous Part:
– 2 Lateral cartilages
– 2 Alar Cartilages
– 1 Septal Cartilages
 Nasal Cavity
• Floor of nasal cavity is formed by palatum durum
(anterior) and palatum molle (posterior)
• Nasal septum is formed of the following:
– perpendicular plate of the ethmoid (bone)
– the vomer (bone)
– septal cartilage (cartilage)
 Nasal Cavity
Medial Wall
Divided into:
– 1/3 Upper parts: olfactory part, for smelling
– 2/3 Lower parts: respiratory part, for breathing
 Nasal Cavity
Lateral Wall
• 3 nasal concha: superior, middle, inferior
• Concha’s function: to spin the air within
the nasal cavity, in order to:
– to warm the air
– filter it
– adding moisture to the air.
 Blood Supply of Nasal Cavity
• Post lateral nasal and post septal branch (Sphenopalatine artery)
• Anterior posterior ethmoid artery (Ophthalmic artery)
• Greater palatine artery (Descenden Palatine artery)
• Septal branch of superior labial artery (facial artery)
• Lateral nasal branch (facial artery)

Kisselbach’s plexus: causes epistaxis if damaged

Huge venous plexus drains the nasal mucosa and causes blood to
flow into the sphenopalatine, facial and ophtalmic veins, in order
to warm air before they go into the lungs.
 Nasal Innervation
Posterior Ethmoid Nerve
(NV1)
Sphenopalatine Ganglion Provide Sensation.
Internal nerve
(mucosal) (NV2)

Oflactory nerve in Cribiform plate

Holds special sensory branches of the
oflactory nerve (NV1)
 Superior aspect of the nose,
Nasal Innervation including the tip, supplied by:
-infratrochlear nerve. (NV1)
Ophtalmic nerve -supratrochlear nerve. (NV1)
(NV1) -external nasal branch of
anterior ethmoid nerve. (NV1)
External nerves
(Skin)
Maxillary nerve Infraorbital nerve (NV2) supplies
(NV2) the inferior and lateral aspects
of the nose, extending to the
lower eyelids
 Paranasal Sinuses
• Function:
– decrease the weight of the facial skeleton
– vocal resonance (change when cold/infection)
– moisten and warm air.
• Paranasal sinuses:
– Frontal
– Ethmoid
– Sphenoid
– maxilla.
 Frontal sinuses
• Located above the nose in the forehead
and between the eyes.
• Not usually present at birth, begin to grow
around age five, and full develop during
the teenage years.
• Drainage: Frontonasal duct into ethmoidal
infundibulum, which open into the
semilunar hiatus of the middle nasal
meatus.
• Supraorbital nerves (NV1)
 Ethmoidal Cell
• Located behind the eyes and behind the
bridge of the nose.
• consist of 7-15 little chambers, each cavity
has its own separate small drainage to nose.
• Usually not visible in plain rö berfore 2 y.o.
• Drainage:
– Anterior and Middle -> middle nasal meatus
– Posterior -> superior meatus
• Nasociliary nerves (NV1)
 Sphenoidal Sinuses
• Are located behind the nose and behind
the eyes and at the base of the brain.
• Derived from a posterior ethmoidal cell
 invade the sphenoid ± 2y.o.
• Drainage: drain along the posterior wall of
the nasal cavity into the pharynx.
• Post ethmoidal nerve.
 Maxillary Sinuses
• Largest sinuses, located behind the
cheekbone, extending from just beneath
the eyes to above the upper teeth on
either side of the nose.
• Drainage: middle nasal meatus
• Superior alveolar nerves (maxillary nerve)
Sinus Drainage
 Pharnyx
• Commonly called throat
• Funnel shaped
• Originates posterior to the nasal and oral cavities
and extends inferior near the level of the bifurcation
of larynx and esophagus.
• Houses of tonsils
• Uvula: closes off nasopharynx during swallowing so
food doesn’t go into nose
• Epiglottis posterior to the tounge: keep food out of
airway
 Pharynx
• Divided into 3 sections:
– Nasopharynx
– Oropharynx
– laryngopharynx
 Nasopharynx
• Superiormost region of the pharynx and continous
with the nasal cavity via internal nares
• Normally, only air passes through
• Contains Pharyngeal tonsil.
• Contains the opening of the auditory tube
(Eustachian tube).
• Auditory tube connects pharynx to middle ear cavity,
to ensure that the air within the middle ear cavity is
equal to atmospheric pressure.
 Oropharynx
• Middle pharyngeal region
• inferior to the uvula and superior to the
epiglottis
• a common pathway for food and air.
• Palatine tonsils are on the lateral wall
between the arches abd the lingual tonsils
are at the base of the tounge.
 Laryngopharyx
• Inferior, narrowed region of the pharynx
• Continuous with the larynx (voice box)
inferiorly.
• Permit passage of both air and food
• Lingual tonsils are located on the posterior
surface of the tounge, which also places
them near the opening of the oral cavity
into the pharynx.
 Pharynx Innervation
Motor Innervation Sensory Innervation
• Glossopharyngeal • Glossopharyngeal (IX
(IX) to oropharynx region)
• Vagus (X) and Spinal • Vagus (X)
Accecory ( XI)
• recurrent laryngeal
 Larynx (voice box)
• Located in the anterior neck at the level of the bodies C4-C6.
• Attaches to hyoid bone superiorly
• Inferiorly is continiues with trachea
• Function:
– Vocalization (speech)
– Keep the airway open (breathing)
– Switching mechanism to route air and food into proper channels
• Closed during swallowing
• Open during breathing
• Laryngeal muscles :
– Cricotyroid muscle
– Thyroarytenoid muscle
– Cricoarytenoid muscle
• Framework of the larynx:
– Have 9 cartilages:
• Single: thyroid, cricoid, epiglottic
• Paired: arytenoid, corniculate, cuneiform
 Epiglottis (9th cartilage)
• Elastic cartilage covered by mucosa
• On a stlak, attached to thyroid cartilage
• Attaches to back of tounge
• During swallowing, larynx is pulled
supertiorly to keep food out of lower
respiratory tract
 Sound Production
Have 2 pairs of ligaments:
• Inferior ligaments, called
vocal ligaments, true vocal
cords
(produce sound when air
passes between them).
• Superior ligaments, called
vestibular ligaments, false
vocal cords
(not produce sound, to protect
the vocal folds.)

The vestibular folds attach to

the corniculate cartilages.
 Sound Production
• Glottis:the spaace between the vocal cords
• The laryngeal muscles important in closing the glottis
during speech and swallowing.
– Extrinsic muscles: Responsible for elevating the larynx during
swallowing
– Intrinsic muscles: when contracted change the length, position,
tension of the vocal cords.
• Sound is produced by the vibration of vocal cords as air
is exhaled
 Innervation of the larynx
Motor innervation Sensory innervation
• External laryngeal (X) • Internal laryngeal (X)
• Reccurent laryngeal sensory above the
(X) false focal cords
• reccurent laryngeal
(X) sensory below the
false vocal cords
 Trachea
• Flexible, slightly tubular organ often
reffered to as the “windpipe”
• Vert C6 – disc IV T4-T5
• C-shaped transverse cartilage rings in its
anterior and lateral wall (open part of the C
facing the posterior)
• The posterior wall of the trachea is
composed mainly of smooth muscle
•Extend through mediastinum
•Trachea bifurcates (carina) at the level of
the sternal angle (Ludovici), into primary
bronchi
•Topography:
–Anterior to the esophagus
–inferior to the larynx
–superior to the primary bronchi
Arterial supply and venous drainage
• The trachea is supplied by anastomoses of:
– Branches of superior and inferior thyroid arteries
– bronchial arteries from the thoracic aorta
• The veins drain to the inferior thyroid venous plexus

Innervation
• the trachea is supplied by branches of the vagus
(constriction), reccurent laryngeal nerves,
sympathetic trunks (relaxation)  supply the tracheal
smooth muscle and the mucosa
• Sympathetic stimulation causes relaxation of tracheal
musculature ehile vagal stimlation causes constriction
 Bronchus
The main bronchi (primary bronchi) divides
within the lung into lobar bronchi
(secondary bronchi), which further divide
into segmental bronchi (tertiary bronchi).

- Right main bronchus:

- Wider
- Shorter
- more vertically (3 branches)
- Left main bronchus:
- Inferolaterally
- inferior to the arch of the aorta
- anterior to esophagus (2
branches)
Each main or primary bronchus runs into hilus of lung posterior to
pulmonary vessels.
 Bronchioles
• Terminal bronchioles → respiratory
bronchioles
• Smooth muscles without cartilages
 Bronchial arteries and veins
• Nutritive vascular system of the pulmonary tissues (bronchial walls and
glands, walls of large vessels, and visceral pleura)
• Interconnect within the lung with branches of the pulmonary arteries
and veins
• The bronchial arteries originate from the thoracic aorta or one of its
branches:
– a single right bronchial artery normally arises from the third posterior
intercostal artery (but occasionally, it originates from the upper left
bronchial artery);
– two left bronchial arteries arise directly from the anterior surface of the
thoracic aorta-the superior left bronchial artery arises at vertebral level
TV, and the inferior one inferior to the left bronchus.
• The bronchial arteries run on the posterior surfaces of the bronchi and
ramify in the lungs to supply pulmonary tissues
• The bronchial veins drain into:
– the pulmonary veins or the left atrium
– azygos vein on the right or into the superior intercostal vein or hemiazygos
vein on the left.
 Innervation
• In the mediastinum
– vagus nerves : posterior to the roots of the lungs
– phrenic nerves : anterior
• Supplied by visceral afferents and efferents distributed through
the anterior pulmonary plexus and posterior pulmonary plexus.
These interconnected plexuses lie anteriorly and posteriorly to
the tracheal bifurcation and main bronchi.
• The anterior plexus is much smaller than the posterior plexus.
• Branches of these plexuses are distributed along branches of the
airway and vessels.
• Visceral efferents from:
– the vagus nerves constrict the bronchioles
– the sympathetic system (sympathetic trunks) dilates the bronchioles
 Lymphatic drainage
• Superficial or subpleural and Deep lymphatics
• Drain into lymph nodes called tracheobronchial.
• Extend from within the lung, through the hilum and
root, and into the posterior mediastinum
• Efferent vessels from these nodes pass superiorly
along the trachea to unite with similar vessels from
parasternal nodes and brachiocephalic nodes to
form the right and left bronchomediastinal
trunks.
• Drain directly into
– deep veins at the base of the neck
– into the right lymphatic trunk or thoracic duct.
Alveolus
- Basic structural unit of gas
exchange in the lung
-Epithel squamosa, epithel
cuboidal (secret surfactant)
-"air-blood barrier" : O2 and
CO2 diffuse (gas exchange)
-Made up of:
-Alveolar ducts
-Alveolar sacs
-Alveoli
 LUNGS
• Apex: Costae 1 – root of neck (± 2.5 - 4 cm)
• Base: rests upon the convex surface of the
diaphragm. Concavity on the base of the right
lung is deeper than that on the left.
• 2 Surfaces
– Costal
– Mediastinal
• 3 Borders
– Inferior
– Anterior
– Posterior
 Root and hilum
• Root : a short tubular collection of structures that together
attach the lung to structures in the mediastinum
• Hilum : where structures enter and leave
• Pulmonary ligament : a thin blade-like fold of pleura projects
inferiorly from the root of the lung and extends from the hilum
to the mediastinum
• Within each root and located in the hilum :
– a pulmonary artery
– two pulmonary veins
– a main bronchus
– bronchial vessels
– nerves
– lymphatics
Pulmonary artery is superior , pulmonary veins are inferior, and the bronchi are posterior in position.
The right bronchus branches in the root, whereas in the left it branches within the lung.
 Right Lung
• 3 lobes and 2 fissures
• Normally, the lobes are freely movable
against each other.
• These invaginations form the fissures:
– oblique fissure separates the inferior lobe
from the middle lobe
– horizontal fissure separates the superior
lobe from the middle lobe
• Oblique fissure: begins roughly at the spinous
process of vertebra T-IV, crosses the fifth
interspace laterally, and then follows the
contour of rib VI anteriorly
• Horizontal fissure: follows the fourth
intercostal space from the sternum until it
meets the oblique fissure as it crosses rib V.
• The medial surface of the right lung :
– heart
– inferior vena cava
– superior vena cava
– azygos vein
– esophagus
 Left Lung
• Smaller than the right lung
• 2 lobes
• Oblique fissure: more oblique than the
right lung’s oblique fissure. Begins
between the spinous processes of
vertebrae TIII and TIV, crosses the fifth
interspace laterally, and follows the
contour of rib VI anteriorly
• Inferior portion of the medial surface :
Cardiac Notch
• An extension called the Lingula extends
from the anterior border of the superior
lobe over the heart bulge.
• The medial surface of the left lung:
– heart
– aortic arch
– thoracic aorta
– esophagus
 Pulmonary arteries
• Originate from the pulmonary trunk
• The bifurcation of the pulmonary trunk occurs to the left of the midline just
inferior to vertebral level TIV/V, and anteroinferiorly to the left of the
bifurcation of the trachea.
• Right pulmonary artery
– Longer than the left and passes horizontally across the mediastinum.
– It passes:
• anteriorly and slightly inferiorly to the tracheal bifurcation and anteriorly to the right main
bronchus
• posteriorly to the ascending aorta, superior vena cava, and upper right pulmonary vein
– Enters the root of the lung and gives off a large branch to the superior lobe of the lung.
The main vessel continues through the hilum of the lung, gives off a second
(recurrent) branch to the superior lobe, and then divides to supply the middle and
inferior lobes
• Left pulmonary artery
– anterior to the descending aorta and posterior to the superior pulmonary vein passes
through the root and hilum and branches within the lung.
 Pulmonary veins
• superior pulmonary vein and an inferior
pulmonary vein carry oxygenated blood
from the lungs back to the
• Begin at the hilum of the lung, pass
through the root of the lung, and
immediately drain into the left atrium
 Innervation
• Nerve of the lungs:
– Parasymphatetic: N. vagus
– Symphatetic: truncus sympathicus
 PLEURAL CAVITIES
• Two pleural cavities, one on either side
of the mediastinum, surround the lungs
– superiorly, they extend above rib I into the
root of the neck;
– inferiorly, they extend to a level just above the
costal margin;
– the medial wall of each pleural cavity is the
mediastinum
 Pleura
• Each Pleura is formed by a mesothelium
(a single layer of flat cells), and an
associated layer of supporting connective
tissue.
• 2 major types, based on location:
– Parietal pleura: outer walls
– Visceral pleura: inner walls
• Pleural Cavity is the space in between
these two walls and is filled with pleural
fluid.
 Parietal pleura
• Costal part: ribs and intercoastal spaces.
• Diaphragmatic part: covers the
diaphragm
• Mediastinal part: covers the mediastinum
• Cervical pleura/Dome of pleura: Dome-
shaped layer of parietal pleura lining the
cervical extension.
• Suprapleural Membrane: Dome-like layer
of fascia that covers the superior surface
of the cervical pleura.
• Provides apical support for the pleural
cavity in the root of the neck.
 Innervation
• The costal pleura : branches from the
intercostal nerves
• The diaphragmatic pleura and the
mediastinal pleura : phrenic nerves
(originating at spinal cord levels C3, C4
and C5)
 Visceral pleura
• Continuous with parietal pleura at the
hilum
• Firmly attached to the surface of the lung,
including both opposed surfaces of the
fissures that divide the lungs into lobes
• Although the visceral pleura is innervated
by visceral afferent nerves that
accompany bronchial vessels, pain is
generally not elicited from this tissue.
 Mediastinum
Mediastinum : central
compartment between the
2 pulmonary cavities

Consist of :
• Superior mediastinum
• Inferior mediastinum :
a. Anterior
b. Media
c. Posterior
Sternal angle (superior & inferior limit)
 Superior Mediastinum
• Thymus
• Artery : Aorta arch, Brachiocephalic artery, left common
carotid & left subclavian
• Vein : brachiocephalic vein, upper half of S. vena cava
• Nerves : Vagus (X) & Phrenic (diaphragm), cardiac
nerve
• Trachea & esophagus
• Thoracic duct & lymphatic trunks
 Inferior Mediastinum (anterior)
• Thymus
• Loose areolar tissue (loose connective tissue)
• Two or three anterior mediastinal lymph nodes
 Inferior Mediastinum (Media)
• Heart, enclosed with Pericardium
• Artery : Ascending aorta, pulmonary arteries (divide into
2)
• Veins : Lower half of superior vena cava, pulmonary
vein (right & left)
• Carina (bifurcation of the trachea)
• Nerve : Phrenic nerve
• Bronchial lymphatic glands
 Inferior Mediastinum (posterior)
• Artery : thoracic part of descending aorta
• Veins : Azygos vein (right side of thoracic vertebra)
• Nerve : vagus (X),
• Esophagus
• Thoracic duct
• Lymph glands
 References
• Drake et al: Gray's Anatomy for Students 2E
• http://www.netterimages.com
• http://education.yahoo.com/reference/gray/subjects/subject/240
• Respiratory system BMS 3, Poppy K. Sasmita Anatomy Dept. 2013
• Tentiran Anatomi Modul Respirasi
http://dc382.4shared.com/doc/hNuuyZcX/preview.html
• http://www.cancer.gov/cancertopics/pdq/treatment/paranasalsinus/P
atient/page1
• http://www.edoctoronline.com/medical-atlas.asp?c=4&id=21673
• http://www.sinus-cure.com.au/nasanat.htm
• http://www.exploreplasticsurgery.com/2011/01/31/nose-
compression-device-for-non-surgical-rhinoplasty/
• http://ourent.blogspot.com/2008/04/5-cartilages-of-nose-external-
nose.html
 References
• http://www.as.miami.edu/chemistry/2086/Chap23/Chap%2023%20T
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• http://legacy.uspharmacist.com/oldformat.asp?url=newlook/files/Fea
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Anesthesia medicine.medscape.com/article/82679-overview
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ml