Respiratory system

Lili Tu (涂丽莉）
Email: [email protected]
 As we all know, COVID-19 epidemic is an
important public health event in the world in 2020.

COVID-19

COVID-19 Lung NCP Diffculty

damage breathing
NCP
 Composition
Respiratory tract Upper respiratory tract
Nose
u Nose
Pharynx
u Pharynx Upper respiratory tract
Larynx
u Larynx
Lower respiratory tract
u Trachea
Lower respiratory tract Trachea
u Bronchi
Principal Bronchi
Lungs Lungs
Paired organs of respiration
 Air Pulmonary

Function: artery
Pulmonary
vein Air
Alveoli

u Inspiring oxygen
u Expiring carbon dioxide
u Vocalization Terminal
bronchi

u olfaction
Capillary networks
u Assisting venous return to heart Around alveoli
Respiratory
membrane
 Section 1 Nose
Composition
External
u External nose nose
u Nasal cavity
u Paranasal sinuses Paranasal
sinuses

Function
u Warming, humidifying and, filtering
inspired air. Nasal cavity
u Smell
u Phonation
The external nose

Nasal bone

Cartilages
Dense
connective
tissue
p Clinical Focus

Nasal flaring

Ala nasi

Ø Nares widen when breathe Nares

(nostrils)
Ø Symptom of respiratory distress
 The nasal cavity
Two halves by nasal septum
u Two parts: Limen
nasi
Proper
nasal
Boundary:Divided by limen nasi cavity

1 -Nasal vestibule - external Nares

Vestibule
2 -Proper nasal cavity - internal
u Two openings Choanae

Ø Nares - anterior
Ø Choanae - posterior Nasopharynx
Nares

Nasal cavity communicate with the

pharynx behind through the choanae.
u Boundaries
Roof－cribriform plate of ethmoid
Cribriform plate of ethmoid
Floor－hard & soft palate
Medial wall－nasal septum
Lateral wall
Lateral wall

Nasal septum
Hard palate

Soft palate
 Spheno-ethmoidal
recess
Ethmoid Sphenoid
Lateral wall Superior
concha

Ø Three nasal conchae - curved shelf of boneMiddle

concha
- superior concha Inferior
concha
- middle concha
- inferior concha
Spheno-ethmoidal
recess
Ø Four air channels Superior
concha Superior
meatus
- spheno-ethmoidal recess
Middle Middle
- superior nasal meatus concha meatus

- middle nasal meatus Inferior

Inferior
meatus
concha
- inferior nasal meatus
Medial wall - Nasal septum

Nasal septum

Perpendicular plate Medial

of ethmoid bone wall

Septal
cartilage

Vomer
 p Clinical Focus

Kiesselbach’s area Kiesselbach’s

plexus

Ø Anteroinferior aspect of the nasal septum

Ø Three arteries form the arterial plexus
Ø The major site of nosebleeds (epistaxis)
 The Mucous membrane of nose
u Olfactory region (blue)
Located upper nasal cavity,above superior nasal conchae,
contains olfactory cells
u Respiratory region: situated out of olfactory region. its function is to
warm, moisten, and clean the inspired air

Lat. Wall of nasal cavity Nasal septum

 Paranasal sinuses
Are the gas cavity in cranium around the nasal cavity
Mucosa of sinuses is migrating with the mucosa of nasal cavity
Have openings pass the nasal cavity
There are four paired sinuses
1 -Frontal sinus-one pair
2 -Sphenoidal sinus-one pair
3 -Maxillary sinus-one pair
4 –Ethmoidal sinus-three groups
(ant.mid. & post. groups)
1.Frontal sinus –open at nasal meatus
2.Sphenoidal sinus -open at sphenoethmoid recess.
3.Maxillary sinus –open at nasal meatus
 Openings of paranasal sinus
Posterior Frontal
ethmoidal sinus
sinus
Anterior ethmoidal
sinus
Superior Middle ethmoidal
meatus sinus

Middle
meatus
 p Clinical Focus
Sinusitis (sinus infection)
Ø Inflammation of the paranasal sinuses;
Ø Infection spread into the sinus through
the opening;
Ø Maxillary sinusitis is more common. Maxillary
sinus Fluid
- opening lies at a higher level than its floor; collected
in sinus
- infected material or pus drain out difficultly.

Elicit localized pain or Transillumination reveal pooling

tenderness of sinus secretions (green)
 The paranasal sinuses and their opening
Sinuses Opening
Frontal Middle meatus

Anterior & Middle group → Middle meatus

Ethmoidal
Posterior group → Superior meatus
Sphenoidal Spheno-ethmoidal recess
Maxillary Middle meatus
Section 2 Pharynx
Nasal
cavity

Common pathway
for air and food. Oral
cavity Pharynx

Larynx

Cricoid
cartilage
Esophagus
 Section 3 Larynx
uPosition: Situated in the anterior part of
the neck (below the hyoid bone)

Mandible

Hyoid bone 4
5
It lies in he neck in front 6
of the fourth, fifth and
Trachea sixth cervical vertebrae.
 Section 3 Larynx
uComposition: Cartilage,muscle & mucosa

Hyoid bone

Trachea
 Section 3 Larynx
u Boundary:
Upper boardline: upper border of epiglottic cartilage;
Lower boardline: lower border of cricoid cartilage

Hyoid bone
u Communication:
to pharynx upwardly,
to trachea downwardly Pharynx
Epiglottic
cartilage
Cricoid
Trachea cartilage
 Section 3 Larynx
u Neighbouring:
anteriorly-skin, fascia, muscle
posteriorly-pharynx
both side-blood vessel, nerve and
lateral lobe of thyroid

u Function:
“voice box” involved in breathing,
sound production (phonation), and
protecting the trachea against food
aspiration
I . Laryngeal Cartilages
 1. Thyroid cartilage
Hyoid bone
Ø The largest of the laryngeal cartilages
Ø Left lamina + Right lamina
Ø Laryngeal prominence (Adam’s apple)

Right Left Superior cornu

lamina lamina

Cricoid
Superior
thyroid notch

Laryngeal
prominence
Inferior cornu
 2. Cricoid cartilage
Ø The most inferior of the laryngeal cartilages
Ø Shaped like a signet ring
Ø Narrow arch + Broad lamina
pharynx
Ø Two articular facets on each side
Facet for Cricoid
articulation with esophagus
Lamina arytenoid cartilage trachea

Arch

Airway Facet for

articulation with Arytenoid
inferior cornu of
thyroid cartilage
Trachea
Inferior horn of
thyroid cartilage
 Vocal
ligament
3. Arytenoid cartilages
Vocal
Ø Pyramid-shaped cartilages process

Ø Three surfaces, a base and an apex

Ø Vocal and muscular process
Muscular
Posterior process
surface
Apex

Anterolateral
surface

Medial
surface
Base Muscular
Vocal process
process
4. Epiglottic cartilage Anterior
surface Posterior
surface
Ø Leaf-shaped cartilage
Ø Attached to the posterior aspect
of the thyroid cartilage by the
thyro-epiglottic ligament
Thyroid

Thyro-epiglottic
ligament

Hyo-epiglottic
ligament

Epiglottis
Hyoid bone
Thyroid

Cricoid
Cartilage of the larynx (specimen)
II . Laryngeal Joints
1. Cricothyroid joint
Ø Inferior cornu of thyroid cartilage
and the sides of the cricoid cartilage
Ø Visor-like movement
II . Laryngeal Joints
2. Cricoarytenoid joint
Ø Lamina of the cricoid cartilage and the bases of the arytenoids
Ø Rotation and gliding movement
III . Laryngeal Ligaments and Membranes
Aperture for
internal branch of
superior laryngeal
nerve and
1. Thyrohyoid membrane associated artery

Hyoid
bone
Ø A tough fibro-elastic ligament
Thyrohyoid
membrane
Ø Spans between the superior
margin of the thyroid
cartilage below and the
hyoid bone above Thyroid
2. Conus elasticus
Ø Cricothyroid ligament / Cricovocal membrane / Cricothyroid membrane

Ø Attached to the arch of cricoid cartilage

Ø Extends superiorly to end in a free upper margin

Vocal
Ø Thickened to form the vocal ligament superiorly process

Ø Anterior thickened part - Arytenoid

median cricothyroid ligament Vocal
ligament

Thyroid
Median
cricothyroid
ligament Median
cricothyroid
ligament
Conus Cricoid
elasticus
p Clinical Focus

Cricothyroid membrane puncture

3. Quadrangular membranes Epiglottis

Ø Attached to the lateral margin of the

epiglottis
Quadrangular
membrane
Ø Extends inferiorly to form two free
margins Vestibular
ligament Apex
(cut away)
- A free posterior margin between Arytenoid
the top of the epiglottis and the
apex of the arytenoid cartilage. Thyroid

- A free lower margin is thickened to

form the vestibular ligament. Vocal
ligament
Conus
elasticus
 Learn by
yourself

Ant. View of the larynx

Post. View of the larynx
IV . Muscles of Larynx
1. Posterior Cricoarytenoid Muscle
Ø Abduction and external rotation of the arytenoid cartilage.
Ø Open the glottis
2. Transverse Arytenoids & Oblique Arytenoids
Ø Transverse -- Adduction of arytenoid cartilages
Ø Oblique -- Sphincter of the laryngeal inlet
Ø Close the glottis
3. Cricothyroid Muscle
Ø Forward and downward rotation
of the thyroid cartilage at the
cricothyroid joint.
Ø Tense and lengthen the vocal fold
4. Thyroarytenoid Muscle
Ø Relax and shorten the vocal fold.
V . Laryngeal Cavity

Ø A tube lined by mucosa

Ø Superior aperture
-- laryngeal inlet opens into the
anterior aspect of the pharynx
pharynx
Ø Inferior bound
-- Connect to the trachea and
communicate with the lungs Aperture of larynx

trachea
Aperture of larynx－bounded by upper border of epiglottic
cartilage, aryepiglottic folds and interarytenoid notch

Recessus piriformis

Post.view of larynx (post.wall of pharynx is cut)

uTwo pairs of shelf like folds Epiglottis

ØVestibular fold Rima glottides (fissure of glottis)

Rima vestibuli
--between the two vestibular Vocal fold
folds is the vestibular fissure Vestibular fold

ØVocal fold
--between the two vocal folds
is the fissure of glottis
Vestibular fold
(mucosa overlying
vestibular ligament)

Vestibular ligament
Vocal fold
(mucosa overlying
vocal ligament)

Vocal ligament
u Three major regions
Ø Laryngeal vestibule
Ø Intermedial cavity of larynx
Ø Infraglottic cavity
Laryngeal vestibule
--Extends from the aperture of
larynx to vestibular fold
Intermedial cavity of larynx
--Extends from the level of the vestibular fissure to the level of the
fissure of glottis
Ø Ventricle of larynx a small recess between
vestibular & vocal folds on each side
Ventricle
of larynx
Ø fissure of glottis
•Inter membranous part: Ant.3/5, between vocal-
folds
•Inter cartilaginous part: Post. 2/5, between
arytenoids cartilages

Fissure of glottis is the narrowest part of laryngeal cavity

Vocal folds and fissure of glottis are called glottis together

Infraglottic cavity
--Extends from vocal folds to the lower border of the cricoid cartilage

p Clinical Focus

laryngeal edema
 Epiglottis
Rima glottides (fissure of glottis)
Rima vestibuli
（vestibular fissure)
Vocal fold
Vestibular fold
(mucosa overlying Vestibular fold
vestibular ligament) Vestibule

Intermedial
Laryngeal cavity
ventricle
Infraglottic
Vocal fold cavity
(mucosa overlying
vocal ligament)
Larynx specimen
 Section 4 Trachea
Description: Is the passage for air. divides
into left & right principal branchiat the level of
sternal angle.
Boundary: C6～T4lower border
Length: about 10cm trachea
Portions: Cervical part & thoracic part
Constitution: 14-20C-shaped cartilages ,
smooth muscle, connective tissue. esophagus

Carina of traches: a sagittal semilunar

rideg inside the bifurcation of trachea.
 Section 4 Trachea
Description: Is the passage for air. divides Tracheal Fibromuscular posterior
mucosa wall (Membranous wall)
into left & right principal branchiat the level of
sternal angle.
Boundary: C6～T4lower border
Length: about 10cm
Tracheal
Portions: Cervical part & thoracic part cartilage
Constitution: 14-20C-shaped cartilages ,
smooth muscle, connective tissue.

Carina of traches: a sagittal semilunar Left main Carina of trachea

bronchus
rideg inside the bifurcation of trachea.
Right main
bronchus
 p Clinical Focus

Tracheostomy:
 The principal Bronchi
Trachae usually divides into right and left principal bronchi at
the level of sternal angle (between T4-T5 vertebrae)
Right principal bronchus
Ø Shorter,wider,& more vertical in position than left one,is
about 2-3cm in length.

Left principal bronchus

Ø Finer,longer & less vertical than right one is about 4-5cm
in length.

Carina of trachea
 The principal Bronchi
Trachae usually divides into right and left principal bronchi
at the level of sternal angle (between T4-T5 vertebrae)
Right principal bronchus
Ø Shorter,wider,& more vertical in position than left
one,is about 2-3cm in length.

Left principal bronchus

Ø Finer,longer & less vertical than right one is about 4-
5cm in length.

Which side of principal bronchus is easy to enter foreign objects?

Carina of trachea
 Bronchial tree
Each principal bronchus divides into lobar bronchi (two on the left, three
on the right), each of which supplies a lobe of lung. Each lobar bronchus then
divided into segmental bronchi, which supply specific segments of the lung.

Bronchi looks like up down tree

 p Clinical Focus
Heimlich maneuver (Abdominal thrust)
Ø First aid procedure used to treat upper airway obstructions by
foreign objects.
Ø A rescuer standing behind an upright patient and using his
hands to exert pressure on the bottom of the diaphragm.
Ø This compresses the lungs and exerts pressure on any object
lodged in the trachea, hopefully expelling it.
 Section 6 Lungs
General description of the Lung
Position: Located in the thoracic cavity by both
sides of mediastinum
Color: Related with age, occupation, health
station
Weight: 800～1300g more in male than female
Air content: 5000～6500ml, more in male than
female
Function: air interchange (both O2and CO2)
Forensic medicine:Density of fetus lung is more
than 1, not floating; after the birth, it is less than 1
in density, floating on the water.
General features
Ø Cone-shaped, the right lung is shorter and
broader, the left one is longer and narrower.
Ø Left lung have two lobes (oblique fissure); it is
longer, lighter and thinner than right lung.
Ø Right lung Lobes : it have three lobes(oblique
fissure & horizental fissure) , right lung is
shorter,heavier and broader.
 External feature of the lungs
Apex: Rises 2～3 cm above the medial 1/3 of clavicle into neck.
Base: Concave,close to diaphragm (diaphragmatic surface).
Two surfaces: Mediastinal surface and sternocostal surface (costal surface).
Three borders: Ant. post. & inf. border.

cardiac notch
of left lung

lingula of
left lung
 Medial surface of the lungs
Left lung Med.surface
Medial surface－concave,related to mediastinum
and vertebrae
–Hilum of lung：area on medial surface where
structures in root enter or leave lung
–Root of lung
u Contents
–Principal bronchus
–Pulmonary artery and vein
–Nerves and lymphatics
u Surrounded by connective tissue
u Order of structures in the root of lung
–From before backward: V.A. B.
–From above downward:
»R. －B. A. V. A-artery
»L. －A. B. V. V-vein
B-bronchus
Right lung (med.surface)
Lung specimen
 Non smokers' lung

The lung of smoker for 15 years The lung of smoker for 30 years
Section 7 Pleura
General features
u Serous membranes forming closed sacs
u Two layers
Visceral pleura－adheres to lung, continuous with parietal
pleura at root of lung
Parietal pleura－lines the thoracic cavity
u Two pleural layers continue with each other at root of lung
forming closed
potential space－pleural cavity
u Contains a small amount fluid
Subatmospheric pressure
 Section 7 Pleura
General features
u Serous membranes forming closed sacs
u Two layers
Visceral pleura－adheres to lung, continuous with parietal
“Balloon invaginate fist”
pleura at root of lung
Parietal pleura－lines the thoracic cavity
u Two pleural layers continue with each other at root of lung
forming closed
potential space－pleural cavity
u Contains a small amount fluid
Subatmospheric pressure
 Named parts of parietal pleura
uCupula of pleura
Extends up into the neck, over the apex of lung,
2-3cm above the medial third of clavicle
uCostal pleura
Lines the inner surface of the wall of the chest
uMediastinal pleura
Lines mediastinum
uDiaphragmatic pleura
Lines diaphragm
Division of pleura
 Pleural recesses
potential spaces of pleural cavity which lungs
are not occupied in quiet respiration
u Costodiaphragmatic recess
are the slit-like intervals between costal and
diaphragmatic pleurae on each side, the lowest
point of pleural cavity
u Costomediastinal recess
between the mediastinal pleural and costal
Costomedia-
pleuraon, the left one is larger stinal recess

Costodiaphragmatic recess
 Pleural cavity
1.It is a closed cavity
2.Each one on both sides
3.Left & right side don’t communicate each other
4.Pressure of cavity is
subatomospheric pressure
5.Contain a little lubricating liquid
6.Costaldiaphrematic recess (lowest)
 p Clinical Focus

Thoracentesis
Ø Pneumothorax
Thoracic wall is open. lung injury
Ø Pleural effusion
The lower boundary of lungs and pleura
 Section 8 Mediastinum Superior
mediastinum
Sternal
angle

Ø Intrathoracic tissue space between Anterior

mediastinum
the two pleural cavities

Ø Divided into two parts

(superior & inferior) by a
horizontal line (passes the
sternal angle)
Middle
mediastinum
Ø Inferior mediastinum is further
subdivided into three by the
heart – anterior, middle and
posterior mediastinum
Posterior
mediastinum
 Superior mediastinum Superior
mediastinum

Upper boundary: thoracic outlet

Lower boundary: the plane from the sternal

angle to lower margin of the 4th thoracic vertebra

Contains:
-Thymus
-Brachiocephalic vein(left & right)
-Superior vena cava
-Phrenic nerve, the vagus nerve, laryngeal recurrent nerve
-The aortic arch and its three branches
-Esophagus, thachea, thoracic duct
Anterior mediastinum
Between the sternum and the anterior wall of the pericardium.

Ø Very narrow Anterior

mediastinum
Ø Contains:
-Thymus or thymus remain
-Anterior mediastinal Lymph nodes
-Internal thoracic artery
Ø This is a common site for thymoma,
dermoid cyst and lymphoma.
Middle mediastinum
Between the anterior and posterior mediastinum.

Ø Contains: Middle
mediastinum
-Heart and great vessels
-Pericardium
-Pericardiacophrenic vessels
-Phrenic nerve

Ø This is a common site for

pericardial cyst.
 Posterior mediastinum
Between the posterior wall of the Posterior
mediastinum
pericardium and the thoracic spine
Ø Contains:
-The main bronchus(left & right)
-Esophagus
-Thoracic aorta
-Azygos vein and hemiazygos vein
-Thoracic duct
-Thoracic sympathetic trunk
Ø This is a common site for bronchogenic cyst, neuroma,
thoracic aortic aneurysm, and diaphragmatic hernia.

Ø The connective tissue can be connected with the connective tissue of neck and
abdominal cavity through the thoracic outlet, the aortic hiatus and esophageal hiatus.
Mediastinum-lateral view (from left & right side)
 The contents you have to master today
1. The constitution of respiratory system.
2. The concept of upper and lower respiratory tract.
3. The position and openings of paranasal sinuses.
4. The cartilage of larynx.
5. The division of laryngeal cavity.
6. The feature of left and right principal bronchi.
7. The morphological feature of lungs (apex,base, surface. border, lobes,
fissure etc)
8. Concept and division of pleura and pleural cavity.
9. Concept and division of mediastinum.
Thank you for your listening