Upper Respiratory Tract - PowerPoint Presentation

Slide1

Upper

Respiratory

Tract

Slide2

Lectures

Objectives

Describe

the

structure

of

nasal

cavity

including

nasal

septum.

Describe

the

structure

of

lateral

wall

of

nasal

cavity

including

conchae

and

meatuses.

Locate

the

openings

of the

paranasal

air sinuses

and

naso‐lacrimal duct in

the

meatuses.

Describe

nasal

innervations,

blood

supply,

and

its

relation

to

epistaxis.

Study

the

structure

of

nasopharynx

and

associated openings

with their

clinical importance.

Describe

the

structure

of

various cartilages

and

membranes

of

the

larynx

.

Describe

muscles of the

larynx

including their

action, nerve

and

blood

supply.

Describe

the

structure

of

vocal cords

and

the

mechanism

of

voice production

and

control

of

air

passageway.

Slide3

Nose

Slide4

Nose

External nose

–

portion

visible on

face

Internal

nose

–

large

cavity

beyond nasal

vestibule

Internal nares

or

choanae

Ducts

from paranasal

sinuses and nasolacrimal ducts open

into

internal

nose

Nasal

cavity

divided

by

nasal

septum

Nasal

conchae subdivide

cavity

into

meatuses

Increase

surface

area

and

prevents

dehydration

Olfactory

receptors

in

olfactory

epithelium

Slide5

External

Nose

Parts

Root

Dorsum

Apex

Naris

(nostrils, anterior nasal apertures)Ala

Slide6

External

Nose

Skeleton

of the

nose

Bony

partFrontal, nasal, maxillary bonesCartilaginous

part

Lateral,

septal, alar cartilagesBlood supply: branches of ophthalmic, maxillary & facial aa.Nerve supplyInfratrochlear (V1)External nasal (V1)Infraorbital (V2)

Slide7

Slide8

Nasal

septum

Bony

part

Perpendicular

plate of ethmoidVomerCartilaginous part

‐

Septal

cartilage

Slide9

Nasal

Cavity

Parts

Nasal

vestibule

Nasal

septumChoanae (posterior nasal apertures)

Walls

of the

nasal cavityFloorRoofLateral wallSphenoethmoidal recessNasal conchaeSuperior, middle, & inferiorMeatuses

Superior,

middle,

&

inferior

Slide10

Nasal

Meatuses

Sphenoethmoidal

recess

Sphenoid

sinusMeatusesSuperiorPosterior ethmoid

sinus

MiddleBulla ethmoidalisMiddle ethmoid sinusHiatus semilunarisMaxillary sinusInfundibulumFrontal sinusAnterior ethmoid

sinus

Inferior

Nasolacrimal

duct

Slide11

Paranasal

Sinuses

Paired

cavities

in

ethmoid,

sphenoid,

frontal and maxillary bonesLined with mucous membranes and open into nasal cavity

Resonating chambers

for

voice, lighten the skullSinusitis is inflammation of the membrane

Slide12

Paranasal

Sinuses

Maxillary

sinus

Between floor of orbit and

roots

of upper molars and premolarsSuperior alveolar nn. (V2)

Frontal

sinusSupraorbital nn. (V1)Sphenoid sinusBody of sphenoidPosterior ethmoidal nn. (V1)Ethmoid sinusAnterior,

middle

&

posterior

Between nasal

cavity

and orbit

Anterior

&

posterior ethmoidal nn.

From

nasociliary n.

(V1)

Slide13

Slide14

Paranasal

Sinuses: X‐ray

Slide15

Nasal

Cavity: Innervation

Olfactory

nerve

Trigeminal

nerveOphthalmic…Maxillary …

Slide16

Nasal

Cavity: Blood

Supply

Anterior

&

posterior ethmoidal

aa.

From ophthalmic a.Sphenopalatine a.From maxillary

a.

Septal branch from facial

a.Kiesselbach’s area & plexusEpistaxisLymph drainageDeep cervical lymph nodesVestibule – submandibular lymph nodes

Slide17

Phary

nx

Slide18

Pharynx

Muscular tube

(5

inch long) hanging from

skull

Skeletal muscle

& mucous membraneCompleted posteriorly & deficient anteriorly (openings into nose, mouth &

larynx)

Extends from internal nares to cricoid cartilage

(C6)Funnel shape – wide superiorly & narrow inferiorly (1.5 cm)FunctionsPassageway for food and airResonating chamber for speech productionTonsil (lymphatic tissue) in the walls protects entryway into body

Slide19

Regions

of the Pharynx

Distinct regions

‐‐ nasopharynx,

oropharynx

and

laryngopharynx

Slide20

Nasophary

nx

Above soft

palate

Openings

Internal

naresPharyngeal isthmusAuditory (Eustachian, pharyngotympanic)

tube

StructuresPharyngeal tonsil (adenoids)Tubal elevationTubal tonsilsSalpingopharyngeal foldSalpingopharyngeus m.Pharyngeal recess

Slide21

O

rophar

y

n

x

From

soft

palate to epiglottisStructuresAt floorPosterior ⅓ of

tongue

Lingual tonsilsMedian glossoepiglotic foldLateral glossoepiglotic foldsValleculae

Slide22

O

rophar

y

n

x

At

lateral

wallPalatoglossal foldPalatoglossus m.Oropharyngeal

isthmus

Palatopharyngeal foldPalatopharyngeus m.Palatine tonsil

Slide23

La

ryng

opha

r

y

n

x

Extends from epiglottis to cricoid cartilagePosterior to laryngeal inletPiriform fossa

Between aryepiglotic

fold

and thyroid cartilage

Slide24

Pharyngeal

Muscles

External circular

muscles

Inserts

into

the pharyngeal rapheSuperior, middle, & inferior constrictor mm.

Overlap

each

other (inferior is more superficial)Cricopharyngeus m.Lower endSphincterInternal longitudinal musclesStylopharyngeus m.Palatopharengeus m.

Salpingopharyngeus

m.

Nerve

supply: pharyngeal

plexus except

stylopharyngeus muscle

(IX)

Slide25

Slide26

Phary

nx

Sensory innervation

Nasopharynx

(V2)

Oropharynx

(IX)Laryngopharynx (X) – internal laryngeal nerveBlood

supply

Ascending

pharyngeal aa.Tonsillar branch of facial aa.Branches of maxillary & lingual aa.Lymph drainageDeep cervical nodesRetropharyngeal or paratracheal nodes →

deep

cervical

Slide27

Larynx

Cartilage

&

connective

tissue

tube

Below hyoid boneAnterior to C4 to C6

Short

passageway

connecting laryngopharynx with tracheaConstructed of 3 single & 3 paired cartilagesFunctionsPassageway for airVoice productionPrevent entrance of food

Slide28

Larynx

Relations

Infrahyoid

mm.

Thyroid

glandMajor blood vessels

Slide29

Larynx:

Cartilages

Slide30

Larynx:

Cartilages

Thyroid

cartilage

The

largestIncomplete ringLaminae

Laryngeal

prominence

(Adam’s apple)Oblique lineSuperior & inferior cornuaCricothyroid joints

Slide31

Larynx:

Cartilages

Cricoid

cartilage

Complete

ringBelow thyroid cartilageLamina (posteriorly)

Cricoarytenoid

jointsArch (anteriorly)Arytenoid cartilagesApex, base, vocal process, & muscular process

Slide32

Larynx:

Cartilages

Epiglottis

Leaf shape

cartilage

(elastic cartilage)

Stalk

– attached to thyroid cartilageAryepiglottic fold

Median and

lateral

glossoepiglottic foldsvalleculae

Slide33

Larynx:

Cartilages

Corniculate cartilages

Above

arytenoids

(attachment

of

aryepiglottic fold)Cuneiform cartilages

In the aryepiglottic

fold (support)

Slide34

Larynx: Membranes

&

Ligaments

Thyrohyoid

membrane

Median

thyrohyoid

ligamentCricotracheal ligamentQuadrangular membrane

Between epiglottis

&

arytenoidVestibular ligament (inferior margin)Vestibular foldImmovable, vascular (pinkish)Cricothyroid ligamentVocal ligament (superior margin)Vocal fold

Mobile,

avascular

(whitish)

Rima

glottidis

(glottis)

Slide35

Larynx:

Cavity

Inlet

of

larynx

Orientation

BoundariesVestibuleBetween inlet &

vestibular

foldsMiddle regionBetween laryngeal foldsLaryngeal sinus (ventricle)Laryngeal sacculeLower region (infraglottic cavity)Between vocal folds & lower border

of

cricoid

Slide36

Larynx:

Muscles

Extrinsic

muscles

Elevators

Suprahyoids

(Digastric, stylohyoid, mylohyoid,

& geniohyoid)Longitudinal pharyngeal (stylopharyngeus, salpingopharyngeus, & palatopharyngeus)

Depressors

(infrahyoid)

Sternothyroid, sternohyoid, & omohyoid

Slide37

Larynx:

Muscles

Intrinsic

muscles

Modification

of

laryngeal

inletNarrowingOblique arytenoid m.

Widening

Thyroepiglottic

m.Movement of vocal cordsTensingCricothyroid m.RelaxingThyroarytenoids (vocalis) m.AdductingLateral cricoarytenoid

m.

Abducting

Posterior

cricoarytenoid

m.

Approximating

aretyneoids

Transverse

arytenoid

m.

Slide38

Larynx:

Muscles

Slide39

Slide40

Voice

Production

Vocal

folds

are

adducted

Muscle contraction pulls elastic ligaments which stretch vocal folds out into airwayVibrate and produce sound with released

air

(frequency or

pitch)Folds can move apart or together, elongate or shorten, tighter or looserAndrogens make folds thicker and longer – slower vibration and lower pitchQuality of voice determined by other structures (mouth, lips, tongue, pharynx, soft palate, & teeth)

Slide41

Larynx

Nerve

supply

Sensory

innervation

(X)Above vocal cords: internal laryngeal n.Below

vocal

cords:

recurrent laryngeal .Motor innervationAll intrinsic muscles innervated by recurrent laryngeal except cricothyroid muscle (external laryngeal n.)Blood supplyUpper half: superior

laryngeal

branch

of

superior

thyroid

a.

Lower half:

inferior

laryngeal

branch

of the

inferior

thyroid

a.

Lymph

drainage

Deep

cervical

nodes