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Parts of nose External nose Nasal cavity Function of nose Respiration Olfaction Protection of lower respiratory passage Conditioning the inspired air Vocal resonance...

Parts of nose External nose Nasal cavity Function of nose Respiration Olfaction Protection of lower respiratory passage Conditioning the inspired air Vocal resonance Nasal reflex functions (e.g. Sneezing) Part of external nose Clinical Rhinophyma (Hypertrophy of sebaceous glands) correlation of external nose Arteries of Dorsal nasal branch of ophthalmic artery external nose Infra-orbital branch of maxillary artery Alar and septal branches of facial artery Sensory nerve External/dorsal nasal and infra-trochlear branches of ophthalmic nerve supply of the Infra-orbital branch of maxillary nerve external nose Procerus produces transverse wrinkles Nasalis Transverse part or Compresses the nasal aperture compressor naris Muscles of Alar part or dilator naris Dilates the nasal aperture the external Depressor dilates the anterior nasal aperture nose septi These muscles supplied by the facial nerve Division of nasal The vestibule cavity The nasal cavity proper Vestibule of nose contains sweat glands, sebaceous glands and coarse hair – vibrissae Limen nasi forms the upper limit Columella forms the medial wall Boundaries of nasal cavity Clinical Deviated nasal septum (DNS) correlation of corrected by submucous resection (SMR) or septo-plasty nasal cavity Nasal concha Superior concha and middle labyrinth of ethmoid bone concha Inferior concha independent bone Supreme concha sometimes Meatuses Inferior meatus- Nasolacrimal duct (6) Middle meatus(bulla ethmoidalis)- middle ethmoidal air cells Middle meatus(hiatus semilunaris)- infundibulum maxillary air sinus (5), Anterior ethmoidal air sinus (3), Frontal air sinus opens (2) Superior meatus- sphenoidal air sinus (1) Lining of nasal Olfactory region- olfactory epithelium cavity Respiratory region- pseudo stratified ciliated columnar epithelium Antero-superior quadrant anterior and posterior ethmoidal arteries branches of ophthalmic artery Arterial supply of Antero-inferior quadrant alar branch of facial artery and the lateral wall of terminal branches of greater nasal cavity palatine arteries Postero-superior quadrant spheno-palatine branch of maxillary artery Postero-inferior quadrant greater palatine branch of maxillary artery supplied by branches of ophthalmic artery, maxillary and facial arteries Venous drainage facial vein of the lateral wall retro-pharyngeal veins and pterygoid venous plexus of nasal cavity Lymphatic submandibular nodes drainage of the retropharyngeal and upper deep cervical group of lymph nodes lateral wall of nasal cavity Little’s area septal branches of anterior ethmoidal, sphenopalatine, greater palatine and superior labial arteries form Kiesselbach’s plexus or Little’s area Arterial supply of Antero-superior part anterior and posterior ethmoidal the nasal septum branches of ophthalmic artery Postero-inferior part sphenopalatine and greater palatine branches of maxillary artery Mobile part of the septum septal branches of superior labial of facial artery Venous drainage superior ophthalmic vein of the nasal pterygoid venous plexus septum internal jugular vein through the facial vein. Lymphatic submandibular lymph nodes drainage of nasal retropharyngeal lymph node septum Nerve supply of Olfactory zone- olfactory nerves, which convey sense of smell nasal septum Remaining zone- branches of ophthalmic and maxillary divisions of trigeminal nerve Nerve supply of Sense of smell (special sensory) olfactory nerves the nasal cavity Nerves of general sense Branches of ophthalmic nerve, maxillary nerve, infraorbital nerve Autonomic nerve sympathetic and parasympathetic derived from Vidian’s nerve of nasal cavity fibres parasympathetic fibres supply nasal glands and control nasal secretion sympathetic fibres cause vasoconstriction Paranasal air sinuses Lined by pseudo-stratified ciliated columnar epithelium four pairs of paranasal air Frontal air sinuses sinuses ethmoidal air sinus Maxillary air sinuses Sphenoidal air sinus Air sinuses formation present in rudimentary form at birth except the frontal air sinus Functions of air sinuses Make the facial bones lighter and establish the adult contour of the face Add resonance to the voice Act as air conditioning chamber by adding humidity and temperature to the inspired air Frontal air sinus Supplied by supra-orbital nerves and vessels Lymphatics drain into sub-mandibular group of lymph nodes Blood supply anterior, middle and posterior superior alveolar vessels of maxillary Maxillary air sinus Lymphatics drain into sub-mandibular group of lymph nodes Nerve supply from anterior, middle and posterior superior alveolar nerves of maxillary nerve and infraorbital nerves Ethmoidal air sinus Blood supply anterior and posterior ethmoidal vessels Lymphatics submandibular group of lymph nodes retropharyngeal air sinus Sphenoidal air sinus Blood supply posterior ethmoidal vessels Nerve supply posterior ethmoidal nerves Lymphatics retro-pharyngeal lymph nodes Parts of the pharynx Nasal part or nasopharynx or epi-pharynx Oral part or oropharynx or meso-pharynx Laryngeal part or laryngopharynx or hypopharynx Nasal part of pharynx lined by ciliated columnar epithelium (nasopharynx) pharynx is supplied by glossopharyngeal (IX), the vagus (X) nerve Features of Nasopharynx Pharyngeal isthmus Tubal elevation- behind pharyngeal recess Salpingopharyngeal fold levator veli palatine muscle pharyngeal tonsil tubal tonsil Feature of Oropharynx supported by body of axis and C3 vertebra tonsillar fossa formed by all three constrictors Feature of Laryngopharynx supported by body of C4,5 and lower part of C3 vertebrae piriform fossa internal laryngeal nerve Waldeyer’s ring Function of larynx Phonation Respiration Protection deglutition Larynx growth Located at the level of C3 – C6 vertebrae larynx in the male grows rapidly angle of thyroid cartilage (Adam’s apple) Skeleton of the larynx Lined by mucous membrane Unpaired cartilages Thyroid cartilage Cricoid cartilage Epiglottis Paired cartilages Arytenoid cartilage Corniculate cartilage Cuniform cartilage cartilages of larynx are derived from 4 th to 6 th pharyngeal arches Thyroid cartilage Made up of hyaline cartilage 90° in males and 120° in females oblique line Sternothyroid muscle Thyrohyoid muscle Inferior constrictor muscle Posterior borders Salpingopharyngeus muscle Palatopharyngeus muscle Stylopharyngeus muscle posterior surface Thyroepiglittic ligament Pair of vestibular ligament Pair of vocal ligament Cricoid cartilage at the level of C6. Made up of hyaline cartilage only cartilage which completely encircles the larynx Arytenoid cartilage mostly of hyaline cartilage gives attachment to the vocal ligament gives attachment to the posterior and lateral cricoarytenoid muscles Structure of laryngeal thyroid, cricoid and basal part of arytenoid cartilages are cartilages composed of hyaline cartilages (ossify after 25 years) apices of arytenoid, corniculate and cuniform cartilages are made up of elastic cartilages and do not ossify Cricothyroid joint Permits rotatory and gliding and Cricoarytenoid movements Laryngeal joints joint Arytenocorniculate No functional significance joint Thyrohyoid membrane pierced by internal laryngeal nerve and superior laryngeal vessels Quadrangular membrane forms the vestibular ligament Cricotracheal ligament Thyroepiglottic ligament Hyoepiglottic ligament Cricothyroid ligament called vocal ligament Laryngeal cavity  Extrinsic muscles Elevators Digastric Thyrohyoid Stylohyoid Mylohyoid Geniohyoid Depressors Sternothyroid Sternohyoid Omohyoid Intrinsic muscles Cricothyroid tenses vocal cords Posterior abducts the vocal cords cricoarytenoid opens the rima glottidis Lateral adducts the vocal cords Muscles of cricoarytenoid closes the rima glottidis larynx Transverse The only unpaired muscle. arytenoid closes the rima glottidis Oblique arytenoid closes the rima glottidis Thyroarytenoid relax the vocal cord Vocalis Aryepiglotticus close the laryngeal inlet Thyroepiglotticus widens the inlet opens the inlet of the larynx supplied by superior laryngeal and recurrent laryngeal nerves Sensory supply Up to the vocal folds (including the vocal fold): internal laryngeal nerve Nerve supply of the larynx Below the vocal folds: recurrent laryngeal nerve Motor supply All intrinsic muscles supplied by recurrent laryngeal nerve Exception: cricothyroid – external laryngeal nerve Blood supply of larynx Vocal folds and superior laryngeal vessels above Below the vocal inferior laryngeal vessels folds lymphatic drainage of deep cervical larynx lymph nodes trachea Develops from laryngo-tracheal diverticulum Structure of trachea made up of fibro-elastic wall last tracheal ring is called carina mucous membrane is lined by ciliated columnar epithelium Blood supply inferior thyroid artery of trachea Veins of the left brachiocephalic vein trachea Lymphatics of pretracheal and paratracheal lymph nodes the trachea Nerve supply Parasympathetic recurrent laryngeal through vagus, of the trachea supply Sympathetic middle cervical sympathetic ganglion, supply Trachea  Mucous lined by pseudostratified ciliated columnar membrane epithelium with goblet cells Submucosa connective tissue, containing large blood vessels and Trachea nerves Mucous, serous and mixed types of glands also occur in this layer. Hyaline cartilage Posterior wall of trachea is devoid of cartilage Posterior wall contain outer longitudinal and inner circular layers of smooth muscles Adventitia outer most layer with connective tissue, blood vessels and nerves. Lung Mucosa pseudostratified ciliated columnar epithelium. Bronchi Lamina propria Contains connective tissue, smooth muscle fibers and mucous and serous glands. Hyaline cartilage seen outside lamina propria and found in small pieces. Bronchiole Mucosa simple columnar cells Lamina propria connective tissue and smooth muscle fibers, Lung Glands and cartilages are absent Alveoli lined by simple squamous cells alveolar phagocytes (dust cells) lining cells of Squamous (type simple alveoli are of 2 1) cells squamous cells. types Secretory (type secretions of 2) cells these cover the inner surface of the alveoli and act as a surfactant, Blood vessels branches of pulmonary artery and tributaries of pulmonary veins are seen close to the bronchi. They are lined by simple squamous epithelium. Thoracic cage Made up of sternum, 12 pairs of ribs and 12 thoracic vertebrae Sternum manubrium, body xiphoid process 12 pairs of ribs 1-7 true ribs (vertebrosternal ribs) Thoracic cage 8-10 false ribs (vertebrochondral ribs) 11-12 floating ribs (vertebral ribs) Functions Protects the upper abdominal viscera, heart, lungs, thymus, nerves and blood vessels Serves for the attachment of muscles involved in respiration Movements of pectoral girdle and upper limb Thoracic inlet Thoracic inlet syndrome Clinical correlation Clinical Funnel chest correlations of (pectus sternum excavatum) Pigeon chest (pectus carinatum) Sternal fracture common in automobile accidents Sternal foramen or cleft sternum Thoracic Presence of articular facets vertebrae Spinous process is long, slender and directed downwards Pedicle is attached to the upper part of the body T2-T8 are typical T1, T9-T12 are atypical Atypical thoracic T1 Cervical in shape vertebrae feature Superior costal facet complete Deep superior vertebral notch Long and horizontal spine T9 Only superior costal demifacet Inferior costal facet missing T10 only single complete costal facet T11 Only single costal facet No transverse articular facet T12 Resemble L1 vertebrae No transverse articular facet Only single large costal facet Inferior Articular facet is everted vertebrae C2 – S1 nerve branch from dorsal rami of spinal nerve supply Ligaments of the Ligamentum nuchae vertebral column Anterior and posterior longitudinal ligament Ligamentum flava Interspinous ligament Supraspinous ligament Inter-transverse ligament Classification of ribs Typical ribs 3 rd – 9 th; typical ribs have same general features (CAT : Curved, Angulated and Twisted) Atypical ribs 1-2, 10-12 special features True ribs 1 st – 7 th ribs; articulate with the sternum False ribs 8 th – 12th ribs; do not articulate with sternum Vertebrosternal 1 st – 7 th ribs ribs Vertebrochondral 8 th – 10th ribs ribs Vertebral ribs or 11th & 12th ribs floating ribs Typical ribs Features of typical ribs Anterior end costochondral joint Posterior end Head Neck Tubercle Shaft intercostal vein, artery and nerve (VAN) Features of atypical ribs: 10th Rib Single articular facet on its head 11th rib single large facet on its head no neck or tubercle has slight angle and shallow costal groove 12th rib single large facet no neck or tubercle no angle or costal groove Much shorter than 11 rib Joints of thoracic cage Sternoclavicular joint Manubrio-sternal joint Xiphisternal joint Costovertebral joints Costotransverse joints Costochondral joints Chondro-sternal joint Interchondral joints Cervical rib can cause thoracic inlet syndrome or cervical rib syndrome Lumbar rib (Gorilla rib) Develops from costal element of L1 vertebra usually does not cause any symptoms 11 intercostal space Typical 3 rd to 6 th space intercostal space Atypical 1 st , 2 nd , 7 th – 11th intercostal spaces intercostal space Intercostal External intercostal muscle muscles Internal intercostal muscle Transversus Intercostalis intimi thoracis Subcostalis Sternocostalis External intercostal muscle supplied by the intercostal nerve (11 pairs) functionally it elevates the ribs during inspiration. Internal intercostal muscle Supplied by the intercostal nerve (11 pairs) functionally it elevates the ribs during expiration Intercostalis Supplied by the intercostal nerve intimus (11 functionally it elevates the ribs during pairs) expiration Transversus thoracis muscle Subcostalis Supplied by the intercostal nerve Functionally depressor of the ribs Sternocostalis Supplied by the intercostal nerves functionally draws down the costal cartilages to which it is inserted. Levatores costarum Functionally it elevates and rotates the neck of the rib in a forward direction; and also rotators and lateral flexors of the vertebral column Intercostal nerve supply Ventral rami of thoracic spinal nerves Clinical correlation of Herpes zoster intercostal Intercostal arteries supply 1 Posterior 1st-2nd - costocervical trunk intercostal 3rd-11th - descending thoracic aorta arteries 2 Anterior 1st-6th - internal thoracic artery intercostal 7th -9th - musculophrenic artery arteries Intercostal vein supply 2 Anterior 1st – 6th - internal thoracic vein intercostal veins 7th-9th - musculophrenic vein 1 Posterior 1-4= superior intercostal vein intercostal vein 5-11= azygos vein and accessory hemiazygos vein features of the central tendon It is trifoliate in shape, having (a) an anterior (central) of diaphragm leaflet, and (b and c) two tongue-shaped posterior leaflets. It is inseparably fused with the fibrous pericardium. Nerve supply to the Right and left phrenic nerves sole motor to the diaphragm diaphragm and sensory to the central part of the diaphragm Lower five intercostal and sensory to the peripheral part subcostal nerves of the diaphragm Artery supply to the Superior phrenic arteries and Inferior phrenic arteries diaphragm Pericardiophrenic arteries Musculophrenic arteries Superior epigastric arteries Lower five posterior intercostal and subcostal arteries vein supply to the Superior phrenic vein and Inferior phrenic vein diaphragm Pericardiophrenic vein Musculophrenic vein Superior epigastric vein Lower five posterior intercostal and subcostal vein Septum transversum Develop Central tendon of diaphragm Pleuroperitoneal membranes Develop Domes of Development of diaphragm diaphragm Dorsal mesentery of Develop Part of diaphragm esophagus around the oesophagus Body wall Develop Peripheral part of diaphragm Clinical correlation of Congenital diaphragmatic Posterolateral hernia- left diaphragm hernias Retrosternal hernia-right Paraesophageal or Rolling hernia Acquired diaphragmatic Traumatic hernia hernias Hiatal (sliding) hernia PLEURA outer layer (parietal pleura) and an inner layer (the visceral or pulmonary pleura) enclose a potential space called pleural cavity outer layer is thicker than the visceral layer Pulmonary filled with loose areolar tissue and contain few lymphatics ligament Function provides dead space for the expansion of inferior pulmonary vein during high venous return as in exercise Costomediastinal Prominent in the cardiac notch of the lung recess resonant to dull, is noticed. This is called superficial cardiac dullness Costo- not filled by lung during quiet inspiration and is partially filled by diaphragmatic lung during deep inspiration recess right recesses is related to the liver and posterior surface of right kidney (separated by the diaphragm) left recess is related to the fundus of stomach, spleen and posterior surface of left kidney (separated by left kidney). Parietal pleura develops from somatopleuric layer of lateral plate mesoderm Parietal pleura is pain sensitive Nerve supply somatic nerves – intercostal and phrenic nerve Arterial supply intercostal, internal thoracic and musculophrenic arteries Veins azygos and internal thoracic veins Lymphatics intercostal, internal mammary, posterior mediastinal and diaphragmatic nodes Visceral pleura develops from splanchnopleuric layer of lateral plate mesoderm Pulmonary pleura is pain insensitive Nerve supply autonomic (sympathetic) nerves (T2-T5), Blood supply bronchial vessels (bronchial artery and vein) Lymphatics bronchopulmonary lymph nodes Clinical correlation Pneumothorax - air in the pleural cavity Of pleural cavity Hydrothorax – fluid in the pleural cavity Hydropneumothorax – fluid with air in the pleural cavity Haemothorax – blood in the pleural cavity Empyema – pus in the pleural cavity Pleurisy (Pleuritis)- Inflammation of the parietal pleura Pneumothorax Tension Pneumothorax Pleural effusion Lungs newborn baby and people living in clean environment, the lungs are rosy pink in colour polluted areas or those who are passive or active smokers, the lungs are mottled with carbon particles and appear brown or black in colour Right lung is shorter and broader (because of right lobe of liver) The left lung is longer and narrower (because the heart projects to the left side) External Apex features of lungs Base or diaphragmatic surface Apex of the covered by cervical pleura and suprapleural membrane or Sibson’s lungs fascia Costal surface Upper 6 ribs in the midclavicular line of lungs Upper 8 ribs in the midaxillary line Upper 10 ribs in the scapular line Medial surface of the lungs posterior small vertebral part (A) large anterior mediastinal part (B) Right and lung lung– Mediastinal surface groove A – Groove for azygos vein B – Groove for SVC C – Groove for IVC D – Groove for oesophagus E – Eparterial bronchus F – Hyparterial bronchus Lobes and Right lung superior, middle and inferior lobes fissures oblique and horizontal fissure Left lung superior and inferior lobes oblique fissure Hilum Right side Eparterial bronchus Right pulmonary artery hyperaterial bronchus superior and Inferior pulmonary vein Left side Left Pulmonary artery Bronchus Superior and Inferior pulmonary vein Arterial supply Bronchial arteries and pulmonary arteries of lungs Venous drainage bronchial (deoxygenated blood) and pulmonary veins (oxygenated of lung blood) Lymphatic bronchopulmonary lymph nodes (hilar lymph nodes). drainage of lungs Nerve supply of Parasympathetic fibres Vagus nerve lungs Sympathetic fibres T2-T5 spinal segments Bronchial tree Consists of principal bronchus, lobar bronchi, terminal bronchioles and respiratory bronchioles Summary of Diaphragm 1) Septum Transversum development 2) Pleuroperitoneal Membranes 3) Dorsal Mesentery of Esophagus 4) Body Wall PLEURA Lateral Mesoderm of Three Laminar Embryonic Disc Parietal Pleura Somatopleure Visceral Pleura Splanchnopleure Pleural cavities Intraembryonic Coelom Right pleural Right Pericardio-Peritoneal Canal cavity Left pleural Left Pericardio-Peritoneal Canal cavity trachea foregut Lung buds respiratory diverticulum Laryngeal inlet 4th pharyngeal arch Lower airway primitive gut. and lungs Nasal cavity Nasal placodes→nasal pits→ nasal sacs→ primitive chonae Primitive mouth Unpaired frontonasal prominence Paired maxillary prominences Paired mandibular prominences paranasal air deverticuli of nasal walls sinuses