pharynx, larynx & lung anatomy a whistle-stop tour by filip & james

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