Fitranto Arjadi

Anatomy, Medical Faculty UNSOED

Objectives:
By the end of this lecture we are going to be
able to:
Describe the anatomical structure and
features of the respiratory system
Recognize arterial supply, and venous
drainage of the respiratory system

Nose

2 openings called nostrils separated by nasal

septum
The lateral margin ala of nose rounded and
mobile.

The framework
of the external
nose is made of:
nasal bones
the maxillae
bone
frontal bone
Below the bone
parts its formed of
plates of
hyaline
cartilage

Divided into two

regions :
The external nose and the
internal nasal cavity
Separated by a midline
nasal septum
Each nasal cavity has a
floor, roof, medial wall,
and lateral wall
Lateral to the nasal
cavities are the orbits

The anterior

apertures of the
nasal cavities are
nares,
nares which
open onto the
inferior surface of
the nose.
The posterior
apertures are the
choanae, which
open into the
nasopharynx.

Sinuses
Ductus

nasolacrimalis

from oral cavity below

by the hard palate

from the cranial cavity
above by parts of the
frontal, ethmoid, and
sphenoid bones.

Nasal septum:

* Above:
perpendicular plate
of the ethmoid.
* Below and in
front: septal
cartilage.
* Below and
behind: vomer.

Walls, floor, and roof

Medial wall
nasal septum, which

is oriented vertically
in median sagittal
plane and separates
right and left nasal
cavities
Septum of :
1.septal cartilage
2.vertical plate of
the ethmoid
3.vomer.

Ethmiod bone
Ethmoid bone
The single ethmoid bone

is one of the most

complex bones in the
skull.
It contributes to the
roof, lateral wall, and
medial wall of both nasal
cavities, and contains
the ethmoidal cells
(ethmoidal sinuses).

Nasal Cavity
- The cavity of the nose is subdivided into
right and left halves by the nasal septum.
- The two halves open anteriorly on the face
through the nostrils (anterior nares), and
open posteriorly into the nasopharynx
through the posterior nasal aperture.

Regions
Each nasal cavity consists of 3

general regions
the nasal vestibule is a small
dilated space just internal to the
naris that is lined by skin and
contains hair follicles;
the respiratory region is the
largest part of the nasal cavity, has
a rich neurovascular supply, and is
lined by respiratory epithelium
composed mainly of ciliated and
mucous cells;
the olfactory region is small, is at
the apex of each nasal cavity, is
lined by olfactory epithelium, and
contains the olfactory receptors.
In addition to housing receptors for
the sense of smell (olfaction), the
nasal cavities adjust the
temperature and humidity of
respired air, and trap and remove
particulate matter from the airway.

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.
I. Floor, formed by:
- Anteriorly: Palatine process of the
maxilla.
- Posteriorly : Horizontal plates of the
palatine bone.
III. Medial wall (nasal septum),
formed by:
- Postero-inferior-------Vomer.
- Superiorly ----- Perpendicular plate of
the ethmoid bone.
- Antero-inferior -----Septal cartilage.

(Roof, floor, and

medial wall of the
nose)

Roof
narrow

Formed by :
1.cribriform plate of
the ethmoid bone
2.nasal and frontal
bones, and
posteriorly
sphenoid Bone.

Floor
It consists of:
palatine process of

maxilla & horizontal plate

of the palatine bone,
which together form the
hard palate.
The naris opens

anteriorly into the floor.

Lateral wall of the nose

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 (below the
inferior nasal concha):
- 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.

Lateral wall of the nose

- The lateral wall of the nose is
subdivided into three areas which
are:
A. Vestibule
B.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).
-Superior meatus : It receives the
opening of posterior ethmoidal air
sinus.

Arterial supply of the

nose
1. Sphenopalatine artery
- It is a branch from the maxillary artery
(main arterial supply).
2. Septal branch of the superior

labial artery from facial artery.

skin of the ala and lower part of the
septum are by branches
3. Ascending branch of the
greater palatine artery from the
maxillary artery .
- There is anastomoses between the
above three arteries to form
Kieselbach's plexus on the
antero-inferior part of the nasal
septum (Littles area).
- This area is a common site for

epistaxis (bleeding from the nose).

4. Anterior and posterior
ethmoidal branches of the
ophthalmic artery. supply the roof
and upper parts of the lateral wall and
septum.

Nerve supply of the

nose
I. Lateral wall
- Olfactory area (1 cm) Olfactory nerves.
(this area includes the roof and upper parts of the septum and lateral nasal walls)
- Vestibular area Infraorbital nerve.
- Respiratory area of the lateral wall:
a. Antero-superior anterior ethmoidal N.
b. Antero-inferior (inf. concha) Internal nasal nerve(from anterior ethmoidal
N)
c. Postero-superior Lateral posterior superior nasal brs.
d. Postero-inferior Lateral posterior inferior nasal brs (from greater palatine N).

Nerve supply
1-Sensory:

ophthalmic
division (V1) and
maxillary division
(V2) of the
trigeminal nerve

The infratrochlear

and external nasal

branches of the
oph-thalmic
nerve (CN V).
Infraorbital branch
of the maxillary
nerve (CN V).

Nerves of
nasal cavity:
1-Sensory:
ophthalmic
division (V1) and
maxillary division
(V2) of the
trigeminal nerve
2- Olfactory
nerve: It is the
nerve of smell.
It supplies the
olfactory
mucosa which is
situated in the
roof of the nasal
cavity.

Sphenopalatine Ganglion
Type: Parasympathetic
ganglion.
Site: In the pterygopalatine
fossa.
Roots (preganglionic fibers):
1. Sensory: From the maxillary
nerve.
2. Sympathetic supply: Deep
petrosal nerve which arises
from the sympathetic plexus
around the internal carotid
artery.
3. Parasympathetic: Greater
petrosal nerve (from facial N)

Sphenopalatine Ganglion
(branches)
1. Postganglionic secretomotor fibers which supply
the lacrimal gland.
2. Lesser palatine nerves.
3. Greater palatine nerve .
- It gives the lateral
posterior inferior nasal
nerves.
4. Lateral and medial
posterior superior nasal
nerves.
5. Nasopalatine nerve.
( long sphenopalatine)
6. Pharyngeal branch to the
pharynx.
7. Branches to the orbital
periosteum.

NB: The postganglionic branches

of the sphenopalatine ganglion
supply the mucous glands of the
palate, nose, nasopharynx and
the lacrimal gland.

II. Nasal septum

- Olfactory area Olfactory N.
- Anterior part Internal nasal N. (from the anterior ethmoidal nerve).
- Postero-superior part Medial posterior superior nasal branches. (from
sphenopalatine ganglion).
- Postero-inferior part Nasopalatine nerve.
( long sphenopalatine nerve).
N.B: The nasopalatine nerve, greater and lesser palatine nerves, medial
and lateral posterior superior nasal nerves, and the posterior inferior
nasal nerve are branches from the sphenopalatine ganglion.

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 -------- Inside
the body of the maxilla.
2. Frontal sinus ----------Between the two plates of the
frontal bone.
3. Sphenoid ---------------- Inside
the body of the sphenoid bone.
4. Ethmoid ----------------- Inside
the lateral part of the ethmoid
bone
- All the sinuses are present at
birth except the frontal sinus
which appears during the
second year.

1) Sphenoidal air sinuses:

*These are 2 sinuses which lie inside the body of
sphenoid and are separated from each other by a bony
septum.
2) Ethmoidal air sinuses:
*These are large number of intercommunicating cavities
present inside the ethmoid bone and open into the
nose. Lies between nose and orbit.
3) Frontal air sinuses:
*These are 2 sinuses which lie in the frontal bone just
above the root of the nose.
*They are separated from each other by a septum.

Openings of the middle meatus:

several paranasal sinuses have their openings in
this meatus as follows:
a) Maxillary air sinus: opens into the hiatus
semilunaris below the bulla ethmoidalis.
b) Anterior ethmoidal sinus: opens into the
hiatus semilunaris in front of the bulla
ethmoidalis.
c) Middle ethmoidal sinus: opens on the bulla
ethmoidalis.
d) Frontal sinus: opens into the upper part of the
hiatus semilunaris.

Other openings in the lateral wall of

the nose:
a) Sphenoidal sinus: opens into the sphenoethmoidal recess just above the superior
concha.
b) Posterior ethmoidal sinus: opens into the
superior meatus (below the superior
concha).
c) Naso-lacrimal duct: opens into the inferior
meatus.

N.B.: All paranasal sinuses open into the middle meatus of the nose
except 2:

1) the sphenoidal sinus (into the spheno-ethmoidal recess).

2) the posterior ethmoidal sinus (into the superior meatus).

MAXILLARY AIR SINUS

It is a pyramidal cavity situated inside the body of the

maxilla. It is the largest paranasal air sinus.
*WALLS:
-Roof: separates the sinus from the orbit and lodges the
infra-orbital
nerve and vessels.
-Floor: is formed by the alveolar process of the maxilla.
The roots of the 1st and 2nd molar teeth project into
the floor.

Relations:

* Medially:
nasal cavity.
The sinus
opens into
the middle
meatus of
the nose.
* Above: orbit
* Below :
roots of the
molar and
premolar
teeth.

Description
The pharynx is situated behind the nasal

cavities, the mouth, and the larynx

It may be divided into nasal, oral, and laryngeal

parts
Its upper, wider end lying under the skull
Its lower, narrow end becoming continuous with

the esophagus opposite the sixth cervical

vertebra

Description

The pharynx has a musculomembranous wall,

which is deficient anteriorly

Here, it is replaced by the posterior openings

into the nose (choanae), the opening into the

mouth, and the inlet of the larynx
By means of the auditory tube, the mucous

membrane is also continuous with that of the

tympanic cavity

Muscles of the Pharynx

Wall of the pharynx consist of the superior,

middle, and inferior constrictor muscles

Fibers of these muscles run in a somewhat
circular direction
Stylopharyngeus and salpingopharyngeus
muscles
Their fibers run in a somewhat longitudinal
direction
(membuka tuba auditiva)

Muscles of
the Pharynx
The three constrictor muscles extend around

the pharyngeal wall to be inserted into a fibrous

band that extends from the pharyngeal
tubercle on the basilar part of the occipital bone
of the skull down to the esophagus
The three constrictor muscles overlap each
other so that the middle constrictor lies on the
outside of the lower part of the superior
constrictor and the inferior constrictor lies
outside the lower part of the middle constrictor

Muscles of the Pharynx

The lower part of the inferior constrictor,

which arises from the cricoid cartilage, is

called the cricopharyngeus muscle
The fibers of the cricopharyngeus pass

horizontally around the lowest and narrowest

part of the pharynx and act as a sphincter

Nasal
Pharynx
This lies above the soft palate and behind the
nasal cavities

In the submucosa of the roof is a collection of

lymphoid tissue called the pharyngeal tonsil

The pharyngeal isthmus is the opening in the

floor between the soft palate and the

posterior pharyngeal wall

On the lateral wall is the opening of the

auditory tube, the elevated ridge of which is

called the tubal elevation

Nasal Pharynx
The pharyngeal recess is a depression in the

pharyngeal wall behind the tubal elevation

The salpingopharyngeal fold is a vertical fold
of mucous membrane covering the
salpingopharyngeus muscle

Oral
Pharynx

This lies behind the oral cavity

The floor is formed by the posterior one third
of the tongue and the interval between the
tongue and epiglottis
In the midline is the median glossoepiglottic
fold
on each side the lateral glossoepiglottic fold
The depression on each side of the median
glossoepiglottic fold is called the vallecula

Oral Pharynx

On the lateral wall on each side are the

palatoglossal and the palatopharyngeal arches or

folds and the palatine tonsils between them
The palatoglossal arch is a fold of mucous
membrane covering the palatoglossus muscle
The interval between the two palatoglossal arches
is called the oropharyngeal isthmus
It marks the boundary between the mouth and
pharynx
The palatopharyngeal arch is a fold of mucous
membrane covering the palatopharyngeus muscle
The recess between the palatoglossal and
palatopharyngeal arches is occupied by the
palatine tonsil

Lymphoid Tissue of
At the junction of the mouth with the oral part of
Pharynx
the pharynx, and the nose with the nasal part of

the pharynx, are collections of lymphoid tissue

The palatine tonsils and the nasopharyngeal
tonsils are the most important
The deep cervical lymph node situated below and
behind the angle of the mandible, which drains
lymph from this organ, is usually enlarged and
tender
Recurrent attacks of tonsillitis are best treated by
tonsillectomy, the external palatine vein, which
lies lateral to the tonsil, may be the source of
troublesome postoperative bleeding

Palatine
Tonsils
The tonsil is covered on its lateral surface by
a fibrous capsule

The capsule is separated from the superior

constrictor muscle by loose areolar tissue

The external palatine vein descends from the

soft palate in this tissue to join the

pharyngeal venous plexus

Lateral to the superior constrictor muscle lie

the styloglossus muscle, the loop of the facial

artery, and the internal carotid artery

Tonsil
Tonsila Palatina:

Sepasang ; pada dinding lateral orofarinx

10-20 invaginasi dalam (kripta) Jebak
microba,encapsulasi
Tonsila faringea (adenoids):
Tunggal; pada atap nasofarinx
tak berkripta, kapsula tipis
Tonsila Lingualis:
Lebih kecil, jumlah banyak, pada basis lidah
Kripta tunggal, kapsula tipis

Laryngeal Pharynx
This lies behind the opening into the larynx
The lateral wall is formed by the thyroid

cartilage and the thyrohyoid membrane

The piriform fossa is a depression in the
mucous membrane on each side of the
laryngeal inlet

Supply of the Pharyngeal

Mucous Membrane
Innervation : (Sensorik)

Nasal pharynx: The maxillary nerve

Oral pharynx: The glossopharyngeal nerve
Laryngeal pharynx: The internal laryngeal branch
of the vagus nerve
Vasc : Ascending pharyngeal, tonsillar
branches of facial arteries, and branches of
maxillary and lingual arteries
Lymph : Directly into the deep cervical lymph
nodes or indirectly via the retropharyngeal or
paratracheal nodes into the deep cervical
nodes

Blood Supply
The tonsillar branch of the facial artery
The veins pierce the superior constrictor

muscle and join the external palatine, the

pharyngeal, or the facial veins
Lymph drains into the upper deep cervical

lymph nodes, just below and behind the angle

of the mandible

Larynx
Specialized organ at
the inlet of air
passage.
Function:
1- Protective sphincter
at the air passage.
2- Phonation.
3- Regulates passage
of air in inspiration
and expiration.
4- Opens & closes
during swallowing,
coughing & sneezing.

Cartilages of the Larynx

Unpaired cartilages
Epiglottis
Thyroid cartilage
Cricoid

Paired cartilages
Arytenoid
Corniculate
Cuneiform
All cartilages are

hyaline except the

epiglottis (elastic)

The framework of the larynx is made up of cartilages.

These cartilages are connected by joints, membranes

& ligaments.
Moved by muscles.
Lined by mucous membranes.

The Laryngeal

cartilage are Nine

3 single & 3
Paired
Single:
Thyroid
Cricoid
Epiglottis.
Paired:
Arytenoids
Corniculate
Cuneiform.

Thyroid Cartilage
It is the largest of the

laryngeal cartilage.
Formed of 2 laminae,
each has superior &
inferior horn.
The angle between 2
laminae is 90 in male
& 120 in female.

It has 2 notches superior

& inferior at the meeting

of its 2 laminae.

 Connection of

the thyroid
cartilage:
Superior: To
hyoid bone by
thyrohyoid
membrane.
Inferior: To cricoid
cartilage by the
cricothyroid joint
& cricothyroid
membrane

Epiglottis:
Leaf-shaped elastic
cartilage.
Lies behind the root of the
tongue.
Connected by its stalk to
the back of the thyroid
cartilage.
Its sides are connected to
the arytenoid cartilage by
aryepiglottic fold.
Its upper end is free. But
its mucous membrane is
connected to the back of
tongue by 3
glossoepiglottic folds one
median & 2 lateral.

Cricoid cartilage:
Hyaline.
Ring shaped, having a narrow anterior arch and wide posterior

lamina.
Connected superiorly to thyroid cartilage by cricothyroid joint and
cricothyroid membrane.

Arytenoid cartilage:
Paired hyaline cartilage.
Shaped like a 3- sided

pyramid.
Its base sits on the superior
surface of the cricoid lamina.
Apex: directed superiorly,
supports the corniculate

cartilage.
Muscular process directed

laterally, gives attachment to

3 muscles:
Posterior & lateral
cricoarytenoid.
And Thyroarytenoid.
Vocal process: directed
forward and gives attachment
to the vocal ligament.

Muscles of the Larynx

2 Major groups
Extrinsic Muscles: ( move the whole larynx)
Elevators:

Digastric, stylohyoid, mylohyoid,

geniohyoid, stylopharyngeus,
salpingopharyngeus & palatopharyngeus.
Depressors: Sternothyroid, sternohyoid &
omohyoid.
Intrinsic Muscles ( movement within larynx)
Control of laryngeal inlet
Control of rima glottidis
Control of length & tension of vocal cords

All intrinsic muscles lie inside the larynx cricothyroid

Cricothyroid Muscle

Origin: Anterior part of arch of cricoid

Insertion: Inferior border & inf. Horn of thyroid
Causes flexion at cricothyroid joint
Lengthens & tightens the vocal ligament
Nerve supply: External laryngeal nerve of superior

laryngeal of vagus.

Posterior cricoarytenoid is the only

abductor of the vocal cords.

Muscles acting on the

arytenoids

Posterior
cricoarytenoids
Lateral cricoarytenoid
Interarytenoid
muscles:
Transverse &
Oblique
Thyroarytenoid
muscle
Aryepiglottic muscles

Thyroarytenoid & Vocalis

Muscles

Action of Intrinsic
Muscles

Innervation of Larynx
MOTOR

All muscles of the larynx are supplied

the recurrent laryngeal nerve EXCEPT

Cricothyroid supplied by external laryngeal

branch of superior laryngeal nerve.

SENSORY & SECRETOMOTOR

Above Vocal Cords: Internal laryngeal

Below Vocal Cords: Recurrent

laryngeal

The interior of the

larynx
It is divided into 3 parts:
1- vestibule: between
laryngeal inlet &
vestibular fold.
2- Ventricle: a depression
extending laterally
between vestibular &
vocal folds.
3- Infraglottic cavity: lies
between the vocal fold &
lower border of cricoid
cartilage.
It is continuous with the
trachea inferiorly.

Blood Supply of Larynx

Superior laryngeal artery

branch of superior thyroid artery

Inferior laryngeal artery branch
of inferior thyroid artery
Veins accompany the arteries

Trachea

The trachea is a mobile cartilaginous and membranous

tube
It begins in the neck as a continuation of the larynx at the
lower border of the cricoid cartilage at the level of the
sixth cervical vertebra
It descends in the midline of the neck
In the thorax the trachea ends below at the carina by
dividing into right and left principal (main) bronchi
During expiration the bifurcation rises by about one
vertebral level
During deep inspiration may be lowered as far as the
sixth thoracic vertebra
In adults the trachea is about 4 in. (11.25 cm) long and
1 in. (2.5 cm) in diameter
The fibroelastic tube is kept patent by the presence of Ushaped rings of hyaline cartilage embedded in its wall
The posterior free ends of the cartilage are connected by
smooth muscle, the trachealis muscle

Hubungan
Anterior: sternum, thymus, vena

brachiocephalica sinistra, arteri carotis communis

sinistra dan arkus aorta
Posterior: Esophagus dan n. Laringeus rekurens
sinistra
Right side: v.azygos vein, n. X destra dan pleura
Left side: Arcus aorta, a. Carotis communis
sinistra, a. Subclavia sinistra, n X sinistra dan n.
Phrenikus sinistra, dan pleura

Trachea

Chapter 22, Respiratory System

Figure 22.6a
85

Trache
a
Insert Fig 23.5 all but b

Windpipe
Divides to

form
Primary

bronchi
Carina:
Cough
reflex

Dense regular connective tissue and smooth

muscle reinforced with c-shaped cart. on the
ant. surface.
Post. Trachea consists of elastic lig. and a
bundle of muscle called the trachealis muscle
The lining of the trachea is pseudostratified
ciliated columnar epithelium with goblet cels

Relation
Anteriorly: The sternum, the thymus, the left

brachiocephalic vein, the origins of the

brachiocephalic and left common carotid arteries,
and the arch of the aorta
Posteriorly: The esophagus and the left
recurrent laryngeal nerve
Right side: The azygos vein, the right vagus
nerve, and the pleura
Left side: The arch of the aorta, the left common
carotid and left subclavian arteries, the left vagus
and left phrenic nerves, and the pleura

Blood
and
nerve
Supply
The sensory nerve supply is from the vagi and the

recurrent laryngeal nerves

Sympathetic nerves supply the trachealis muscle
The upper two thirds are supplied by the inferior
thyroid arteries
The lower third is supplied by the bronchial arteries

Lymph Drainage
The lymph drains into the pretracheal and

paratracheal lymph nodes and the deep

cervical nodes

Bronchi
The trachea bifurcates behind the arch of the

aorta into the right and left principal (primary,

or main) bronchi
The bronchi divide into several million

terminal bronchioles that terminate in one or

more respiratory bronchioles

Bronchi
Each respiratory bronchiole divides into 2 to

11 alveolar ducts that enter the alveolar sacs

The alveoli arise from the walls of the sacs as

diverticula

Right Principal Bronchus

Is wider, shorter, and more vertical than the

left
Is about 1 in. (2.5 cm) long
Before entering the hilum of the right lung, it
gives off the superior lobar bronchu
On entering the hilum, it divides into a middle
and an inferior lobar bronchus

Left Principal Bronchus

Is narrower, longer, and more horizontal than

the right and is about 2 in. (5 cm) long

It passes to the left below the arch of the
aorta and in front of the esophagus
On entering the hilum of the left lung, the
principal bronchus divides into a superior and
an inferior lobar bronchus

Bronchopulmonary
Segment
The bronchopulmonary segments are the

anatomic, functional, and surgical units of the

lungs

Each lobar (secondary) bronchus gives off

branches called segmental (tertiary) bronchi

Each segmental bronchus passes to a

structurally and functionally independent unit

of a lung lobe called a bronchopulmonary
segment, surrounded by connective tissue

Bronchopulmonary
Segment
The segmental bronchus is accompanied by a
branch of the pulmonary artery
Each segment has its own lymphatic vessels

and autonomic nerve supply

On entering a bronchopulmonary segment,

each segmental bronchus divides repeatedly

Bronchopulmonary
Segment
As the bronchi become smaller, the U-shaped
bars of cartilage found in the trachea are
gradually replaced by irregular plates of
cartilage
The smallest bronchi divide and give rise to

bronchioles, which are less than 1 mm in

diameter

Bronchopulmonary
Segment
Bronchioles possess no cartilage in their walls and
are lined with columnar ciliated epithelium

The submucosa possesses a complete layer of

circularly arranged smooth muscle fibers

The bronchioles then divide and give rise to
terminal bronchioles which show delicate
outpouchings from their walls

Gaseous exchange between blood and air takes

place in the walls of these outpouchings, which

explains the name respiratory bronchiole

Bronchopulmonary
Segment
The diameter of a respiratory bronchiole is about 0.5

mm
The respiratory bronchioles end by branching into
alveolar ducts, which lead into tubular passages with
numerous thin-walled outpouchings called alveolar sacs
The alveolar sacs consist of several alveoli opening into
a single chamber
Each alveolus is surrounded by a rich network of blood
capillaries
Gaseous exchange takes place between the air in the
alveolar lumen through the alveolar wall into the blood
within the surrounding capillaries

Characteristics of
Bronchopulmonary
Segment
It is a subdivision of a lung lobe
It is pyramid shaped, with its apex toward the

lung root
It is surrounded by connective tissue
It has a segmental bronchus, a segmental
artery, lymph vessels, and autonomic nerves
The segmental vein lies in the connective tissue
between adjacent bronchopulmonary segments
Because it is a structural unit, a diseased
segment can be removed surgically

LOKASI PARU-PARU DI
RONGGA DADA

Lungs

Two lungs are soft, spongy and elastic

In the child, they are pink, but with age, they

become dark and mottled because of the

inhalation of dust particles
These particles are trapped in the phagocytes
of the lung
The lungs are situated so that one lies on
each side of the mediastinum

Lungs

Two lungs are separated from each other by

the heart and great vessels and other

structures in the mediastinum
Each lung is conical, covered with visceral

pleura and suspended free in its own pleural

cavity
Attached to the mediastinum only by its root

Lungs
A blunt apex projects upward into the neck for

about 1 in. (2.5 cm) above the clavicle

A concave base that sits on the diaphragm

A convex costal surface, which corresponds to

the concave chest wall

A concave mediastinal surface, which is molded

to the pericardium and other mediastinal

structures

Lungs
Hilum is a depression in which the bronchi,

vessels, and nerves that form the root enter and

leave the lung
The anterior border is thin and overlaps the heart
It is here on the left lung that the cardiac notch is

found
The posterior border is thick and lies beside the

vertebral column

Lobes and Fissures of Rt.

Lung
The right lung is slightly larger than the left
Divided by the oblique and horizontal fissures

into three lobes: upper, middle, and lower

The oblique fissure runs from the inferior

border upward and backward across the

medial and costal surfaces until it cuts the
posterior border about 2.5 in. (6.25 cm) below
the apex

Lobes and Fissures of Rt.

Lung
The left lung is divided by a similar oblique
fissure into two lobes: upper and lower
There is no horizontal fissure in the left lung

Right lung
Superior lobe: Apical, posterior, anterior
Middle lobe: Lateral, medial
Inferior lobe: Superior (apical), medial basal,

anterior basal, lateral basal, posterior basal

Left lung
Superior lobe: Apical, posterior, anterior,

superior lingular, inferior lingular

Inferior lobe: Superior (apical), medial basal,

anterior basal, lateral basal, posterior basal

Blood Supply
The bronchi and the connective tissue of the lung

receive their blood supply from the bronchial arteries,

which are branches of the descending aorta
The bronchial veins communicate with the pulmonary
veins and drain into the azygos and hemiazygos veins
The alveoli receive deoxygenated blood from the
terminal branches of the pulmonary arteries
The oxygenated blood leaving the alveolar capillaries

drains into the tributaries of the pulmonary veins

Two pulmonary veins leave each lung root to empty

into the left atrium of the heart

Lymph Drainage
The lymph vessels originate in superficial and

deep plexuses
They are not present in the alveolar walls
The superficial (subpleural) plexus lies

beneath the visceral pleura and drains over

the surface of the lung toward the hilum,
where the lymph vessels enter the
bronchopulmonary nodes

Lymph Drainage
The deep plexus travels to the hilum of the

lung and enters the bronchopulmonary nodes

All the lymph from the lung leaves the hilum

and drains into the tracheobronchial nodes

and then into the bronchomediastinal lymph
trunks

Nerve
Supply
At the root
of each lung is a pulmonary
plexus composed of efferent and afferent
autonomic nerve fibers
The plexus is formed from branches of the
sympathetic trunk and receives
parasympathetic fibers from the vagus nerve
The sympathetic efferent fibers produce
bronchodilatation and vasoconstriction
The parasympathetic efferent fibers produce
bronchoconstriction, vasodilatation, and
increased glandular secretion

Location
The pleurae and lungs lie on either side of the

mediastinum within the chest cavity

Each pleura has two parts:
Parietal layer
Visceral layer

Parietal
Layer

It lines the thoracic wall

Covers the thoracic surface of the diaphragm

and the lateral aspect of the mediastinum

Extends into the root of the neck to line the

undersurface of the suprapleural membrane

at the thoracic outlet

Visceral Layer
It completely covers the outer surfaces of the

lungs
Extends into the depths of the interlobar

fissures

Pleural Cuff
The two layers continuous with one another

by means of a cuff of pleura

This cuff surrounds the structures entering

and leaving the lung at the hilum of each lung

Pleural cuff hangs down as a loose fold called

the pulmonary ligament

Pleural Cavity

The parietal and visceral layers are

separated from one another by a slitlike

space called pleural cavity
Clinicians use the term pleural space instead
of the anatomic term pleural cavity
Pleural cavity contains thin film of tissue
fluid called pleural fluid
Fluid permits the two layers to move on
each other with the minimum of friction

Cervical Pleura

Parietal pleura is divided into the region in

which it lies or the surface that it covers

The cervical pleura extends up into the neck
It lines the undersurface of the suprapleural
membrane
It reaches a level 1 to 1.5 in. (2.5 to 4 cm)
above the medial third of the clavicle

Costal Pleura
It lines the inner surfaces of:
The ribs
The costal cartilages
The intercostal spaces
The sides of the vertebral bodies
The back of the sternum

Diaphragmatic Pleura
It covers the thoracic surface of the

diaphragm
In quiet respiration, the costal and

diaphragmatic pleurae are in apposition to

each other below the lower border of the lung
Costal and diaphragmatic pleurae separate in

deep inspiration

Costodiaphragmatic
Recess
The lower area of the pleural cavity into which
the lung expands on inspiration is referred to
as the costodiaphragmatic recess

Mediastinal
Pleura
It covers and forms the lateral boundary of the
mediastinum

It is reflected as a cuff around the vessels and

bronchi at the hilum of the lung

Then continuous with the visceral pleura

Each lung lies free except at the hilum
it is attached to the blood vessels and bronchi that

constitute the lung root

Costodiaphragmatic
Are slitlike spaces between the costal and diaphragmatic parietal
recesses
pleurae

Separated only by a capillary layer of pleural fluid

During inspiration, the lower margins of the lungs descend into the

recesses

During expiration, the lower margins of the lungs ascend so that

the costal and diaphragmatic pleurae come together again

Are situated along the anterior margins of the pleura

They are slitlike spaces between the costal and the mediastinal

parietal pleurae

Separated by a capillary layer of pleural fluid

During inspiration and expiration, the anterior borders of the lungs

slide in and out of the recesses

Costomediastinal
Recesses
Are situated along the anterior margins of the
pleura
They are slitlike spaces between the costal and

the mediastinal parietal pleurae

Separated by a capillary layer of pleural fluid
During inspiration and expiration, the anterior

borders of the lungs slide in and out of the

recesses

Nerve Supply

The parietal pleura is sensitive to pain, temperature,

touch and pressure, and is supplied as follows:

The costal pleura is segmentally supplied by the

intercostal nerves
The mediastinal pleura is supplied by the phrenic

nerve
The diaphragmatic pleura is supplied over the domes

by the phrenic nerve and around the periphery by the

lower six intercostal nerves

Nerve Supply
The visceral pleura covering the lungs is

sensitive to stretch
It is insensitive to common sensations such as

pain and touch

It receives an autonomic nerve supply from

the pulmonary plexus

Pleural
Fluid
The pleural space normally contains 5 to 10 ml of
clear fluid
It lubricates the opposing surfaces of the visceral

and parietal pleurae during respiration

The formation of the fluid results from hydrostatic

and osmotic pressures between the capillaries

The pleural fluid is normally absorbed into the

capillaries of the visceral pleura

The Muscles of
Breathing
Inspiratory muscles

Diaphragm

External
Intercostalis

Sternocleidomastodeus

Scalenus
Expiratory muscles

Internal
Intercostalis

Abdominal
Muscles

INSPIRASI
1.
2.

Otot utama:
Diafragma n phrenicus
(Cervical 3,4,5)
m. intercotalis externus n
intercosta

Otot tambahan
Jika inspirasi dalam
1.
m. Sternocleido mastoideus
mengangkat sternum ke atas
2.
m. Scalenus mengangkat
costa 1,2
3.
M.serratus anterior
Otot-otot di abdomen : a.l m
rectus abdominis menarik
ke arah bawah pd costa bag
bawah
M. Intercostalis internus

EKSPIRASI

Pengaturan respirasi:
Area Respirasi pada Batang Otak
Pusat respirasi medulla
Grup Dorsal stimulasi

diaphragma inspirasi
Grup Ventral stimulasi m.
intercostal internus dan m.
abdominal ekpirasi kuat
Grup Respirasi Pontine
(pneumotaxic)
Terlibat dalam perubahan
inspirasi dan ekspirasi
terutama mengatur
kecepatan dan dalamnya
inspirasi

Modifikasi Ventilasi

Pusat napas

Memulai awal rata-rata napas

Terletak pd formasio retikularis

medulla oblongata (MO)

Kemoreseptor
Zat pengatur utama : CO2
Perubahan pH menstimulasi
area kemo-sensitif
kecepatan dan dalamnya
pernapasan
Kadar O2 darah berefek pada
respirasi jika jumlah menurun
50% dari normal.
Kemoreseptor pusat
terletak di MO
Kemoreseptor tepi terletak
di badan aorta dan badan
carotis
Sistem Cerebral dan limbik
Respirasi dapat dikontrol
secara volunter dan
dimodifikasi dengan emosi

Medullary Respiratory
Centers

Chapter 22, Respiratory System

Figure 22.25
151

Selamat Belajar