pharynx, larynx & lung anatomy a whistle-stop tour by filip & james
TRANSCRIPT
Pharynx, Larynx & Lung Anatomy
A whistle-stop tour
By filip & James
Pharynx
Nasopharynx
Oropharynx
Laryngopharynx
Middle Ear
• Muscular region connecting the nasal and oral cavities with larynx and oesophagus
Pharynx is formed by 3x pharyngeal constrictors
Reduce size of pharynx
Squeeze food down pharynx (peristalsis)
Pharyngeal Constrictors
Superior constrictor
Middle constrictor
Inferior constrictor Paralysis causes lack of gag reflex, uncoordinated swallowing and increased risk of aspiration
Constrictors stack inside each other forming a structurally-sound functional unit
Pharyngeal pouch/diverticulum can fill with food causing halitosis or coughing-up of food
Pharyngeal Constrictors
Midline Raphe
(Similar to a long tendon)
‘Weak Spot’Pharyngeal
pouch / diverticulum
SC
MC
IC
Pharynx – Internal Muscles
Longitudinal (internal) muscles elevate (shorten) & widen pharynx
Salpingopharyngeus
Stylopharyngeus(CN IX)
Tensor veli palatini(CN Vc)
Levator veli palatini
All pharyngeal muscles Motor innervated by CNX except stylopharyngeaus & tensor veli palatini
SC
MC
IC
Palatopharyngeus
Pharynx– innervation
• Motor: CNX (Vagus)
• Superior laryngeal nerve Damage = Monotonous voice
• Recurrent (inferior) laryngeal nerveDamage = hoarse/weakened voice
• Sensory: • CN IX
Palatoglossal & paltopharyngeal arches
Palatine tonsil
Lymphoid Tissue - Tonsils
Tunstall & Shah 2012 Pocket Tutor: Surface Anatomy
Tonsillar (lymphoid) tissue sits in the entrances to the pharynx
Pharyngeal(Adenoid)
Tubal
Palatine
Lingual
Collectively known as Waldeyer ring of lymphoid tissue
Larynx
What is the function of the larynx? (4)
◦ Prevents entrance of fluid and particles
◦ Allows regulation of intrathoracic & intra-abdominal pressure (Valsava manoeuvre)
◦ Enables phonation (production of sound)
◦ Speech articulation is controlled by the pharynx, tongue & lips
Hyoid bone
Thyrohyoid membrane
Thyroid cartilage
Laryngeal prominence
Cricoid cartilage
Cricoid cartilage
Arytenoid cartilage
Epiglottis(elastic cartilage)
Cricothyroid membrane(emergency airway)
Larynx – Bone & Cartilages
Cricovocal membrane Thickened free edge = vocal ligament
Arytenoid cartilagesArticulate with cricoid cartilage via synovial joint that permit pivoting movements
Larynx – Arytenoids & Vocal Folds
Arytenoids as viewed from above in transverse
section
Posterior
Vocal Process
Muscular Process
Anterior
Joint position
Superior Laryngeal Nerve
CricothyroidPivots thyroid cartilage
forward and down on the cricoid & tenses the vocal
folds
Superior laryngeal nerve
(External laryngeal nerve)
(Internal laryngeal n.)
Anterior Posterior
Posterior cricoarytenoid muscleLateral cricoarytenoid muscle
Posterior cricoarytenoid muscle(abducts vocal ligaments)
Lateral cricoarytenoid muscle(adducts vocal ligaments)
Ant.
Post.
Ant.
Post.
Recurrent Layrngeal Nerve
Thyroarytenoid& vocalis
Pull arytenoid cartilage anteriorly & thyroid cartilage posteriorly and
superiorly
Relaxes vocal fold (or parts of it) and lowers pitch of voice
Ant.
Post.
Recurrent Layrngeal Nerve
Vocal Folds
Vestibular folds(false vocal folds)
Epiglottis
Aryepiglotic fold
Rima glottidis(gap between vocal folds)
Posterior
Anterior
What makes up the TBT?
TracheaBronchiBronchiolesTerminal bronchiolesAlveolar ductsAlveolar sacsAlveoli
LUNGS
What do structures entering the lung pass through?◦Hilum
What two layers form the pleura of the lungs?◦Visceral◦Parietal
What holds the pleura together?◦Surface tension
Superior Lobe
Inferior Lobe Middle Lobe
Superior Lobe
Inferior Lobe
RIGHT LEFT
Oblique fissure
Horizontal fissure
Oblique fissure
Lingula
Right lung has 3 lobes and the left has 2 lobes
Disease/collapse/atelectasis can affect lobes independently
Tunstall & Shah 2012 Pocket Tutor: Surface Anatomy
Lung Surface Markings
2cc
6cc
6rib MCL
8 rib MAL
Apex sits ~2cm above medial 1/3 of clavicle
Horizontal fissure:4thcc horizontally back to oblique fissure
Oblique Fissure: T3 Spinous Process to 6th cc anteriorly
Lung is soft and compliant so will fill many empty spaces in the thorax
Note the tracheal bifurcation at sternal plane or just below T4/T5
Costodiaphragmatic recessThe region between the lung and pleura reflection
Tunstall & Shah 2012 Pocket Tutor: Surface Anatomy
Lung Surface Markings
10 rib PVL - lung
Oblique Fissure: T3 Spinous Process to 6th cc anteriorly
Penetrating damage to lung tissue can cause pneumothorax
Upper
lobe
Lower lobe
Auscultate lower lobe of lung posteriorly
12 rib PVL - pleura
Tunstall & Shah 2012 Pocket Tutor: Surface Anatomy
Lung Surface Markings
Horizontal fissure:4thcc horizontally back to oblique fissure
Oblique Fissure: T3 Spinous Process to 6th cc anteriorly
Upper lobe
Middle lobe
Lower lobeAuscultate middle lobe of lung laterally
Mid-axillary line
Lymphatic drainage
Lymphatic drainage from the lungs follows the tracheobronchial tree
Hilar/bronchopulmonary nodes
Tracheobronchial nodes
Paratracheal nodes
Bronchomediastinal duct
Thoracic duct/left subclavian veinLeft upper lobe
Right lymphatic duct /subclavian veinAll lymph except left upper lobe