Respiratory System PDF

(008) RESPIRATORY SYSTEM DR. GLENDA TAGORDA | 11/23/2020 k. Nerve Supply l. Blood Supply...

(008) RESPIRATORY SYSTEM DR. GLENDA TAGORDA | 11/23/2020 k. Nerve Supply l. Blood Supply OUTLINE m. Lymph Drainage I. INTRODUCTION a. Airway Anatomy b. Lung Anatomy c. Anatomical Division I. INTRODUCTION i. URT ii. LRT d. Functional Division i. Conducting Division ii. Respiratory Division II. NOSE a. External Nose i. Components and Framework ii. Blood Supply iii. Nerve Supply b. Nasal Cavity i. Boundaries ii. Mucous Membrane iii. Nerve Supply iv. Lymph Drainage v. Blood supply III. SINUSES The anatomy of the respiratory system can be divided into a. Drainage of Mucus and 2 major parts, airway anatomy and lung anatomy Function b. Maxillary Sinus A. AIRWAY ANATOMY c. Frontal Sinus d. Sphenoidal Sinus - Extrathoracic (superior) airway: includes the e. Ethmoidal Sinus supraglottic, glottic, and infraglottic regions IV. PHARYNX - Intrathoracic (inferior) airway: includes the a. Nasopharynx trachea, bronchi, and multiple bronchial b. Oropharynx generations main function: conduction of air to c. Laryngopharynx the alveolar surface d. Sensory Nerve Supply e. Blood Supply B. LUNG ANATOMY f. Lymph Drainage - includes the lung parenchyma (respiratory g. Swallowing and bronchioles, alveolar ducts and alveoli) Pharyngeal Muscles - function: mainly involved in the gas exchange at V. LARYNX the alveolar level a. Generalities - The lung parenchyma is further subdivided into b. Cartilages c. Epiglottis and Glottis lobes and segments d. Folds - Function: an organ system that rhythmically takes e. Movement of Vocal in air and expels it from the body, thereby Cords supplying the body with oxygen and expelling the f. Sound Production carbon dioxide that it generates g. Laryngeal Cavity - principal organs: nose, sinuses, pharynx, larynx, h. Sphincteric function trachea, bronchi, bronchioles and lungs i. Function of Laryngeal - Each lobes are further divided into broncho- Inlet pulmonary segments j. Valsalva Maneuver PREPARED BY: MOTIC, GLAZIA; MUNAR, REUBENER; KOLIPAKA, ELISHEBA; MONCADA, RUSTY; KANNAN, SNEHA  (008) RESPIRATORY SYSTEM DR. GLENDA TAGORDA | 11/23/2020 C. ANATOMICAL DIVISION - frontal processes of the maxillae (3) framework of external nose below is 1. UPPER RESPIRATORY TRACT formed of plates of hyaline cartilage a. The upper respiratory track starts with nasal cavity (nose), Pharynx and Larynx b. the respiratory organs in the head and neck c. airway that includes the nose, sinuses pharynx and larynx 2. LOWER RESPIRATORY TRACT a. The lower respiratory tract starts from trachea, bronchi, bronchioles down to alveoli b. the respiratory organs of the thorax c. regions from the trachea, bronchi, bronchioles, lungs D. FUNCTIONAL DIVISION 2. BLOOD SUPPLY OF THE EXTERNAL NOSE 1. CONDUCTING DIVISION a. branches of the ophthalmic and the a. consists of those passages that serve only for maxillary arteries - supplies skin of the airflow external nose b. nose through the major bronchioles b. branches from the facial artery - supplies c. Conducting Portion conducts air from the skin of the ala and the lower part of the nose to the pharynx, larynx down to trachea, septum bronchi, bronchioles and end in terminal bronchioles (end of conducting portion) 2. RESPIRATORY DIVISION a. The beginning of respiratory portion would be respiratory bronchioles b. consists of the alveoli and other gas- exchange regions of the distal airway c. from respiratory bronchioles alveoli II. NOSE A. EXTERNAL NOSE 1. COMPONENTS AND FRAMEWORK a. Orifices: two elliptical orifices called the nostrils or nares, which are separated from each other by the nasal septum b. Lateral margin: the ala nasi which is rounded and mobile c. Framework of the external nose above: - the nasal part of the frontal bone (1) - nasal bones (2) PREPARED BY: MOTIC, GLAZIA; MUNAR, REUBENER; KOLIPAKA, ELISHEBA; MONCADA, RUSTY; KANNAN, SNEHA  (008) RESPIRATORY SYSTEM DR. GLENDA TAGORDA | 11/23/2020 3. NERVE SUPPLY OF THE EXTERNAL NOSE a. ROOF OF NASAL CAVITY Narrow and is formed by: - Anteriorly by the nasal and frontal bones CN V (Trigeminal): - Middle by the cribriform plate of the a. infratrochlear and external nasal branches of the ethmoid ophthalmic nerve (CN V1) - Posteriorly by the downward sloping b. infraorbital branch of the maxillary nerve (CN V2) body of the sphenoid B. NASAL CAVTITY b. MEDIAL WALL OF NASAL CAVITY 1. BOUNDARIES The anterior parts of the nasal cavities found within the nose are held open by a skeletal framework, which consists partly of bone and mainly of cartilage. The bony parts are where the nose is continuous with the skull where the nasal bones and parts of the maxillae and frontal bones provide support. Anteriorly is provided by lateral processes of the septal cartilage, major alar and three or four minor alar cartilages, and one septal cartilage within the midline that forms the anterior part of the septum. Nasal septum - Begins from the nostrils in front ends to - divides the nasal cavity into right and left the posterior nasal apertures or choanae halves behind, where the nose opens into the - parts: nasopharynx o upper part of nasal septum: - Each half of the nasal cavity has a floor, a formed by vertical plate of the roof, a lateral wall, and a medial wall ethmoid and vomer o anterior part: formed by the septal cartilage - The septum rarely lies in the midline, thus increasing the size of one half of the nasal cavity and decreasing the size of the other PREPARED BY: MOTIC, GLAZIA; MUNAR, REUBENER; KOLIPAKA, ELISHEBA; MONCADA, RUSTY; KANNAN, SNEHA  (008) RESPIRATORY SYSTEM DR. GLENDA TAGORDA | 11/23/2020 c. LATERAL WALL OF NASAL CAVITY o The infundibulum is continuous with the frontal sinus Superior lies below the superior posterior meatus concha ethmoid sinuses Sphenoet small hollow space above sphenoid air hmoidal the superior concha sinus Recess Middle Meatus - Passes through from the infundibulum of hiatum - Conchae increase the area of contact between tissues of the lateral wall and therefore the respired air semilunaris through frontal sinus showing that - The openings of the paranasal sinuses, which are there is communication between two. extensions of the nasal cavity that erode into the encompassing bones during childhood and early adulthood, are on the lateral wall and roof of the nasal cavities. The lateral wall also contains the opening of the nasolacrimal duct, which drains tears from the eye into the cavity - Turbinates/conchae: lateral wall bone projections: a. superior nasal concha b. middle nasal concha c. inferior nasal concha - Meatus: The space below each concha is called a meatus and is named after the turbinate above it Nasal Description Receives Meatuses opening/s of 2. MUCOUS MEMBRANE Inferior lies below the inferior nasolacrimal meatus concha duct a. Linings of the Nasal Mucosa Middle lies below the middle - the anterior meatus concha & contains the: and middle - Ethmoid Bulla: a ethmoidal rounded swelling sinuses /bony projection - hiatus formed by the middle semilunaris ethmoidal air sinuses, - maxillary which open on its sinus via upper border hiatus - Hiatus semilunaris: - semilunaris) o A curved opening - frontal sinus that lies just via below the bulla infundibulu o The anterior end m) - squamous mucosa: vestibule the nasal of the hiatus leads into a vestibule is a dilated chamber inside the ala funnel-shaped nasi it lined with modified skin and has coarse channel called hairs (stiff vibrissae or guard hairs, that block the infundibulum the inhalation of large particles) - olfactory mucous membrane o lines the area above the superior concha PREPARED BY: MOTIC, GLAZIA; MUNAR, REUBENER; KOLIPAKA, ELISHEBA; MONCADA, RUSTY; KANNAN, SNEHA  (008) RESPIRATORY SYSTEM DR. GLENDA TAGORDA | 11/23/2020 o contains nerve endings sensitive to the 4. LYMPH DRAINAGE reception of smell. - respiratory mucous membrane lines the lower part of the nasal cavity. A large plexus of veins in the submucous connective tissue is present in the respiratory region. b. Function of the Nasal Mucosa - The presence of warm blood in the venous plexuses serves to heat up the inspired air as it enters the respiratory system. - The presence of mucus on the surfaces of the conchae traps foreign particles and organisms in the inspired air, which are then swallowed and destroyed by gastric acid. 3. NERVE SUPPLY a. submandibular nodes: receives lymph vessels draining the vestibule. The nodes can be palpated in between the angle of mandible and tip of the mandible. b. upper deep cervical nodes: receives vessels that drain remainder of the nasal cavity. The nodes can be palpated underneath the sternocleidomastoid. 5. BLOOD SUPPLY a. CN I (olfactory) - The olfactory nerves from the olfactory mucous membrane ascend through the cribriform plate of the ethmoid bone to the olfactory bulbs b. CN V (trigeminal) - nerves of ordinary sensation: - ophthalmic division (V1) of CN V - maxillary division (V2) of CN V - The arterial supply to the nasal cavity is from branches of the maxillary artery - The most important branch is the sphenopalatine artery - The sphenopalatine artery anastomoses with the septal branch of the superior labial branch of the facial artery in the region of the vestibule - Kiesselbach's plexus a. a vascular network of the five arteries that supply the nasal septum PREPARED BY: MOTIC, GLAZIA; MUNAR, REUBENER; KOLIPAKA, ELISHEBA; MONCADA, RUSTY; KANNAN, SNEHA  (008) RESPIRATORY SYSTEM DR. GLENDA TAGORDA | 11/23/2020 b. The arteries anastomose to form the plexus which 9. Secretion cannot be drained into nasal cavity, so they is a common site for nosebleeds accumulate in the sinuses which are supposed to be c. It lies in the anterior inferior part of the septum air filled known as Little's area, also Kiesselbach's area, or 10. Clinical significance: When the apertures of the Kiesselbach's triangle. The submucous venous sinuses are blocked or they become filled with fluid, plexus is drained by veins that accompany the the quality of the voice is markedly changed arteries FUNCTION: It keeps us upright III. SINUSES B. MAXILLARY SINUS 1. Are cavities found in the interior of the maxilla, frontal, sphenoid, and ethmoid bones, 2. Arranged in pairs 3. Are lined with mucoperiosteum and filled with air; 4. They communicate with the nasal cavity through relatively small apertures called ostia 5. Only frontal and maxillary sinuses are accessible to clinical examination A. DRAINAGE OF MUCUS AND FUNCTION 1. The maxillary sinus is pyramidal in shape and located within the body of the maxilla behind the skin of the cheek 2. Boundaries of maxillary sinus roof : formed by the floor of the orbit floor :related to the roots of the premolars and molar teeth. 3. Drainage of maxillary sinus:opens into the middle meatus of the nose through the hiatus semilunaris The opening of this sinus is near the top of the base, within the center of the semilunar hiatus, which grooves the lateral wall of the middle nasal meatus 6. The mucus produced by the mucous membrane is moved into the nose by ciliary action of the columnar cells 7. Drainage of the mucus is also achieved by the siphon action created during the blowing of the nose 8. The function of the sinuses: a. act as resonators to the voice; (makes voice loud, clear and deep). The result of resonance is always a big vibration - that is, a loud sound b. reduce the weight of the skull PREPARED BY: MOTIC, GLAZIA; MUNAR, REUBENER; KOLIPAKA, ELISHEBA; MONCADA, RUSTY; KANNAN, SNEHA  (008) RESPIRATORY SYSTEM DR. GLENDA TAGORDA | 11/23/2020 C. FRONTAL SINUSES 2. Each sinus opens into the sphenoethmoidal recess above the superior concha Innervation of the sphenoidal sinuses is provided by the posterior ethmoidal branch of the ophthalmic nerve (V1), and also the maxillary nerve (V2) via orbital branches from the pterygopalatine ganglion E. ETHMOIDAL SINUSES 1. The two frontal sinuses are contained within the frontal bone 2. They are separated from each other by a bony septum. 3. Each sinus is roughly triangular, extending upward above the medial end of the eyebrow and backward into the medial part of the roof of the orbit. 4. Each frontal sinus opens into the middle meatus of the 1. The ethmoidal sinuses are anterior, middle, and nose through the infundibulum posterior The frontal sinuses are innervated by branches of the 2. contained within the ethmoid bone, between the nose supra-orbital nerve from the ophthalmic nerve (V1). and the orbit Their blood supply is from branches of the anterior 3. They are separated from the orbit by a thin plate of bone ethmoidal arteries so that infection can readily spread from the sinuses into the orbit. D. SPHENOIDAL SINUSES a. anterior ethmoid sinuses open into the infundibulum b. middle ethmoid sinuses open into the middle meatus, on or above the bulla ethmoidalis c. posterior ethmoid sinuses open into the superior meatus (check the end for the summary of paranasal sinuses) 1. The two sphenoidal sinuses lie within the body of the sphenoid bone PREPARED BY: MOTIC, GLAZIA; MUNAR, REUBENER; KOLIPAKA, ELISHEBA; MONCADA, RUSTY; KANNAN, SNEHA  (008) RESPIRATORY SYSTEM DR. GLENDA TAGORDA | 11/23/2020 b. lower, narrow end becoming continuous with IV. PHARYNX the esophagus opposite the 6th cervical vertebra 4. Musculomembranous wall of the pharynx deficient anteriorly and replaced by the: a. Posterior choanae b. opening into the mouth c. the inlet of the larynx 5. continuous with that of the tympanic cavity by means of the auditory tube 1. The pharynx is situated behind the nasal cavities, the mouth, and the larynx 2. Divided into nasopharynx, oropharynx, laryngopharynx 3. Funnel shaped: a. upper, wider end lying under the skull PREPARED BY: MOTIC, GLAZIA; MUNAR, REUBENER; KOLIPAKA, ELISHEBA; MONCADA, RUSTY; KANNAN, SNEHA  (008) RESPIRATORY SYSTEM DR. GLENDA TAGORDA | 11/23/2020 A. NASOPHARYNX B. OROPHARYNX 1. Lies behind the opening into the larynx 2. The lateral wall is formed by the thyroid cartilage and the thyrohyoid membrane. 3. The piriform fossa is a depression in the mucous membrane on each side of the laryngeal inlet 1. lies above the soft palate and behind the nasal cavities - The palatoglossal folds (arches), one on either 2. In the submucosa of the roof is a collection of side, that cover the palatoglossal muscles, mark lymphoid tissue called the pharyngeal tonsil the boundary between the rima and therefore the 3. pharyngeal isthmus is the opening in the floor oropharynx. between the soft palate and the posterior pharyngeal - When holding liquid or solids within the oral wall. On the lateral wall is the opening of the auditory cavity, the oropharyngeal isthmus is closed by tube, the elevated ridge of which is called the tubal depression of the soft palate, elevation of the back elevation of the tongue, and movement toward the midline a. Eustachian tube: tube that links the nasopharynx of the palatoglossal and palatopharyngeal folds. to the middle ear. This enables an individual to breathe while b. fossa of Rosen muller is a bilateral projection of chewing or manipulating material within the oral the nasopharynx just below the skull base. It is cavity also called the lateral pharyngeal recess or simply the pharyngeal recess. The fossa is covered by nasopharyngeal mucosa and is the most common site of origin of nasopharyngeal carcinoma (NPC) There is a large collection of lymphoid tissue (the pharyngeal tonsil) within the mucosa covering the roof of the nasopharynx. Enlargement of this tonsil, known then as adenoids, can occlude the nasopharynx so that breathing is just possible through the rima PREPARED BY: MOTIC, GLAZIA; MUNAR, REUBENER; KOLIPAKA, ELISHEBA; MONCADA, RUSTY; KANNAN, SNEHA  (008) RESPIRATORY SYSTEM DR. GLENDA TAGORDA | 11/23/2020 C. LARYNGOPHARYNX E. BLOOD SUPPLY 1. Ascending pharyngeal 2. tonsillar branches of facial arteries 3. branches of maxillary and lingual arteries - Veins of the pharynx form a plexus, which drains superiorly into the pterygoid plexus within the infratemporal fossa, and inferiorly into the facial 1. Lies behind the opening into the larynx and internal jugular veins 2. The lateral wall is formed by the thyroid cartilage and the thyrohyoid membrane. 3. The piriform fossa is a depression in the mucous F. LYMPH DRAINAGE membrane on each side of the laryngeal inlet - The laryngopharynx extends from the superior margin of the epiglottis to the top of the esophagus at the level of vertebra cvi D. SENSORY NERVE SUPPLY 1. Directly into the deep cervical lymph nodes o 2. indirectly via the retropharyngeal or paratracheal nodes into the deep cervical nodes 1. Nasopharynx: Trigeminal nerve Maxillary branch (V2) 2. Oropharynx: Glossopharyngeal nerve 3. Laryngoharynx (around the entrance into the larynx): The internal laryngeal branch of the vagus nerve PREPARED BY: MOTIC, GLAZIA; MUNAR, REUBENER; KOLIPAKA, ELISHEBA; MONCADA, RUSTY; KANNAN, SNEHA  (008) RESPIRATORY SYSTEM DR. GLENDA TAGORDA | 11/23/2020 G. ACT OF SWALLOWING; PHARYNGEAL MUSCLES o palatopharyngeus muscles. Action: Elevates wall of pharynx, pulls palatopharyngeal arch medially like side curtains c. When soft palate is elevated oropharynx is shut off from the nasopharynx: - Air may enter pharynx thru the mouth to laryngopharynx - Same set up of allows for expectoration of mucus from respiratory system through the mouth - allows the maximum expiration of air through the mouth as in the use of wind instruments such as the trumpet. 1. Masticated food is formed into a ball or bolus on the dorsum of the tongue and voluntarily pushed upward and backward against the undersurface of the hard palate. (air and food can pass through pharynx). During mastication, air can enter the oropharynx via the mouth. 4. Elevation of the laryngopharynx (stylopharyngeus, salpingopharyngeus, palatopharyngeus thyrohyoid, and muscles) 2. The muscle of the soft palate then squeeze the bolus backward into the pharynx. From this point onward, the process of swallowing becomes an involuntary act. (air from mouth and food can pass) 3. nasopharynx is shut off from the oropharynx: (air from mouth and food can pass) a. Why? To prevent the passage of food and drink into the nasal cavities b. How is it done? - elevation of soft palate (contraction of Levator Veli Palatini) - the pulling forward of the posterior wall of the pharynx by the superior constrictor muscle and palatopharyngeus muscles o Superior, constrictor muscle: Action: aids soft palate in closing off nasal pharynx; and propels bolus downward PREPARED BY: MOTIC, GLAZIA; MUNAR, REUBENER; KOLIPAKA, ELISHEBA; MONCADA, RUSTY; KANNAN, SNEHA  (008) RESPIRATORY SYSTEM DR. GLENDA TAGORDA | 11/23/2020 a. Larynx is pushed upward to the posterior surface of Cricopharyngeus muscle action: Sphincter at lower end of the epiglottis, so that the food goes to the pharynx esophagus and the entrance into the larynx is closed, INNERVATION: shutting the larynx by pulling it upwards, the same 1. All the muscles of the pharynx are innervated by as closing the nasopharynx PHARYNGEAL PLEXUS except for b. (During the pharyngeal phase, since the trachea is 2. The stylopharyngeus: innervated by the blocked by the epiglottis, breathing is temporarily glossopharyngeal nerve stopped, causing apnea.) Pharyngeal muscles in 3. (Check the end for the summary of muscles of the action pharynx) - Stylopharyngeus: Elevates larynx during swallowing. Elevation of the laryngopharynx to V. LARYNX direct the food towards the esophagus and not the larynx - SalpingopharyngeusElevates pharynx - Palatopharyngeus: Elevates wall of pharynx, pulls palatopharyngeal arch medially 5. The laryngeal entrance (inlet) is made smaller to aid in preventing food from entering the airway The Larynx 1. Cartilages of the LarynxL 3 large solitary, 3 small paired 2. Laryngeal Folds 3. Muscles of the Larynx a. Movements of the Vocal Folds with Respiration b. Voice Production in the Larynx 4. Cavity of the Larynx 6. The bolus of food is propelled downward over the 5. Inlet of the Larynx epiglottis to reach lower part of the pharynx 6. Sphincteric Function of the Larynx a. inferior constrictor muscles action: Propels bolus downward b. middle constrictor muscles action: Propels bolus downward c. Superior constrictor muscles action: Propels bolus downward 7. Finally, the lower part of the pharyngeal wall (the cricopharyngeus muscle) relaxes and the bolus enters the esophagus. PREPARED BY: MOTIC, GLAZIA; MUNAR, REUBENER; KOLIPAKA, ELISHEBA; MONCADA, RUSTY; KANNAN, SNEHA  (008) RESPIRATORY SYSTEM DR. GLENDA TAGORDA | 11/23/2020 A. GENERALTIES B. CARTILAGES LARYNX: CARTILAGES (LARGE AND SOLITARY) solitary EPIGLOTTIC THYROID CRICOID and CARTILAGE CARTILAGE CARTILAGE relatively large cartilage of the larynx Location most -Below Inferior to superior epiglottic the thyroid one cartilage cartilage -Above cricoid cartilage Shape spoon Largest ringlike 1. The larynx is an organ that provides a protective shaped shieldlike sphincter at the inlet of the air passages and is responsible shape for voice production. Function supportive -broadly -connects 2. Location: lies at the level of the 4th-6th cervical plate in the covers the the larynx vertebrae epiglottis anterior and to the 3. Relations: lateral aspects trachea a. It is situated below the tongue and hyoid bone of the larynx -thyroid b. between the great blood vessels of the neck -“Adam’s and cricoid c. Above:It opens above into the laryngeal part of apple” is an cartilages the anterior peak essentially d. below it is continuous with the trachea. of the thyroid constitute cartilage the “box” called the of the laryngeal voice box” prominence -Testosterone stimulates the growth of this prominence, which is therefore larger in males than in 4. The larynx is covered in front by the infrahyoid strap females muscles and at the sides by the thyroid gland. 5. The framework of the larynx is formed of cartilages that are held together by ligaments and membranes, moved by muscles, and lined by mucous membrane. PREPARED BY: MOTIC, GLAZIA; MUNAR, REUBENER; KOLIPAKA, ELISHEBA; MONCADA, RUSTY; KANNAN, SNEHA  (008) RESPIRATORY SYSTEM DR. GLENDA TAGORDA | 11/23/2020 LARYNX: CARTILAGES (PAIRED AND SMALL) Glottis= rima glottis and vocal fold ARYTENOID CORNICULATE CUNEIFORM 2. consisting of the vocal cords and the opening CARTILAGES CARTILAGES CARTILAGES between them boundaries: front by the vocal folds shape pyramid conical- rod-shaped behind by the medial surface of the arytenoid shaped shaped cartilages function Apex: give -found in Rima glottis: A cleft or gap between the vocal folds articulates attachment to the with the aryepiglottic D. FOLDS corniculate aryepiglottic folds (Check the end for the images) cartilage, folds -serve to Base: strengthen E. MOVEMENT OF VOCAL CORDS articulates aryepiglottic MOVEMENT OF VOCAL CORDS WITH RESPIRATION with the folds lamina of the cricoid cartilage vocal process: projects forward and gives attachment to the vocal ligament muscular 1. depend on the movements of the arytenoid process : cartilages, which rotate and slide up and down on projects the sloping shoulder of the superior border of the laterally gives cricoid cartilage attachment to 2. Five muscles move the vocal folds (cords) the posterior a. Posterior cricoarytenoid: abducting the vocal and lateral cords cricoarytenoid b. Lateral cricoarytenoid:adducting the vocal cords muscles c. Transverse arytenoid aka interarytenoid: (Check the end for the images) approximates the arytenoid cartilages d. Thyroarytenoid: relaxing the vocal cords e. Cricothyroid muscle: tenses the vocal cords C. EPIGLOTTIS AND GLOTTIS EPIGLOTTIS OPENING OF THE RIMA GLOTTIDES - Muscles that move vocal cords: Posterior 1. The flap is made of elastic cartilage covered with a cricoarytenoid muscle mucous membrane, attached to the entrance of the larynx. 2. It projects obliquely upwards behind the tongue and the hyoid bone, pointing dorsally 3. Function: keeps food from entering the windpipe and the lungs. GLOTTIS 1. narrowest part of the larynx measures about 2.5 cm from front to back in the male adult and less in the female. PREPARED BY: MOTIC, GLAZIA; MUNAR, REUBENER; KOLIPAKA, ELISHEBA; MONCADA, RUSTY; KANNAN, SNEHA  (008) RESPIRATORY SYSTEM DR. GLENDA TAGORDA | 11/23/2020 together by contraction of the transverse arytenoid muscles During expiration a. vocal folds are adducted b. leaving a small gap between them SLACKENING/ RELAXING OF VOCAL CORDS - Action: Abducts the vocal cords by rotating arytenoid cartilage. The rima glottidis is opened During quiet inspiration a. vocal folds are abducted b. rima glottidis is triangular in shape with the apex in front During deep inspiration a. vocal cords are maximally abducted b. Rima glottidis is diamond in shape (because of the maximal lateral rotation of the arytenoid cartilages) - Thyroarytenoid muscle - Action: Relaxes vocal cords CLOSING OF RIMA GLOTTIDES - lower-pitched sound are produced when the cords are more slacked/relaxed STRETCHING OF VOCAL CORDS - Muscles that move vocal cords: o Lateral cricoarytenoid muscle Action: Adducts the vocal cords by Cricothyroid muscle rotating arytenoid cartilage 1. Action: Tenses vocal cords o transverse arytenoid muscles 2. stretched by contraction of the cricothyroid muscle posterior part of the glottis is narrowed 3. high-pitched sound are produced: when the cords are when the arytenoid cartilages are drawn relatively taut /stretched PREPARED BY: MOTIC, GLAZIA; MUNAR, REUBENER; KOLIPAKA, ELISHEBA; MONCADA, RUSTY; KANNAN, SNEHA  (008) RESPIRATORY SYSTEM DR. GLENDA TAGORDA | 11/23/2020 G. SOUND PRODUCTION OF LARYNX H. LARYNGEAL CAVITY Produced by intermittent release of expired air between the adducted vocal folds results in their vibration and in the production of sound Quality high-pitched sound: when the cords are relatively taut /stretched lower-pitched sound : produced when the cords are more slack/relax Difference in sex In adult males compared to female vocal cords are usually longer and thicker vibrate more slowly produce lower-pitched 1. Boundaries: extends from the laryngeal inlet to the sounds lower border of the of the cricoid cartilage where it is Loudness of sound determined by the force of continuous with the cavity of the trachea. the air passing between 2. narrow in the region of the vestibular folds(rima the vocal cords vestibule) Sound vs intelligible Vocal cords alone produce 3. narrowest in the region of the vocal cords(rima speech sound but not intelligible glottidis) speech 4. It is divided into three regions: crude sounds from the a. Laryngeal vestibule/supraglottic: situated larynx are formed into between the inlet and the vestibular folds. Is words by actions of the the upper chamber of the laryngeal cavity pharynx, oral cavity, between the laryngeal inlet and also the tongue, and lips vestibular. Folds, which encloses the vestibular ligaments and associated soft tissues. b. Middle region/Laryngeal Ventricle: situated between the vestibular folds above and the vocal folds below. Is very thin c. Lower region/Infraglottic: situated between the vocal folds above and the lower border of the cricoid cartilage below. Is the foremost inferior chamber of the laryngeal cavity and is between the vocal folds (which encloses the vocal ligaments and related soft tissues) and therefore the inferior opening of the larynx PREPARED BY: MOTIC, GLAZIA; MUNAR, REUBENER; KOLIPAKA, ELISHEBA; MONCADA, RUSTY; KANNAN, SNEHA  (008) RESPIRATORY SYSTEM DR. GLENDA TAGORDA | 11/23/2020 Where are the sphincters in the larynx? is the function 1. oblique arytenoid muscle of the two Sphincters of the Larynx in relation to a. Action: Narrows the inlet by bringing the swallowing, coughing and straining (Valsalva aryepiglottic folds together maneuver)? b. Effect: Narrowing the inlet 2. thyroepiglottic muscle Sphincter is a circular muscle that normally maintains a. action: Widens the inlet by pulling the constriction of a natural body passage or orifice and which aryepiglottic folds apart relaxes as required by normal physiological functioning. b. effect: widening of the inlet Two sphincters in the larynx: J. FUNCTION OF LARYNGEAL INLET 1. sphincter in Laryngeal inlet 2. sphincter at the Rima glottides I. SPHINCTERIC FUNCTION: LARYNGEAL INLET BOUNDARIES: used only during swallowing: laryngeal inlet is narrowed by oblique arytenoid muscle and capped by the epiglottis The opening is wider in front than behind and is bounded 1. As the bolus of food is passed backward between the by: tongue and the hard palate, the larynx is pulled up a. Anterior: upper edge of epiglottis (E) beneath the back of the tongue. b. Lateral: aryepiglottic folds (AEF) 2. The inlet of the larynx is narrowed by the action of c. Posterior: mucous between arytenoids (A) the oblique arytenoid and aryepiglottic muscles. 3. The epiglottis is pulled backward by the tongue and MUSCLES: serves as a cap over the laryngeal inlet. Larynx: Two Intrinsic muscles that modify the laryngeal 4. The bolus of food, or fluids, then enters the inlet: esophagus by passing over the epiglottis or moving down the grooves on either side of the laryngeal inlet, the piriform fossae. 5. Anatomically, breathing is inhibited during part of the swallow process, thus causing swallow apnea. SWALLOWING PROCESS Narrowing and widening the laryngeal inlet is for swallowing The swallowing process is divided into three steps: (1) the oral preparation phase, (2) the pharyngeal phase, and (3) the esophageal phase PREPARED BY: MOTIC, GLAZIA; MUNAR, REUBENER; KOLIPAKA, ELISHEBA; MONCADA, RUSTY; KANNAN, SNEHA  (008) RESPIRATORY SYSTEM DR. GLENDA TAGORDA | 11/23/2020 During the oral phase Irritation in the airways leads to a coughing reflex - food is chewed into a viscous bolus. - The volume and viscosity of the bolus is also K. VALSALVA MANEUVER sensed in this phase, so that the swallowing apparatus can adapt to the bolus. In the pharyngeal phase - the bolus travels through the pharynx and passes the upper esophageal sphincter. - A set of muscles is activated to propel the bolus and - the epiglottis moves downward to cover the vocal folds and to protect the trachea from contamination. during the esophageal phase - the bolus is pushed towards the stomach - During the pharyngeal phase, since the trachea is blocked by the epiglottis, breathing is temporarily stopped, causing apnea Larynx: Sphincter at the rima glottides 1. Attempting to forcibly exhale while keeping mouth and Function in coughing or sneezing nose close (closed glottis) - intrathoracic pressure increases to as much as 80 mmHG 2. Used in abdominal straining associated with - Micturition - Defecation - parturition 3. Process: - After deep inspiration, the rima glottidis is closed. - The muscles of the anterior abdominal wall contract - c. the upward movement of the diaphragm is prevented by the presence of compressed air within the respiratory tract - After a prolonged effort, the person often releases some of the air by momentarily opening the rima glottidis, producing a grunting sound. a. After inspiration, the vocal folds are adducted, and the muscles of expiration are made to contract The aryepiglotticus is a muscle of the larynx running in the strongly. aryepiglottic fold from the arytenoid cartilage to the b. As a result, the intrathoracic pressure rises, and the epiglottis. Aryepiglottic folds extends from the epiglottis vocal folds are suddenly abducted. to the arytenoid cartilage c. The sudden release of the compressed air will often dislodge foreign particles or mucus from the respiratory tract and carry the material up into the pharynx, where the material is either swallowed or expectorated. Sneezing same mechanism but to direct released air towards the nasal passageways the uvula is depressed PREPARED BY: MOTIC, GLAZIA; MUNAR, REUBENER; KOLIPAKA, ELISHEBA; MONCADA, RUSTY; KANNAN, SNEHA  (008) RESPIRATORY SYSTEM DR. GLENDA TAGORDA | 11/23/2020 Movements quiet Deep expiration L. NERVE SUPPLY of the Vocal inspiration inspiration Folds with Respiration Position of vocal folds maximally vocal folds vocal cords are abducted are abducted adducted Shape of rima diamond leaving a rima glottidis is shape small gap glottidis triangular (because of between in shape the them with the maximal apex inlateral front rotation of the arytenoid cartilages) During the quiet inspiration vocal folds are abducted to Sensory Nerves allow the entry of air a. Above the vocal cords: The internal laryngeal branch of the superior laryngeal branch of the vagus b. Below the level of the vocal cords: The recurrent laryngeal nerve Motor Nerves a. Recurrent laryngeal nerve. All the intrinsic muscles of the larynx except the cricothyroid muscle b. External laryngeal nerve MUCOUS MEMBRANE OF THE LARYNX a. The mucous membrane of the larynx lines the cavity and is covered with ciliated columnar epithelium. b. On the vocal cords where the mucous membrane is subject to repeated trauma during phonation, The cricothyroid muscle (tenses vocal cords) is supplied by the mucous membrane is covered with stratified the external laryngeal branch of the superior laryngeal squamous epithelium branch of the vagus. M. BLOOD SUPPLY a. Upper half of the larynx: The superior laryngeal branch of the superior thyroid artery PREPARED BY: MOTIC, GLAZIA; MUNAR, REUBENER; KOLIPAKA, ELISHEBA; MONCADA, RUSTY; KANNAN, SNEHA  (008) RESPIRATORY SYSTEM DR. GLENDA TAGORDA | 11/23/2020 b. Lower half of the larynx: The inferior laryngeal branch of the inferior thyroid artery N. LYMPH DRAINAGE The lymph vessels drain into the deep cervical group of node Figure 1: Laryngeal Cartilages with respect to Epiglottis APPENDIX Table 1. Summary of Paranasal Sinuses PREPARED BY: MOTIC, GLAZIA; MUNAR, REUBENER; KOLIPAKA, ELISHEBA; MONCADA, RUSTY; KANNAN, SNEHA  (008) RESPIRATORY SYSTEM DR. GLENDA TAGORDA | 11/23/2020 Figure 2: Laryngeal Cartilages Figure 3: VOCAL FOLDS Figure 3: Opening of the Rima Glottides PREPARED BY: MOTIC, GLAZIA; MUNAR, REUBENER; KOLIPAKA, ELISHEBA; MONCADA, RUSTY; KANNAN, SNEHA  (008) RESPIRATORY SYSTEM DR. GLENDA TAGORDA | 11/23/2020 Figure 4: Function of Laryngeal Sphincter in Coughing/ Sneezing Figure 5: Vocal cords, Epiglottis, Rima glottide Figure 6: Role of Rima Glottidis in Breathing PREPARED BY: MOTIC, GLAZIA; MUNAR, REUBENER; KOLIPAKA, ELISHEBA; MONCADA, RUSTY; KANNAN, SNEHA  (008) RESPIRATORY SYSTEM DR. GLENDA TAGORDA | 11/23/2020 Table 2. Summary of Muscles of the Pharynx Table 3. Summary of Intrinsic Muscles of the Larynx VI. REFERENCES 1. Snell, Richard (2012). Snell’s Clinical Anatomy by Regions(10th ed) Lippincott Williams & Wilkins. CHAPTER 3 The Thorax: Part II—The Thoracic Cavity 2. Netter,Frank H. MD(2018) Atlas of Human Anatomy( 7th ed).Saunders Elsevier PREPARED BY: MOTIC, GLAZIA; MUNAR, REUBENER; KOLIPAKA, ELISHEBA; MONCADA, RUSTY; KANNAN, SNEHA  (008) RESPIRATORY SYSTEM DR. GLENDA TAGORDA | 11/23/2020 VI QUESTIONS AND ANSWERS Answers: 1.) Forms the lateral margins of the nose, it rounded and 1. Orifice mobile. 2. Respiratory bronchioles to alveoli 2.) What consist the respiratory division of the respiratory 3. Meatus system? 4. Kiesselbach’s plexus 3.) What do you call the space below the concha? 5. Quality of voice is changed when aperture of sinuses is 4.) A vascular network of five arteries that supply the nasal blocked septum. 6. Facial artery 5.) What is the clinical significance of paranasal sinuses? 7. Stylopharyngeus 6.) Blood supply that supplies the skin of the ala and lower 8. Superior constrictor muscle part of septum 9. Elastic cartilage 7.) Elevates larynx during swallowing 10. Corniculate cartilage 8.) Aids soft palate in closing off nasal pharynx and propels bolus downward. 9.) What cartilage that make up the epiglottis? 10.) A conical shape cartilage? PREPARED BY: MOTIC, GLAZIA; MUNAR, REUBENER; KOLIPAKA, ELISHEBA; MONCADA, RUSTY; KANNAN, SNEHA