Respiratory System Anatomy

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ANATOMY II

LECTURER SEDA GÖZENER CANBÜLBÜL


RESPIRATORY SYSTEM
(SYSTEMA RESPIRATORIUM)
• The system that exchanges
oxygen in the atmosphere
with carbon dioxide in the
body is called the respiratory
system.
• The main organ of
respiration is the lungs.
Oxygen and carbon dioxide
exchange takes place in
these organs.
• Respiration is made up of two parts:
• External respiration: Occurs in the lungs. Oxygen
passes into the blood, carbon dioxide in the blood
passes to the lungs and is given out from there.
• Internal respiration: It occurs between blood and
tissues. Oxygen in the blood passes to the tissues, and
carbon dioxide from the tissues into the blood.
• The respiratory system consists of the following organs:

• Nose (Nasus)
• Mouth (Oris)
• Pharynx (Pharynx)
• Throat (Larynx)
• Windpipe (Trachea)
• Lung (Pulmo)

• The organs that make up the respiratory system are examined in


two separate systems.
• These are the upper respiratory tract and the lower respiratory
tract.
Upper respiratory tract Lower respiratory tract
• Nose (Nasus) • Trachea
• Mouth (Oris) • Lung (Pulmo)
• Sinus Paranasales • Bronchus
• Pharynx (Pharynx) • Bronchiolus
• Throat (Larynx) • Alveolus Pulmonis
Nose (Nasus)
• It is an organ made of bone and
cartilage, covered with muscle and skin.
• Air purification, humidification, heating,
sense of smell
• Nasus Externus (External Nose)
• Cavitas Nasi (Nasal Cavity)
• Cartilages forming the nose;
• cartilago septi nasi
• cartilago alaris major
• cartilago alares minores
Nasus Externus (External Nose)
Radix nasi,
Dorsum nasi,
Apex nasi,
Alae nasi,
Nares
Cavitas Nasi (Nasal Cavity)
• From nares to choana
• Vestibulum nasi
• upper, lower wall
• interior and exterior wall
Upper wall
• Corpus ossis
sphenoidalis
• Lamina cribrosa
ossis ethmoidalis
• Spina nasalis of os
frontale
• Os nasale
Lower wall
• The anterior 3/4 is the
processus palatinus of
the maxilla
• The posterior 1/4 is
lamina horizontalis ossis
palatini
• The lateral wall of the nasal • It forms the bony part of the
cavity consists of the following septum nasi from the lamina
bones: maxilla, os nasale, os perpendicularis of the os
ethmoidale, concha nasalis ethmoidale and the vomer. The
inferior, os lacrimale, os cartilage part consists of the
palatinum, os sphenoidale. cartilago septi nasi.
• The two nasal cavities are located at the top of
the airway and contain olfactory receptors.
• They resemble long wedges with large upward
constrictions of their undersides.
• They are held open by a skeletal framework
made of bone and cartilage.
• The smaller anterior regions of the cavities are
surrounded by the external nose, while the
larger posterior regions are centrally located
within the skull.
• The anterior openings of the nasal cavities are
the nostrils that open to the lower surface of the
nose.
• The posterior openings are the choanas that
open into the nasopharynx.
• nasal cavities;
• separated from each other by the nasal septum
(septum nasi) in the midline.
• It is separated from the oral cavity below by the hard
palate (palatum state).
• It is separated from the cranial cavity above by the
frontal, ethmoid, and sphenoid bones.
• There are 3 important bony prominences on the lateral
walls of the nasal cavities;
• Concha nasalis superior
• Concha nasalis medius
• Concha nasalis inferior
• These protrusions allow narrow passages to form.
• Recessus sphenoethmoidalis
• meatus nasi superior
• meatus nasi medius
• meatus nasi inferior
Choanae
• Air enters the nasal cavity through the aperture piriformis
and passes through the recessus sphenoethmoidalis, meatus
nasi superior, medius and inferior, and reaches the
nasopharynx through the choanas.
• Nosebleeds (epistaxis) are the most common bleeding. (A.
sphenopalatina - A. palatina major anastomosis)
• Ways of spread of rhinitis (inflammation of the mucous
membrane lining the nasal cavities)
• Lamina cribriformis - fossa cranii anterior
• Choanae – nasopharynx, retropharyngeal
• Tuba auditiva (eustachian tube) – middle ear
• Through the holes in the nasal cavity – into the paranasal
sinuses
• Ductus nasolacrimalis - tear system
Paranasal Sinuses
(Sinus Paranasales)
• There are four paranasal air
sinuses;
• cellulae ethmoidalis
• sinus sphenoidalis
• sinus maxillaris
• sinus frontalis
• Each is named according to the
bone it is found in.
• These bones are also pneumatic
bones, os frontale, os
ethmoidale, os sphenoidale, and
maxilla.
• The total volume of all sinuses is
approximately 80 cm³.
Radiological images of
the paranasal sinuses
• The paranasal sinuses develop from the nasal cavities and form
into the bones they are in.
• All paranasal sinuses:
• It is covered with ciliated and mucus-secreting respiratory mucosa.
• They open to the outer wall of the nasal cavity and discharge their
secretions.
• It is innervated by branches of the trigeminal nerve [V].
• Function of paranasal sinuses;
• Providing the resonance of the sound thanks to the cavities,
• Contributing to odor by providing air distribution,
• contribute to the heat exchange of the inhaled air,
• easing the weight of the bones in the front of the skull and facilitating balance
• is to produce mucus to moisten the nose and inhaled air.
• Sinus frontalis: These are sinuses of different sizes, one on
each side and located at the top.
• Each is triangular in shape and is located in the lower part of
the os frontale.
• The sinus frontalis opens to the anterior portion of the meatus
nasi medius via the ductus nasofrontalis.
• Cellulae ethmoidales: Composed of many thin-walled small
cavities. Most of it is found in the labyrinthus ethmoidalis of the os
ethmoidale.
• It is divided into 3 parts;
• Cellulae ethmoidales anteriores: to meatus nasi medius
• Cellulae ethmoidales mediae: to meatus nasi medius
• Cellulae ethmoidales posteriores: opens to the meatus nasi superior.
• Since ethmoidal cells often protrude beyond the labyrinthus
ethmoidalis boundaries into the bones, os frontale, maxilla, os
lacrimale, os sphenoidale, and os palatinum may join their walls.
• Sinus maxillaris:
• It is the largest of the paranasal sinuses and is pyramidal shaped sinuses
that completely fill the body of the maxilla.
• The medial wall or floor of the maxillary sinus into the nasal cavity;
topping proc. directed towards the zygomaticus.
• It opens into the meatus nasi medius with the ostium sinus maxillaris.
• The relationships of the maxillary sinus are as follows:
• The superolateral surface (roof) is associated with the orbita above.
• The anterolateral surface is inferior, associated with the roots of the upper
molars and premolars and the front of the face.
• The posterior wall is associated with the infratemporal fossa.
• Sinus sphenoidalis are located on both sides of the body of the sphenoid
bone.
• The aperture opens into the roof of the nasal cavity (recessus
sphenoethmoidalis) through the sinus sphenodalis.
• Sinus sphenoidalis above n. with opticus and pituitary gland, posteriorly
with pons, laterally with sinus cavernosus and passing through it a. It is
adjacent to the carotis interna and some pairs of skulls (cranial nerves).
• In case of inflammation due to the very thin walls of the infection, the
infection can easily affect the neighboring structures. Fossa cranii
anterior can pass into fossa cranii media and orbita.
Pharynx (Pharynx)
• The pharynx is a
musculofacial half-cylinder
that connects the oral and
nasal cavities in the head
to the larynx and
esophagus in the neck.
• The pharyngeal space is a common pathway for air and
food.
• The pharynx attaches to the base of the skull above and
descends to approximately the level of the C6 vertebra
with the upper part of the esophagus.
• The walls of the pharynx are connected anteriorly to the nasal cavities, the oral cavity and the sides of the larynx.
• According to these connection points, the pharynx is divided into three regions as nasopharynx, oropharynx and
laryngopharynx:
• The posterior openings (choana) of the nasal cavities open into the nasopharynx.
• The posterior opening of the oral cavity (oropharyngeal isthmus) opens into the oropharynx.
• The upper opening of the larynx (laryngeal entrance) opens into the laryngopharynx.
• In addition to these openings, the pharyngeal cavity is associated with the posterior third of the tongue and the
posterior aspect of the larynx.
• The pharyngotympanic tube (eustachian tube) opens into the lateral walls of the nasopharynx.
Waldeyer's lymphatic circle
• The lymphoid tissue communities (Waldeyer's tonsillar ring) in the pharyngeal
mucosa surrounding the nasopharynx and oropharynx openings are part of the
body's defense system. These communities vary in size. It mainly occurs in three
areas:
• The pharyngeal tonsil, known as adenoids when enlarged, is located in the midline in the
roof of the nasopharynx.
• The palatine tonsils are located between the oropharyngeal and palatopharyngeal arches,
just behind the oropharyngeal isthmus. (Tonsils can be seen by pressing the tongue down
through a patient's open mouth.)
• The lingual tonsils are numerous lymphoid nodules, collectively located in the posterior third
of the tongue.
• Small lymphoid nodules are also seen on the upper surface of the soft palate and
the tuba auditiva (eustachian tube), which opens into the nasopharynx.
• Waldeyer's lymphatic circle
• tonsilla pharyngea
• tonsilla tubaria
• tonsilla palatine
• tonsilla lingualis
Larynx
• The larynx is a hollow muscle-ligamentous
structure with a cartilaginous framework
that forms the apex of the lower respiratory
tract.
• The larynx cavity is continuous with the
trachea below. Above, it opens into the
laryngopharynx, just behind the tongue,
slightly below the posterior opening of the
tongue and oral cavity.
• The larynx acts both as a valve (or sphincter)
to close the lower airway and as a tool for
producing sound.
• larynx:
• Three large single cartilages (cartilago cricoidea,
cartilago thyroidea, and cartilago epiglottica)
• Three smaller pairs of cartilages (cartilago
arytenoidea, cartilago corniculata, and cartilago
cuneiformis)
• It consists of a fibro-elastic membrane and
numerous inner muscles.
• The larynx hangs above the hyoid bone and is attached to the trachea below by
membranes and ligaments.
• It is highly mobile in the neck and can move up, down and back and forth with
the extrinsic muscles attached to the larynx itself or the hyoid bone.
• During swallowing, large upward and forward movements of the larynx facilitate
the closure of the laryngeal inlet and the opening of the esophagus.
• Motor and sensory innervation of the larynx is provided by the vagus nerve [X].
• Cartilago Cricoidea
• Cartilago Thyroidea
• It is the largest larynx cartilage.
• The angle of the prominentia laryngea protrusion (Adam's apple)
is narrower in men (90°) than in women (120°), so it can be seen
more easily in men from the outside.
Adam's Apple
(prominentia laryngea protrusion at the anterior part of the Thyroid Cartilage)
• https://www.youtube.com/watch?v=rxOMOKqEOVc
• Cartilago Epiglottica
• Cartilago Arytenoidea
• Cartilago Corniculata
• Cartilago Cuneiformis
Joints and Ligaments of Larynx
• Art. cricothyroidea
• Cartilago thyroidea makes forward,
and backward movements called
scale movements.
• Art. cricoarytenoidea
• internal and external rotation
• move forward and backward
• Lig. thyroepiglotticum
• Lig. hyoepiglotticum
• Membrane thyrohyoidea:
Made of elastic fibrous
connective tissue, it lies
between the cartilago
thyroidea and the body and
cornu majus of the os
hyoideum.
• Membrane fibroelastica laryngis:
• It is divided into two parts by the
formation of a pocket called the
venticulus laryngis.
• Upper part of the membrana
quadrangularis
• Its lower part is called the conus elasticus.
• The membrane quadrangularis attaches
anteriorly to the inner surface of the
angulus thyroideus, to the lateral edges
of the epiglottis, and posteriorly to the
cartilago arytenoidea and cartilago
corniculata.
• Ligament to the thick and firm lower
border of the membrane
quadrangularis. called the vestibular
(false vocal cords).
• Conus elasticus attaches below to the upper edge of the
cartilago cricoidea, anteriorly to the inner surface of the
angulus thyroideus, and posteriorly to the proc.vocalis of the
cartilago arytenoidea.
• Its upper edge is free and thicker, called lig.vocale (true vocal
cords).
Larynx muscles
• The extrinsic muscles are the muscles that extend from the adjacent
structures to the larynx and adjust the position of the entire larynx.
The larynx attached to the os hyoideum changes its position
according to the movements of this bone. [Extrinsic muscles (supra-
hyoid and sub-hyoid muscles) are shown in the movement system.]
• Intrinsic muscles lie between the cartilages of the larynx. With the
movements of these muscles, the movement of the larynx cartilages
and therefore the condition of the vocal cords changes.
• M. cricothyroidea: In its
contraction, it pulls the anterior
side of the cartilago cricoidea
upwards, stretches and stretches
the length of the plica vocalis by
pulling the cartilago arytenoidea
downwards.
• M. cricoarytenoideus posterior:
The rima glottidis (mizmar
space) widens as the cartilago
arytenoidea are opened
outward during contraction. It
is the only muscle that expands
the mizmar space.

• M. cricoarytenoideus lateralis:
It narrows the mizmar space by
internally rotating the cartilago
arytenoidea.
• M. thyroarytenoideus: The pars
lateralis part pulls the cartilago
arytenoidea inward and narrows
the rima glottidis.
• M. vocalis: It is called the part of
M.thyroarytenoideus pars vocalis.
With its contraction, the plica vocalis
is stretched and thickened without
shortening.
• M. arytenoideus: It narrows the
mizmar space by bringing the
cartilago arytenoidea closer
together in their contractions.
Video of vocal cords while singing
• https://www.youtube.com/watch?v=-XGds2GAvGQ
Cavitas Laryngis

• Aditus Laryngis
• Vestibulum Laryngis
• Ventriculus Laryngis
• Cavitas Infraglottica
TRACHEA (RESPIRATORY PIPE)
• It starts from the lower edge of the larynx (at the level of the C6 vertebra) and extends to the upper edge of
the T5 (lower edge of the manubrium sterni).
• The trachea is a tube 2.5 cm wide, 10-12 cm long, composed of flexible, air-conducting cartilage rings.
• At the level of the T4-5 vertebral body, it is divided into two as bronchus principalis dexter (right) and sinister
(left) with an angle of approximately 55-70°.
• The trachea is in the mediastinum and midline, lying anterior to the esophagus.
• The pars cervicalis begins just below the larynx.
• Pars thoracica bifurcatio extends to the trachea.
• It is made of cartilage and membranes.
• It expands during inspiration (inhale) and contracts during expiration (exhale).
Posterior view
of trachea
• Trachea; It is divided
into two branches as
bronchus principalis
dexter and bronchus
Front view of
principalis sinister. trachea
• The fork formed by
these branches is called
bifurcatio trachea.
• Bronchus principalis dexter extends more vertically than
bronchus principalis sinister. Therefore, if a person aspirates a
foreign body, it is more likely to enter the bronchus principalis
dexter.
• Due to the asymmetry of the heart, the left main bronchus
(bronchus principalis sinister) is longer than the right one.
Neighborhoods of Trachea
• Pars cervicalis:
• On the front:
• isthmus section of
gl.thyroidea (at the level of
2,3rd rings)
• v. thyroid inferior
• m. sternohyoideus
• m. sternothyroideus
• fascia pretrachealis
• arcus venosus jugularis
• at the back
• esophagus
• Laterally
• a. carrotis communis
• g. lateral lobes of thyroidea
• a. thyroid inferior
• n. laryngealis recurrens
Neighborhoods of Trachea
• Pars thoracica:
• On the front:
– manubrium stern
– thymus remnants
– v. brachiocephalica sinistra
– arcus aortae
– truncus brachiocephalicus
– a. carrotis communis sinistra
• at the back
– esophagus
• On the right side
– pleura
– right n. vagus
– truncus brachiocephalicus at the root
of the neck
• on the left
– left n. laryngealis recurrens
– arcus aortae
– a. carrotis communis sinistra
– a. subclavia sinistra
Bronchial Branching
• Trachea • Trachea
• Bronchus principalis dexter – Bronchus principalis sinister
• Bronchus lobaris • Bronchus lobaris
• Bronchus segmentalis • Bronchus segmentalis
• Bronchiolus lobularis – Bronchiolus lobularis
• Bronchiolus terminalis – Bronchiolus terminalis
• Bronchiolus respiratorius – Bronchiolus respiratorius
• Ductus alveolaris » Ductus alveolaris
• Saccus alveolaris » Saccus alveolaris
• Alveolus pulmonis » Alveolus pulmonis
Bronchus Principalis Dexter
• Bronchus lobaris superior
dexter:
• Bronchus segmentalis apicalis BI
• Bronchus segmentalis posterior BII
• Bronchus segmentalis anterior BIII
• Bronchus lobaris medius dexter:
• Bronchus segmentalis lateralis BIV
• Bronchus segmentalis medialis BV
• Bronchus lobaris inferior dexter:
• Bronchus segmentalis superior BVI
• Bronchus segmentalis basalis
medialis VII
• Bronchus segmentalis basalis
anterior BVIII
• Bronchus segmentalis basalis
lateralis BIX
• Bronchus segmentalis basalis
posterior BX
Bronchus Principalis Sinister
• Bronchus lobaris superior
sinister:
• Bronchus segmentalis
apicoposterior BI+II
• Bronchus segmentalis anterior
BIII
• Bronchus lingularis superior
BIV
• Bronchus lingularis inferior BV
• Bronchus lobaris inferior
sinister:
• Bronchus segmentalis superior
BVI
• Bronchus segmentalis basalis
medialis BVII
• Bronchus segmentalis basalis
anterior BVIII
• Bronchus segmentalis basalis
lateralis BIX
• Bronchus segmentalis basalis
posterior BX
• The part of the body between
the neck and the abdomen is
the thorax.
• The thorax is an irregular
cylinder with a narrow opening
(apertura thoracis superior) at
the top and a relatively larger
opening (apertura thoracis
inferior) below.
• Apertura thoracis superior is
open, continuous with the neck;
The aperture thoracis is closed
by the inferior diaphragm.
• The space within this region is
called the thoracic cavity
(cavitas thoracis).
LUNGS
• Lungs are the main organs of the respiratory system. They are located on either side of the heart and mediastinum and
occupy most of the chest cavity.
• Each lung is free in the pleural cavity, except for parts of the hilum and pulmonary ligament, where they attach to the
mediastinum.
• A healthy lung is spongy and elastic, with some air at all times.
• It can swim if it is removed from the thorax and placed in water.
• When removed from the thorax, they shrink to 1/3 their size as the negative pressure environments change.
• Its surface is smooth and shiny.
• It divides into 3 lobes on the right and 2 lobes on the left.
• The right lung weighs approximately
625 g and the left lung is 567 g.
• Lungs take approximately 3700 cm³ of
air in an adult male in inspiration after
a deep expiration.
• The volume of a fully filled lung,
together with its tissue and air, is
about 6500 cm³.
• However, in normal respiration, 500
cm³ of air is inhaled and exhaled in an
adult male.
• These values are less in women.
• Normal breathing is done 15-20 times
per minute.
LUNGS
• The lungs are responsible for uptake of oxygen into the
blood and expulsion of carbon dioxide.
• The functional design of the thorax facilitates this
complex process.
• Acting together, the respiratory muscles and diaphragm
increase the intrathoracic volume and create a negative
pressure in the pleural space that causes lung expansion.
• The resulting reduction in alveolar pressure allows air to
be delivered through the upper respiratory tract,
trachea, bronchi and bronchioles, and finally to the
alveoli, where gas exchange takes place.
Lung lobes and slits
• In the right lung:
• fissura obliqua; It separates the lobus medius and lobus inferior from each
other.
• fissura horizontalis; It is found only in the right lung and separates the lobus
superior and lobus medius.
• In the left lung:
• fissura obliqua; It separates the lobus superior and lobus inferior from each
other.
Right Lung (Pulmo dexter)
• Lobus superior
• Segmentum apicale SI
• Segmentum posterius SII
• Segmentum anterius SIII
• Lobus medius
• Segmentum laterale SIV
• Segmentum mediale SV
• Lobus inferior
• Segmentum superius SVI
• Segmentum basale mediale
SVII
• Segmentum basale
anterius SVIII
• Segmentum basale laterale
SIX
• Segmentum basale
posterius SX
Left Lung (Pulmo sinister)
• Lobus superior
• Segmentum apicoposterius
SI+II
• Segmentum anterius SIII
• Segmentum lingulare
superius SIV
• Segmentum lingulare inferius
SV
• Lobus inferior
• Segmentum superius SVI
• Segmentum basale mediale
SVII
• Segmentum basale anterius
SVIII
• Segmentum basale laterale
SIX
• Segmentum basale posterius
SX
LUNG (Pulmo)
• Apex pulmonis:
• It is approximately at the level of the 1st
and 2nd ribs. Because the right apex
pulmonis is smaller and closer to the
trachea than the left, percussion at the
root of the right neck does not respond as
well as the left.
• Basis pulmonis (Facies diaphragmatica):
• The broad base of the lung conforms to the
shape of the diaphragm. Through the
diaphragm, it is adjacent to the right lobe
of the liver on the right, the left lobe of the
liver, stomach and spleen on the left.
• Facies costalis:
• It is the largest facet of the lungs. The
traces of the costas are visible.
• Facies mediastinalis
• It is the side of the lungs facing
the mediastinum and each
other. Here is a large depression
called the impressio cardiaca
where the heart sits. Posterior
and superior to the Impressio
cardiaca is the hilum pulmonis.
From here, the vessels, nerves
and bronchi of the lung enter
and exit. All formations entering
and exiting the lung are called
radix pulmonis.
• In the right lung, facies
mediastinalis; v. azygos, v. traces
of the cava superior and
esophagus are found.
• In the left lung, there is a deeper
impressio cardiaca than the right
one, arcus aortae, subclavia
sinistra, v. traces of
brachiocephalica sinistra and
oesephagus are found.
• Facies interlobaris
• Margo anterior
• Margo inferior
Pleura (Lung Membrane)
• The lungs are surrounded by a serous
membrane called the pleura.
• It is in the form of two-layered
membranous sacs that surround both
lungs separately.
• The membrane layer just above the lung
is called the pleura visceralis.
• The parts of the thoracic cavity that
cover the inner surface of the
diaphragm, the upper surface of the
diaphragm, and the mediastinum facing
the lung are called is pleura parietalis.
• The space between the two layers of
pleura is called cavitas pleuralis.
• Since the sacs of the two lungs are
different from each other, the infection
that occurs in one does not pass to the
other.
Pleura (Lung Membrane)
• The space between the two pleural sacs is
called the mediastinum.
• Lungs; The airway is connected to the
mediastinum by a root formed by
pulmonary blood vessels, lymphatic
tissues, and nerves.
• There is only a potential space between
the pleura visceralis covering the lung and
the pleura parietalis.
• The lung does not completely fill the
potential space of the pleural cavity, parts
that the lung does not fill form recesses
and are important for adapting to changes
in lung volume during breathing.
• The largest and most clinically significant
impasse, the recessus
costodiaphragmaticus, runs downward
between the thoracic wall and the
diaphragm.
Recessus costodiaphragmaticus
• The largest and clinically most important impasse,
recessus costodiaphragmaticus, occurs in the part of
the pleura parietalis between the costal pleura and the
diaphragmatic pleura.
• Recessus costodiaphragmaticus are the areas between
the lungs and the inferior margins of the pleural
cavities.
• After taking a deep breath, it takes its shallowest form,
and after a deep exhalation, it takes its deepest form.
• In normal breathing, the lower edges of the lungs
extend to the 6th rib at the linea medioclavicularis
(imaginary line passing through the middle of the
clavicula), to the 8th rib at the linea axillaris media line,
and to the 10th thoracic vertebra at the vertebral line.
• At the same level, it approaches the lower border of
the pleura parietalis, which is at the level of the 8th rib,
10th rib, and 12th thoracic vertebra, respectively. In this
way, recessus costodiaphragmaticus becomes shallow.
• Since the lungs will go up during exhalation, the
recessus costodiaphragmaticus deepens and expands
when exhaling.
Mediastinum
• The mediastinum is a midline segment that extends from the sternum anteriorly to the
thoracic vertebrae posteriorly and from the upper thoracic opening to the lower thoracic
opening, bordered laterally by the pleura mediastinalis.
• A horizontal plane passing through the intervertebral disc and angulus sterni between the
T4 and T5 vertebrae divides the mediastinum into its superior and inferior parts.
• The mediastinum superius is the portion above this passing plane.
• The mediastinum inferius is the portion below this passing plane and is segmented by the
pericardium surrounding the pericardial cavity in which the heart is located.
• Mediastinum medius contains the pericardium and heart.
• The mediastinum anterius is between the sternum and the pericardium.
• The mediastinum posterius is located between the pericardium and the thoracic vertebrae.
mediastinum sağ yandan görünüşü mediastinum sol yandan görünüşü
Diaphragm
• The diaphragm is a thin muscle-
tendon structure that fills the
lower thoracic opening and
separates the thoracic cavity from
the abdominal cavity.
• The structures it holds are:
• xiphoid process of the sternum
• costal margins of the chest wall
• XI. and XII. the ends of the costa
• posterior abdominal wall structures
• lumbar vertebrae
• Muscle fibers join from these
peripheral attachment points to
join the centrum tendineum. The
pericardium is attached to the
middle part of the central tendon.
• Structures passing through the thorax and abdomen pass through the diaphragm:
• The inferior V. cava passes through the centrum tendineum at approximately the level
of the 8th thoracic vertebra.
• The esophagus passes through the muscular part of the diaphragm just to the left of
the midline, approximately at the level of the 10th thoracic vertebra.
• The vagus nerves pass through the esophagus and the diaphragm.
• The aorta passes through the diaphragm at the level of the 12th thoracic vertebra.

FORAMEN VENAE CAVAE (T8)


HIATUS OESOPHAGEUS (T10)
HIATUS AORTICUS (T12)
Thoracic and diaphragmatic
movements during breathing
• One of the main functions of the chest wall and
diaphragm is to change the volume of the thorax to
allow air in and out of the lungs.
• As you breathe in, the dimensions of the thorax
change vertically, laterally, and anteroposteriorly.
• The rise and fall of the diaphragm significantly
alters the vertical dimensions of the thorax.
• When the muscle fibers of the diaphragm contract,
a descent (the muscle becomes horizontal and
flattened) occurs. When the diaphragm is loose, its
shape is domed like an umbrella.
• Changes in the anteroposterior and
lateral dimensions are due to the rise
and fall of the ribs.
• The posterior ends of the ribs attach to
the vertebral column, while the
anterior ends of most ribs articulate
with the sternum or adjacent ribs.
• Because the anterior ends of the ribs
are lower in level than the posterior
ends, when the ribs rise, they move the
sternum up and forward. Also, the
angle between the body of the
sternum and the manubrium may
become slightly wider.
• When the ribs are depressed, the
sternum moves down and back.
• This 'pump handle' movement allows
the antero-posterior movement of the
rib cage to change.
• Aside from the anterior ends of
the ribs being lower than the
posterior ends, the middle of
the body parts tend to be lower
than the two ends.
• When the ribs rise, the middle
of their trunk moves laterally.
• This “bucket handle” movement
increases the lateral dimensions
of the thorax.
• Any muscle attached to the ribs
could potentially move one rib
relative to the other and
therefore act as accessory
respiratory muscles.
• Muscles in the neck and
abdomen can fix or change the
positions of the upper and
lower ribs.
RESPIRATORY MUSCLES
• m. pectoralis major
• m. pectoralis minor
• m. subclavius
• m. serratus anterior
• mm. intercostales
• m. transversus thoracis
• diaphragma
• NORMAL RESPIRATORY
• In inspiration;
• By contracting the diaphragm, the vertical diameter of the thorax is increased and
the intrathoracic pressure is decreased.
• m. intercostalis externas (3rd-10th) increase the anteroposterior diameter of the
thorax by lifting the ribs.
• Expiration is passive.
• DEEP BREATHING
• In inspiration;
• m. intercostalis externa, mm. scalenius, m. sternocleidomastoideus, m. levator
costarum, m. serratus anterior and m. serratus lowers intrathoracic pressure by
raising the posterior ribs.
• Expiration is passive.
• FORCED RESPIRATORY
• In inspiration;
• all deep breathing muscles lift the ribs. M. levator scapulae, m. trapezius and
m. With the contraction of the rhomboideus, the scapula is fixed and m. The
ribs are lifted by the pectoralis. Support is obtained from the upper
extremities.
• Expiration is active.
• m. quadratus lumborum, m. intercostalis interna, m. subcostalis, m.
transversus thoracis, m. Active expiration is done by the serratus posterior
inferior muscles. By raising the intra-abdominal pressure with the contraction
of the abdominal muscles, m. The diaphragm is forced upward. Thus, chest
volume decreases and intrathoracic pressure rises.

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