Systemic Anatomy For Respiratory Technology Program PDF

Systemic anatomy for respiratory Technology Of the Respiratory Therapy Program by Marwa Abdel- Samad Al-Gholam MD Anatomy and Embryology Assistant professor of Anatomy and...

Systemic anatomy for respiratory Technology Of the Respiratory Therapy Program by Marwa Abdel- Samad Al-Gholam MD Anatomy and Embryology Assistant professor of Anatomy and Embryology Menoufia University  Objectives (Ilos) By the end of this lecture, the student should be able to: ✓ Localize the different paranasal sinuses and know their important functions. ✓ Describe communications, special features of the nasopharynx ✓ Differentiate the frontal and maxillary paranasal sinuses regarding: the site, vascular and nerve supply. ✓ Maxillary sinus is the most infected one, Explain ✓ The nasopharynx is permanently opened, give reason.  Anatomy of the “Para-nasal sinus” ❑ The paranasal sinuses are air- filled spaces in some bones surrounding the nasal cavity. ❑ These sinuses open in the lateral wall of the nasal cavity. ❑ They are named frontal, ethmoidal sphenoidal and maxillary corresponding to the bone in which they are located. The sinuses are visible on plain radiograph of skull as translucent areas in the respective bones. The main function of the paranasal sinuses is to warm and humidify the inspired air. They add to the resonance of voice and reduce the weight of skull. Frontal sinus Bulla ethmoidalis Middle meatus ❑ Drainage of the sinus: it is drained by the frontonasal duct into the middle meatus. ❑ Blood and nerve supply: supraorbital nerve & vessels. Hiatus semilunaris ❑ Lymph drainage: submandibular lymph nodes Frontal sinus Frontal sinus Frontonasal duct  Ethmoidal sinuses Site: the ethmoidal sinuses are anterior, middle, and posterior and they are contained within the ethmoid bone, between the nose and the orbit.  Ethmoidal sinuses Posterior ethmoidal Middle ethmoidal Anterior ethmoidal Lymph drainage: Anterior and middle ethmoidal sinuses → submandibular lymph nodes. Posterior ethmoidal sinus → retropharyngeal lymph nodes.  Frontal & ethmoidal sinuses Posterior ethmoidal Frontonasal duct Anterior ethmoidal Middle ethmoidal Blood and nerve supply: ✓ Anterior and middle ethmoidal sinuses are supplied by the anterior ethmoidal a. and n. ✓ Posterior ethmoidal sinus is supplied by the posterior ethmoidal artery and nerve. Sphenoid sinus Site: The two sphenoidal sinuses lie within the body of the sphenoid bone. Relations: the posterior part of the roof is related to the pituitary gland.  SS SS Each lateral wall is related to the cavernous sinus and its contents. ▪ Blood and nerve supply: by the posterior ethmoidal artery and nerve. ▪ Lymph drainage: retropharyngeal lymph nodes.  Frontal, ethmoidal & sphenoidal sinuses Posterior ethmoidal Spheno-ethmoidal recess Sphenoidal Frontonasal duct Anterior ethmoidal Middle ethmoidal Lymph drainage: retropharyngeal lymph nodes Maxillary sinus Site: The maxillary sinuses, one on each side, are the largest of the paranasal sinuses and completely fill the bodies of the maxillae Relations: The roof is formed by the floor of the orbit. The floor is related to the roots of the upper premolar and molar teeth.  Maxillary sinuses Maxillary sinus Blood supply: Facial, infraorbital and greater palatine arteries. Nerve supply: Anterior, middle, and posterior superior alveolar nerves and infraorbital N. Frontal, ethmoidal, sphenoidal & maxillary sinuses Posterior ethmoidal Spheno-ethmoidal recess Sphenoidal Frontonasal duct Maxillary Anterior ethmoidal Middle ethmoidal Nasolacrimal duct Infection of any above mentioned sinuses may follow common cold and leading to sinusitis  Infection of the frontal sinus may spread to the frontal lobe of the brain and meninges as the frontal sinus related posterior to the anterior cranial fossa. Infection of ethmoidal sinuses may spread into orbit, lead to orbital cellulitis.  Opening of 1- The high position of maxillary maxillary sinus sinus opening impedes its natural drainage  Listen to the answer 2- The roots of upper premolar and molar teeth project in the floor of maxillary air sinus, as the bone is very thin here, so infection from caries teeth can spread to the sinus resulting in maxillary sinusitis 3- The pus of frontal sinusitis may run via hiatus Frontal air sinus semilunaris to the maxillary sinus. Hiatus semilunaris Pharynx It is a musculomembranous tube which lies behind the nose, mouth and larynx. The pharyngeal cavity is a common pathway for air and food Pharynx Base of the skull It extends from the base of Lower border of skull to the lower border of cricoid cartilage cricoid cartilage where it becomes continuous with esophagus. Cricoid cartilage Lateral view  Posterior view Nasopharynx Nasopharynx: lies behind the nose. It extends from base of the skull to the upper surface of soft palate.  Posterior view Oropharynx Oropharynx: lies behind the mouth. It extends from soft palate to the level of epiglottis.  Laryngopharynx Lateral view Laryngeal inlet Lies behind the larynx. It extends from the Posterior view level of epiglottis to the esophagus. Structure of the Pharyngeal Wall Nasopharynx Pharyngeobasilar fascia ▪ It is permanently opened to allow free breathing due to the following: - It has rigid wall due to well- developed pharyngobasilar fascia - Its wall is uncovered by constrictor muscles. Nasopharyngeal tonsil Nasopharyngeal tonsil The nasopharyngeal tonsil is a lymphoid collection that lies in the mucosa of the nasopharynx at the junction of roof and posterior wall. It increases in size up to the age of six years and then gradually atrophies.  a SAQ: Regarding this b diagram answer the following questions: c 1- Name the marked bone (a). Cribriform plate of ethmoid. 2- Name the paranasal sinus that opens in the marked meatus (b). posterior ethmoidal sinus 3- Name the marked structure (b). Nasopharyngeal tonsil  Hypertrophy of nasopharyngeal tonsil Normal = Adenoid Nasopharyngeal tonsil Hypertrophy of nasopharyngeal tonsil is called adenoids. Sometimes, in children the adenoids may obstruct the nasopharynx completely giving rise to mouth breathing.  Nasopharynx communication It is in communication with middle ear via the auditory tubes.  Inferior nasal concha Tubal elevation Pharyngeal opening of the auditory tube Pharyngeal opening of the auditory tube: situated 1 cm behind the inferior nasal concha. The pharyngeal opening is bounded above and behind by the tubal elevation, produced by the cartilage of the auditory tube.  Inferior nasal concha Tubal elevation Pharyngeal opening of the auditory tube Salpingopharyngeal fold The lower end of the tubal elevation is continuous with a vertical mucous fold called the salpingopharyngeal fold.  Inferior nasal concha Tubal elevation Pharyngeal recess Salpingopharyngeal fold Behind the tubal elevation, there is the "pharyngeal recess”. Oropharynx Oropharynx Palatine tonsil Palatine tonsil → one on each side in the tonsillar fossa. Tonsillar fossa → between the palatoglossal fold anteriorly and the palatopharyngeal fold posteriorly. Waldeyer's ring (pharyngeal lymphoid ring) is a ringed arrangement of lymphoid organs in the pharynx. Waldeyer's ring surrounds the naso- and oropharynx, with some of its tonsillar tissue located above and some below the soft palate (and to the back of the mouth cavity). Structure The ring consists of the (from top to bottom): 1 Pharyngeal tonsil (or "adenoid"), located on the nasopharynx 2 Tubal tonsils on each side, where each auditory tube opens into the nasopharynx 2 Palatine tonsils located in the oropharynx Lingual tonsils, a collection of lymphatic tissue located on the back part of the tongue Waldeyer's ring (pharyngeal lymphoid ring) Laryngopharynx Laryngopharynx Piriform fossa → on the lateral wall, one on each side of the inlet of the larynx. Posterior view Laryngeal inlet Piriform recess This fossa is the site of the impaction of foreign bodies. The internal & recurrent laryngeal nerve lies on its floor. So vulnerable to injury during removal of foreign body * Arterial blood supply: branches from ECA Ascending pharyngeal, Ascending palatine and greater palatine arteries. *Venous drainage: Pharyngeal venous plexus.  Lymphatic drainage: Retropharyngeal lymph nodes. Nerve supply: Pharyngeal branch from ptergyopalatine ganglion. Problem solving: A 25 years old woman suffered from recurrent nasal obstruction, greenish discharge and severe pain over the upper jaw. On examination, the diagnosis was sinusitis (inflammation of paranasal sinuses ). 1- Which of the following sinuses was the most affected? a. Frontal b. Maxillary c. Sphenoid d. Ethmoidal 2- Name the site of the opening of this sinus in the lateral nasal wall.