Development of respiratory system

Dr. Mohamed Gamal Ayoub

lecturer of anatomy
dTQM health care from AUC
mental health diploma from HIPH

gu.edu.eg
 ILOs:
By the end of this lecture, the student should be able to:
1. Describe the development of the tracheobronchial tree
2. Describe the stages of lung development and the postnatal
changes.
3. Correlate between the respiratory development and the common
anomalies in the respiratory system
 DEVELOPMENT OF THE RESPIRATORY
It begins to develop aroundSYSTEM
the middle of the 4th week
Point of start: the primitive pharynx

foregut primitive
primitive pharynx
pharynx

3
Origin
1-Foregut Endoderm 2-Splanchnic mesoderm
Epithelia lining (muscles, cartilage, BV&CT)
(larynx, trachea, bronchi & lung alveoli)
6
 Respiratory diverticulum (Lung bud)
connected é Pharynx
Expand Caudally
2 Tracheo-Esophageal Ridges
Fuse
Tracheo-Esophageal Septum

Laryngotracheal tube(ventral)
Esophagus (dorsal)
The caudal end of the laryngo- Each lung bud forms a Main Bronchus
tracheal tube grows down into the → Secondary (Lobar) Bronchi
splanchnic mesoderm → divides (3 on the right side & 2 on the left side).
into → Tertiary (Segmental) Bronchi
right and left lung bud → Terminal Bronchioles.
11
 Congenital Anomalies
(1) Oesophageal atresia & tracheo-oesophageal fistula

(2) Surfactant deficiency hyaline membrane disease

Atresia = obliteration
fistula = abnormal communication.

13
Thank You

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Anatomy of Nose, Paranasal
sinuses and Pharynx

Dr. Mohamed Gamal Ayoub

lecturer of anatomy
dTQM health care from AUC
mental health diploma from HIPH

gu.edu.eg
ILOs:
By the end of this lecture, the student should be able to:
● Describe the anatomy of the nose; septum, lateral wall and
openings
● Describe the anatomy of paranasal sinuses
● Describe the anatomy of the pharynx.
 Nasal Cavity
- subdivided into right and left halves by the nasal
septum.
- open anteriorly on the face through the nostrils (anterior
nares), and open posteriorly into the nasopharynx through
the posterior nasal opening.
 Bony skeleton of the nose
I. Roof, formed by:
- Anterior part------ Nasal part of the frontal
bone + Nasal bone.
- Middle part ------ Cribriform plate of the
ethmoid bone.
- Posterior part------Body of the sphenoid
bone.
 Bony skeleton of the nose

II. Floor, formed by:

- Anteriorly: Palatine process of the maxilla.
- Posteriorly : Horizontal plates of the
palatine bone.
 Bony skeleton of the nose
III. Medial wall (nasal septum), formed by:
- Antero-inferior -----Septal cartilage.
- Postero-inferior-------Vomer.
- Superiorly ----- Perpendicular plate of the
ethmoid bone.
-
 Superior
Crista C.
galli

Cribriform plate

Midddle
Air Cells C.

Perpendicular
plate

The ethmoid bone forms part of the roof, part of

the nasal septum and the sup.& middle conchae.
IV. Lateral wall of the nose
.Nasal conchae and meatuses:
1. Conchae
- They are bony plates covered with
mucous membrane.
- They are three (superior, middle, and
inferior nasal conchae).
2. Meatuses
- They are depressions below and lateral to
each concha (superior, middle, and
inferior meatuses).
-
 Lateral wall of the nose
a.Superior meatus :
- It receives the opening of posterior ethmoidal air sinus.
b. Middle meatus : It has
* Bulla ethmoidalis:
- It is a rounded elevation where the middle ethmoidal
air sinus opens in it.
* Hiatus semilunaris:
- It is a crescenteric groove () lying below the bulla
ethmoidalis.
- It receives the following openings:
i. Anterior ethmoial air sinus.
ii. Frontal air sinus.
iii. Maxillary air sinus.
c. Inferior meatus
- It receives the nasolacrimal duct.
d. Spheno-ethmoidal recess:
- It is a triangular fossa between the superior concha
and the roof of the nose.
- It receives the opening of the sphenoidal air sinus.
Sphenoethmoidal recess;
sphenoid sinus
Superior meatus; Spheno-ethmoidal recess

posterior ethmoid sinus

Middle meatus; recess

middle ethmoid sinus Bulla ethmoidalis Sup.

mid.
anterior ethmoid sinus Hiatus semilunaris
meatus
Frontal sinus
maxillary sinus Inf. meatus
Inferior meatus;
nasolacrimal duct.
 Para-nasal Air Sinuses
Definition:
- They are air-filled spaces in certain bones which
form the boundary of the nasal cavity.
- They open into the lateral wall of the nose.
Functions:
1. Warming and humidifying the inspired air.
2. Diminishing the weight of the skull.
3. They add resonance to the voice.
Types:
1. Maxillary sinus
2. Frontal sinus
3. Sphenoid
4. Ethmoid
- All the sinuses are present at birth
except the frontal sinus which appears during
the second year.
Pharynx:
● A muscular tube extending from
the base of skull to the lower
border of cricoid cartilage (6th
cervical vert.)
● It lacks the presence of anterior
wall
● Length : 5 inches
● it is divided into:
1. Nasopharynx
2. Oropharynx
3. laryngeopharynx
 The interior of the pharynx
- the pharynx is divided into 3 parts:
1. Nasopharynx
2. Oropharynx
3. Laryngeopharynx
 Nasopharynx

Lateral wall: On each side and it contains:

1. Opening of auditory tube, which
connects it to the middle ear.
2. Tubal elevation,
3. Salpingopharyngeal fold
 Oropharynx

❑ Lies behind oral cavity

❑ Lateral wall: it shows
palatoglossal and
palato pharyngeal Soft Palate
arches with palatine Palatine
Tonsils
tonsils in between
Palato glossal
arch
Platopharyngeal
arch
Tongue

epiglottis
 Laryngeopharynx

Epiglottis

It extends from epiglottis to cricoid

cartilage
Lateral wall: it shows Piriform fossa
(Site of foreign body impact that
causes cough
Cricoid
cartilag
e
“Success is not final, failure is not fatal:it
is the courage to continue that counts.”
Winston Churchill
Thank You

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Anatomy of mediastinum,
diaphragm, intercostal spaces
Dr. Mohamed Gamal Ayoub
lecturer of anatomy
dTQM health care from AUC
mental health diploma from HIPH

gu.edu.eg
 ILOs:
By the end of this lecture, the student should be able
to:
● Describe divisions and comments of each mediastinum.
● Discuss the normal anatomy of the diaphragm.
● Identify the openings of the diaphragm regarding their position
and structures passing through.
● Identify intercostal spaces and muscles
DEFINITION
 Divisions of the mediastinum

● Mediastinum is divided by an
imaginary plane extending
T4

from sternal angle anteriorly

to lower border of body of T4
posteriorly into 2 parts:
1. Superior mediastinum above
the imaginary plane
2. Inferior mediastinum below
the imaginary plane
6
7
1. Esophagus
2. Trachea
3. Arch of aorta
4. Big branches of aortic arch
5. brachiocephalic veins , arch
of azygos
6. Upper ½ of superior vena
cava
7. Remains of thymus
8. Phrenic nerves
9. Vagi nerves
10. Left recurrent laryngeal
nerve
11. Thoracic duct
12. Mediastinal LN
13. Sympathetic trunk

8
9
10
11
12
13
N.B.
● Ascending aorta ---- middle mediastinum
● Arch of aorta ---- superior mediastinum
● Descending aorta ---- posterior mediastinum
Diaphragm
Right crus has sphincteric action on lower end of esophagus 17
hiatus Hernia:
19
Major openings in the diaphragm
Aortic Opening Esophageal Opening I. V. C. Opening
• T12 vertebra • T10 vertebra • T8 vertebra
• l inch to left of middle • 1 inch to right of
1. Site: • In the mid- line.
line. middle line.

• Behind median arcuate

• In the right crus. • In the central tendon.
ligament.

• Aorta to left
2. • Thoracic duct in • Esophagus
• I.V.C,
Structures between. • 2 Vagi.
inside: • right Phrenic nerve
• Azygos vein to the
right.
INTERCOSTAL SPACES
22
23
 External intercostal

Fibers →
obliquely
downwards &
forwards
Internal intercostal muscle
Fibers →
downward
s&
backwards
Actions of intercostals
External intercostals
(Inspiratory muscle)

Internal & innermost intercostals

(Expiratory muscle)
 Sternocostalis

Origin→ lower third of back of

sternum, xiphoid process
Insertion → slips pass
upwards & laterally to insert
into 3rd to 6th cc
 The Intercostal (and Subcostal) Nerves
Classification and Arrangement:
Two nerves of special characteristics:
The 1st nerve: most of its fibers ascend to join the brachial plexus.
The 12th (subcostal) nerve: runs its whole course in the abdominal wall.
Five typical intercostal nerves: from the 2nd to the 6th nerves; they run their
whole course in the thoracic wall (the 2nd supplies also the upper limb).
Five non-typical intercostal nerves: from the 7th to the 11th nerves; they run
part of their course in the thoracic wall and part in the abdominal wall
(thoracoabdominal nerves).
Thank You

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Anatomy of lung and pleura

Dr. Mohamed Gamal Ayoub

lecturer of anatomy
dTQM health care from AUC
mental health diploma from HIPH

gu.edu.eg
 ILOs:
➢ By the end of this lecture, the student should be able to:
• Describe the shape, apex, base, surfaces and borders of each lung.
• Compare between right and left lung
• List the bronchopulmonary segments and their clinical importance.
• Discuss the nerve and blood supply of the lungs
• Describe surface anatomy of the lung.
• Define the pleura and its layers
• Describe surface anatomy of the pleura.
It contains the
Mediastinal in the
middle and a
pleural cavity &
lung on each side
The Pleura
● It is a closed serous
sac invaginated by
the lung from its
medial aspect
● Part of pleura
covering the lung→
visceral pleura
● Part of pleura lining
thoracic wall→
parietal pleura
Pleural cavity
 ● Subdivisions of
parietal pleura:
1. Cervical pleura
2. Costal pleura
3. Mediastinal pleura
4. Diaphragmatic pleura

1. Cervical Pleura→ bulging up through thoracic inlet into root of neck.

2. Costal pleura → lines ribs & intercostal spaces
3. Mediastinal pleura → covering the side of mediastinum
4. Diaphragmatic pleura → covers upper surface of diaphragm
 Nerve supply of the parietal pleura

❑ Parietal pleura is highly sensitive to pain

❑ Costal pleura & peripheral part of
diaphragmatic pleura → intercostal n
-------(referred to thoracic abdominal wall .

❑ Mediastinal pleura & central part of

diaphragmatic pleura→ phrenic n
--------- referred to root of neck & shoulder
Surface anatomy of pleura

clavicle
Surface anatomy of pleura
Surface anatomy of pleura
● Point of summit of cervical pleura→ 1 inch above
medial 1/3 of clavicle
● Point behind sternal angle close to midline
opposite 2nd costal cartilage
● Point behind sternum close to midline opposite 4 th
costal cartilage
● On right side → point behind sternum close to
midline opposite 6th cc
● On left side → point behind 6th cc 2 cm from
sternum
● Point on 8th rib → midclavicular line
● Point on 10th rib → midaxillary line
● Point just below medial end of 12 th rib opposite T12
spine
● Abnormal fillings of the pleural cavity:
a. Pneumothorax: = air
b. Hemothorax:= blood
c. Pyothorax(or empyema):= pus
d. Pleural effusion:
Lung : Shape, surfaces & borders

● Shape→ like half a cone

● Has apex & base
● Has costal & medial
surfaces
● Has anterior, posterior &
inferior borders
 The borders are :
1. The inferior border is sharp
encircling diaphragmatic surface
2. The anterior border is sharp
- right lung, anterior border is straight
- left lung, lower part presents cardiac notch
and, lingula
- separates the costal surface from the
Mediastinal surface.
1. The posterior border is rounded
Apex
one inch above the medial third of the clavicle (in front).
covered by the cervical pleura.
 Base of right lung
● More concave on right lung related to the
diaphragm & right lobe of liver
 Base of left lung
● Less concave on left lung related to the
diaphragm & left lobe of liver, stomach &
spleen
 Costal surface of lung
● related to ribs &
intercostal spaces

● Right lung has 2

fissures→ horizontal &
oblique dividing lung
into 3 lobes : upper,
lower & middle lobes

● Left lung has one

oblique fissure dividing
lung into upper & lower
lobes
Oblique fissure:
begins at the posterior border of the lung at 3rd thoracic spine , and extends
downwards, forwards and medially to end at the inferior border at 6th
costochondral junction.

Transverse fissure (right lung only)

a deep fissure which separate the upper lobe from the middle lobe. It begins
at the anterior border of the right lung opposite 4th costal cartilage and
extends to the right and slightly upwards to end by meeting the oblique
fissure at midaxillary line

20
 Medial surface of lung
● Contains hilum of
lung ( area which
gives passage to
structures forming
root of lung )
● Area in front of
hilum→ anterior or
Mediastinal part
● Area behind
hilum→ posterior or
vertebral part
 Root of right lung
● Contains 3 major structures →
bronchus( eparterial & hyparterial )
pulmonary artery
2 pulmonary veins
(superior& inferior)
Root of left lung
● Contains 3 major structures
→ main bronchus ,
pulmonary artery
2 pulmonary veins
(superior& INFERIOR)
Relations of mediastinal surface of right lung
✓ Pericardial impression (Rt atrium)
✓ Groove for IVC
✓ Groove for SVC
✓ Arch of azygos
✓ Trachea & right vagus
✓ Esophagus
✓ Azygos vein
Relations of mediastinal surface of left lung
✓ Pericardial impression(Lt ventricle)
✓ Groove for arch of aorta
✓ Oesophagus
✓ Left subclavian artery
✓ Left common carotid a
✓ Descending thoracic aorta

Cardiac notch

lingula
Differences between right and left lungs
Right lung Left lung
-Short, wide -Long, narrow
-no cardiac notch -cardiac notch
- Has 3 lobe - Has 2 lobes
separated by 2 separated by 1
fissures fissure
- Contains 10 -Contains 8
Bronchopulmonary Bronchopulmonary
segments: segments:
 Surface anatomy of the lung
● Apex of lung→ same as pleura
1 inch above medial 1/3 of
clavicle
● Anterior border→ like anterior
margin of pleura, point behind
sternoclavicular joint→opp 2nd
cc close to midline→ opp 4th cc
close to midline
● Then differs on right and left
sides
 Surface anatomy of the lung
● On right side:
from point on 4th cc vertically
down to 6th cc

● On left side: from point on

4th cc it deviates laterally to
form the cardiac notch to a
point on 6th cc 4cm from
median plane
● 6th rib in
midclavicular line
then 8th rib in
midaxillary line
Then point 1 inch
lateral to spine of
T10
Bronchopulmonary Segments of Lungs
Bronchopulmonary Segments
● A functionally independent unit of lung
tissue supplied by
- a segmental bronchus, a branch of
pulmonary artery, has its own lymphatics
and innervation.
● Each segment is wedge shaped having
an apex at the hilum and a base at the
surface of the lung.
● If a bronchopulmonary segment is
diseased, it can be surgically excised
(segmentectomy), leaving the
healthy part of the lung intact.
Bronchopulmonary segments of right lung
1. Superior lobe:
a) Apical
b) Anterior
c) Posterior
2. Middle lobe:
a) Medial
b) Lateral
3. Inferior lobe:
a) (apical)
b) Anterior basal
c) Posterior basal
d) Lateral basal
e) Medial basal
Lateral bronchopulmonary segment of middle lobe
Bronchopulmonary segments of left lung
1. Superior Lobe :
a) Apico Posterior
b) Anterior
c) Superior lingular
d) Inferior lingular
2. Inferior lobe :
a) Superior (apical)
b) Anterior basal
c) Posterior basal
d) Lateral basal
 Arterial supply of lungs
● Right lung→ one bronchial artery
from right 3rd posterior intercostal

● Left lung → 2 bronchial arteries→

from descending thoracic aorta
Venous drainage of lungs

❑ Right bronchial vein→

azygos vein
❑ left bronchial vein →
accessory hemiazygos vein
 Nerve supply of lungs

● Sympathetic & parasympathetic

innervation by the anterior and
posterior pulmonary plexuses
Thank You

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Anatomy of larynx, trachea

Dr. Mohamed Gamal Ayoub

lecturer of anatomy
dTQM health care from AUC
mental health diploma from HIPH

gu.edu.eg
 ILOs:
➢ By the end of this lecture, the student should be
able to:
● Describe the anatomy of the larynx.
● Identify the blood and nerve supply of the larynx.
● Describe the anatomy of the trachea.
● Identify the parts of the bronchial tree and lower
airways and describe their normal anatomy.
Larynx

Function:
1. organ of phonation (voice production).
II. respiratory function (air way).
( It is formed of a group of cartilages connected by Ms,
Ligaments and joints).

Site:
it lies below the hyoid bone in the midline of the neck at the
level of C. 4 – 6 vertebrae.
Cartilages of the Larynx

Single cartilages Paired cartilages

- Thyroid cartilage. - Arytenoid cartilage.

- Cricoid cartilage. - Corniculate cartilage.

- Epiglottic cartilage. - Cuneiform cartilage.

major cartilages of the larynx Epiglotti
Epiglottis s
Hyoid

Hyoid

Thyroid cart.
Thyroid cart.

Arytenoid
Arytenoid cart. Vocal Cord
cart.

Cricoid cart. Cricoid cart.

Anterior view Posterior view Sagittal Section

 1. Thyroid cartilage

-consists of two laminae which are fused anteriorly to form laryngeal prominence (Adam’s apple)
- Each lamina has two horns and two tubercles on its lateral surface
- The two tubercles are connected by the oblique line.
 2- Cricoid cartilage

- signet-ring in shape (it is the only complete

cartilaginous ring in upper respiratory airway).
- It lies at the level of C. 6.
-It is formed of :- quadrate lamina (posterior) and
- a narrow arch (anterior).
- The quadrate lamina contains two facets which are:
a. Superior facet: Articulates with arytenoid cartilage
(one on each side).
b. Inferior facet: Articulates with the inferior horn of
the thyroid cartilage (one on each side).
 3. Epiglottis
- leaf-shaped elastic cartilage
which lies behind the tongue.
-It has:- superior rounded free border
- inferior tapering end which is
attached to the upper part of
thyroid notch.
 4.Arytenoid cartilage
It is pyramidal in shape.
- The base articulates with upper
facet of the quadrate lamina of
cricoid cartilage.
Has 2 important processes:
-Vocal process: anterior angle of
base and gives attachment to
vocal ligament.
-Muscular process: lateral angle of
base and gives attachment to
muscles.
5. Corniculate cartilage
- It articulates with apex of each arytenoid and
lies in the aryepiglottic fold.

6. Cuneiform cartilage
- articulates
with the upper surface of the
corniculate cartilage and lies in the aryepiglottic
fold.
Ligaments and membranes of the
larynx:
● They are either:
1. Extrinsic (thyrohyoid membrane, cricothyroid
membrane, crico-tracheal ligament
2. Intrinsic (quadrangular membrane and cricothyroid
ligaments)
Quadrangular membrane (ligament):
● Fibroelastic membrane,
extending from the sides of
epiglottis anteriorly to the
arytenoid cartilages posteriorly.
● Its upper free border forms the
aryepiglottic fold.
● Its lower free border forms the
vestibular fold.
Cricothyroid ligament:
● Originates from the cricoid
cartilage and extends superiorly,
where it terminates with free
(unattached) upper margin which
forms the vocal ligament (true
vocal cord).
● The vocal ligament is
attached anteriorly to the inner
aspect of the angle of thyroid
cartilage, and posteriorly to the
arytenoid cartilage.
Laryngeal inlet:
Boundaries:
● Anterior: Upper edge of the
epiglottis.
● On each side: Aryepiglottic
folds.
● Posterior: Mucous fold between
the arytenoids.
Cavity of the larynx:
● It is divided into three compartments by
two pairs of folds
-The upper folds called vestibular folds (false
vocal cords) and
- the lower folds are called vocal folds (true
vocal folds).

● It shows 3 parts:
1. Vestibule (upper part): extends from
laryngeal inlet to vestibular folds.
2. Sinus (ventricle) of larynx (middle
part: between vestibular folds above and
vocal folds below. The gap between two
vocal folds called rima glottidis.
3. Infra-glottic part (lower part) extending
from vocal folds to lower border of cricoid
cartilage.
Muscles of the larynx(acting on laryngeal inlet)

1. Aryepiglottic muscles
2. Transverse arytenoid
3. Oblique arytenoids
● N.B: No muscle produces
opening of the laryngeal inlet, it
is only opened by the elastic
recoil of the epiglottis.
Muscles of the larynx (acting on vocal cord)
A: Muscles producing abduction C: Muscles stretching (tensing)
of the vocal cords: the vocal cords:
● Posterior crico-arytenoid. ● Cricothyroid muscle.

B: Muscles producing adduction D: Muscles relaxing the vocal

of the vocal cord: cords:
○ Lateral crico-arytenoid . ● Thyroarytenoid muscle.
○ Transverse arytenoid.
● Vocalis muscle.
○ Oblique arytenoids.
Nerve supply of the larynx:
● Motor: ● Sensory:
● All intrinsic muscles of the ● Above the vocal cords:
larynx are supplied by the Internal laryngeal nerve
recurrent laryngeal nerve (from vagus N).
EXCEPT the cricothyroid which ● Below the vocal cords:
is supplied by the external Recurrent laryngeal nerve
laryngeal nerve. (from vagus N).
Nerve supply of larynx
Blood supply of the larynx:
A. Arterial supply:
● Above the vocal cords: Superior laryngeal artery ( a
branch of superior thyroid artery).
● Below the vocal cords: Inferior laryngeal artery ( a
branch of inferior thyroid artery).
B. Venous drainage:
● It drains its venous blood into the corresponding
superior and inferior thyroid veins respectively.
Venous drainage of larynx Arterial supply of larynx
Clinical note:
● Injury of the external laryngeal nerve (in thyroidectomy) leads to
paralysis of the cricothyroid muscle which results in low pitched voice.
● Injury of the recurrent laryngeal nerve (in thyroidectomy):
✓ If partial injury: It leads to adduction of the vocal cord. If this occurs
bilaterally, it leads to suffocation (obstruction of the air way).
✓ If complete injury: it leads to cadaveric position of the vocal cords (mid-
way between abduction and adduction).
✓ Explanation: The fibers which produce abduction lies in the outer part
of the nerve (affected by partial injury), while the fibers which produce
adduction lies in the central part of the nerve (affected by complete
injury).
 Ends in the thorax, at the level
TRACHEA of the sternal angle (lower
border of T4 )
begins: in the neck,
at the level of the Divides: into 2 main bronchi.
lower border of C6, as a
continuation of the
larynx,
Length : 4-5 inches (10-
12 cm)
cervical part: Upper 1/2
in the neck

Thoracic part: lower 1/2

in the thorax (superior
mediastinum).

16- 20 C-shaped cartilaginous

rings.

Rings are deficient posteriorly

to allow distension of the
esophagus during swallowing.
Blood and nerve supply of the trachea:
● Arterial supply: from bronchial
arteries.
● Venous drainage: via bronchial
veins to azygos system of veins.
 Bronchi:
● The trachea terminates at the level of T4 by dividing into right
and left main bronchi which are asymmetrical.

• A foreign body which may enter trachea will pass more commonly to right bronchus
because it is wider and more in line with the trachea.
Bronchial tree:
● The trachea divides into right and left main
bronchi, with more division of the main bronchi it
gives rise to lobar then segmental bronchi.
● Each segmental bronchus is distributed to a
localized part of lung tissue forming what is called
the broncho-pulmonary segments.
Thank You

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