Chapter 3 Respiratory System

The respiratory
system means organs
for exchange of gaseous
substance between the
air and the blood
stream. The respiratory
system includes two
parts: conducting and
respiratory. The
conducting part, or air
passages, consists of
the nose, pharynx,
larynx, trachea and
principal bronchi
(Fig.3-1). The right
and left lungs are the
essential respiratory
organs (respiratory
part). The primary function of this system is to supply the body with
oxygen and to get rid of excess carbon dioxide resulting from cell
metabolism.

Section 1 Nose

Thenose is not only the first part of respiratory tract but also an
organ of smell and phonation; it includes external nose, nasal
cavity and paranasal sinuses.

I. External Nose

The external nose is shaped like a pyramid. It has a root, a back,

and an apex of nose, twoalae nasi and two nares, which is separated
from each other by a median septum. The external nose is composed of bones
and cartilages covered with skin.

II. Nasal Cavity

It is divided into right and left halves by the nasal septum.

The right and left nasal cavitiesopen in front through nares and
communicate with the pharynx behind through the choanae. The nasal mucous
membrane lines the nasal cavity and adheres intimately to the
perichondrium.
I) Nasal vestibule The anterior portion of the nasal
cavity is called the nasal vestibule,which is just inside the alae nasi
and posteriorly limited by the limen nasi (Fig.3-2). It is lined by skin
containing hairs and sebaceous glands.
II)
Proper nasal
cavity
Each cavity
has a roof, a
floor, a
medial wall
and a lateral
wall. The roof
is formed by
the nasal
bones, cribri
form plateof
the ethmoid bone. The floor is formed by the upper surface of the hard
palate in front (two-thirds) and the soft palate behind (one-third).
There are the superior, middle and inferior nasal conchae, which project
from the lateral wall up downward and subdivide the nasal cavity into
superior, middle and inferior nasal meatuses located below corresponding
concha. Above and behind the superior nasal concha there is
the sphenoethmoidal recess (Fig.3-2).

The inferior nasal meatus receives the termination of

the nasolacrimal duct. The middle nasal meatus, superior nasal meatus and
sphenoethmoidal recess receive the openings of paranasal sinuses.
The nasal mucous membrane lines entirely the nasal cavity, it
contains many mucous glands and blood vessels, so that the inspired air can
be warmed and humidified. The olfactory receptors lie in the mucous
membrane lining the upper portion of the nasal cavity (above the level of
superior nasal concha) where is called the olfactory region (Fig. 3-2).
The rest of medial and lateral nasal wall covered by a thick glandular and
vascular mucous membrane constitute the respiratory region.
Ⅲ. Paranasal ( or Accessory ) Sinuses
In the bones around the nasal cavity there are some air cells
called paranasal sinuses, they are the frontal sinus, maxillary
sinus, ethmoidal sinus and sphenoidal sinus. All these sinuses vary in
size, open into the nasal cavity and are lined by mucous membrane, which is
continuous with that of the nasal cavity. So the infection of nasal cavity
may spread to the paranasal sinuses, resulting in sinusitis (Fig.3-3, 4).
I) fron
tal
sinuses
They lie in
the frontal
bone, and
drain into the
middle nasal
meatuses of the nose.
II) Maxillary sinuses They are large cavities in the bodies
of the maxilla. They are drained by one of more openings into the middle
nasal meatuses.
Ⅲ) Ethmoidal sinuses They are composed of a lot of small
irregular spaces within the labyrinth of ethmoid bone and can be divided
into anterior, middle and posterior groups. The anterior and middle groups
of the ethmoidal sinuses open into the middle nasal meatuses. The posterior
group empties into the superior nasal meatuses.
Ⅳ) Sphenoidal sinuses They are contained within the body of
the sphenoid bone and divided into right and left parts by a bony septum.
They open into the sphenoethmoidal recesses.
All sinuses are small at birth and usually enlarge to a certain
extent during childhood and adolescence.
Section 2 Pharynx
The pharynx is the common channel for both alimentary
(or digestive) and respiratorysystems, the food and air pathways cross
each other in pharynx (Fig.3-1). Further description of pharynx, see the
alimentary system.

Section 3 Larynx

The larynx is a part of respiratory passage as well as the organ

of phonation. It lies in the neck in front of the fourth, fifth and sixth
cervical vertebrae. In the adult, it is about 4.5 cm long. Above, it is
closely related to the hyoid bone and the root of tongue. Below, it
extends to thetrachea at the level of the sixth cervical vertebra.
Posteriorly it communicates with the laryngeal part of pharynx.
The larynx consists of a framework of cartilages that are connected together by
ligaments, membranes and joints. It also has a number of small muscles, which move the
cartilages. Some of them are important in phonation and in closing the aperture of larynx
during swallowing. The larynx is lined with mucous membrane, which is continuous with that
of pharynx above and that of trachea below.

I. Laryngeal Cartilages (Figs.3-5, 6)

I) Thyroid cartilage It is the largest and comprises two

laminae, which are fused in front but divergent behind. At the fused part
there is a median elevation termed the laryngeal prominence (or Adam ’ s
apple). There is the superior thyroid notch at the upper border of the
fusing part. The posterior border of each lamina is prolonged upward and
downward forming the superior and inferior cornu. The superior cornu is
connected to the greater horn of hyoid bone while theinferior
cornu joins to the cricoid cartilage.
Ⅱ ) Cricoid cartilage It is ring-shaped and composed of
a lamina of cricoid cartilagebehind, a narrow arch of cricoid
cartilage in front. The lamina articulates with the arytenoid cartilages.
The cricoid cartilage is at the level of the sixth cervical vertebra and
its lower border marks the ends of pharynx and larynx, and hence the
commencement of the esophagus and trachea.
Ⅲ ) Arytenoid cartilages They are two small pyramids and
articulate with the superoposterior border of the cricoid cartilage. Each
presents an apex above and a base below, the base sends a vocal
process forward for attachment of the vocal ligament and a muscular
processlateral
ly for
muscularattach
ment.
Ⅳ )
Epiglottic
cartilage I
t is a leaf-
shaped elasti
c cartilage.
Its upper end
is broad and
forms the
anterior
portion of the
aperture of
larynx. Its
lower end is
attached to
the back of
thyroid
cartilage. This
cartilage
covered by
mucous membrane
forms
the epiglottis.
The lower part
of posterior
surface of the epiglottis projects backward and forms the epiglottic
tubercle.

Ⅱ. Laryngeal Joints (Figs.3-5, 6)

I) The cricothyroid joint It is located between the inferior cornu

of the thyroid cartilage and the lateral surface of cricoid cartilage. It
can be rotated around the coronal axis, so that the length and the
tenseness of the vocal fold may be changed.
Ⅱ ) The cricoarytenoid joint It is located between the lamina of
cricoid cartilage and the base of the arytenoid cartilage. When the
arytenoid cartilage glide and rotate on the cricoid, apposition and
abduction of vocal folds can be occurred.

Ⅲ. Laryngeal Ligaments and Membranes

I) Thyrohyoid membrane It is located between the superior border

of the thyroid cartilage and the hyoid bone (Figs.3-5, 6).
Ⅱ) Conus elasticus It extends upward from the cricoid cartilage
to the arytenoid cartilages and the posterior surface of the thyroid
cartilage. Its superior border is free and forms the vocal
ligament, which extends from the posterior surface of thyroid to the vocal
process of arytenoid cartilage.

Ⅲ ) Quadrangular membranes They are extend between the lateral

border of the epiglottic cartilage and the arytenoid cartilage. They are
quadrangle at lateral view. Their lower borders are free and form
the vestibular ligaments.
IV. Muscles of Larynx (Fig.3-7)

They are skeletal muscle, which serve principally to open and close
the glottis and regulate the tension of the vocal fold. According to the
function, these muscles can be divided into four groups:
I) The posterior cricoarytenoid It can open the glottis.
Ⅱ ) The transverse arytenoids and the oblique arytenoids It can
close the glottis.
Ⅲ ) Cricothyroid and the posterior cricoarytenoid It can tense
and lengthen the vocal fold.
IV) Thyroarytehoid It can relax and shorten the vocal fold.

V. Laryngeal Cavity

It is divided into three parts (Fig.3-8): ① the laryngeal vestibule, extending from
the aperture (inlet) of larynx to the vestibular folds; ②the intermediate cavity of larynx,
the narrowest portion between the level of rima vestibuli and the fissure of glottis; ③and
the infraglottic cavity, lying below the vocal folds and extending downward to the lower
border of the cricoid cartilage.
The vestibular folds extend anteroposteriorly on either side of the
larynx and enclose between them a slit, the rima vestibuli. The ventricles
of larynx are the lateral expansions of the laryngeal cavity between the
vestibular and the vocal folds.
The vocal folds are two folds of mucous membrane, which are closely bound to the
underlying vocal ligament. The folds are pearly white in the living body because of absence
of submucous layer and blood vessels. The slit between the two vocal folds is the fissure of
glottis. The glottisconsists of the vocal folds and the slit between them. Apposition of the
vocal folds is necessary for normal phonation; similarly their abduction is necessary to widen
the passage and allow utmost in respiratory activity.

Section 4 The Trachea

The trachea is the passage for air, about 9.8~10.6 cm in length and 1.5~2.0 cm in
diameter in the adult (Fig.3-9). It is located in the midline of neck and upper thorax, and in
front of theesophagus. It extends from the lower border of the cricoid cartilage at the level
of sixth cervical vertebra to the level of the
sternal angle (corresponding to the lower border of the fourth thoracic vertebra),
where it divides into the right and left principal bronchi.
The wall of
trachea is
composed of
tracheal cartilage,
smooth muscle,
and connective
tissue and lined
with
the pseudostratif
ied ciliated
columnar
epithelium.
About 15 ~ 30 C-shaped rings of hyaline cartilage keep the lumen of the trachea open and
support it except posteriorly where it is closed by the tracheal muscle and lies against the
anterior surface of the esophagus. The posterior wall of trachea permits the esophagus to
expand during swallowing. The carina of trachea is a sagittal semilunar ridge inside
the bifurcation of trachea, which can be seen through bronchoscope and used as a guide to
the bronchi.

Section 5 Bronchi

The trachea terminates at the level of fourth thoracic vertebra and

divides into the right and left principal bronchi (Figs.3-9, 10).
The right principal bronchus is about 2~3cm long and is shorter,
wider and more vertical in position than the left, thus foreign objects
from the trachea usually pass to the right side. The left principal
bronchus is smaller in caliber but about twice as long as the right (5cm).
The bronchi are similar in structure to the trachea.
As entering the lungs, the principal bronchus branches to form lobar
bronchi, which enter the lobes of lung. The lobar bronchi continue to
branch, forming smaller bronchi called the segmental bronchi, which are
subdivided into the bronchioles. The bronchioles ramify into smaller tubes
called the terminal bronchioles. These branches resemble a tree and are
called the bronchial tree(Fig.3-9).

Section 6 Lungs

The lungs (Figs.3-10, 11) are the essential organs of respiration. They are placed on
either side within the thorax and are separated from each other by the heart and other contents
of mediastinum. Healthy lungs always contain some air so they may float in water. In the
newborn, which has not breath, the lungs will not float in water. At birth the lungs are
pinkish-white, but they turn dark grey with age and become almost black due to carbonaceous
deposits.

I. External Features of Lungs

The right lung is shorter than the left one because the right dome of the diaphragm is
higher, and it is wider because the heart and pericardium bulge more to the left. Each lung is
conical and has an apex, a base, two surfaces and three borders.
The apex of lung is rounded and extends to about 2~3 cm above the
level of the medial one-third of the clavicle.
 The base of
lung is concave
and related to
the diaphragm,
which separates
the right lung
from the liver
and the left
lung from the
stomach, spleen
and liver, so
the base of lung
is also called
thediaphragmatic
surface.
The lung
possesses a
costal surface
and a medial
surface. The costal surface is smooth, convex and related to the inner
surface of the ribs, costal cartilages and intercostal spaces. The medial
surface is related to the mediastinum, so it is also called
the mediastinal surface. Near the center of this surface, there is a
depression called the hilum of lung. The structures entering and emerging
the hilum is called the root of lung, which is short broad pedicle and
consists of the principal bronchi, pulmonary artery and veins, nerves,
bronchial vessels, lymphatics and lymph nodes.

The borders of lung include anterior, posterior and inferior borders. The anterior border is
thin and sharp, having a deep notch at the fourth and fifth intercostal spaces in the left lung,
called thecardiac notch of left lung, beneath which is the lingula of left lung. The posterior
border is round, the inferior border is also sharp and separates the base of lung from the costal
and medial surfaces.

Ⅱ. Lobes and Segments of Lungs

 The left lung is divided into superior and inferior lobes by
an oblique fissure. The right lung is divided into superior, middle and
inferior lobes by a
horizontal fissure of
right lung and an
oblique fissure. The
lobes of lung are
subdivided into smaller
units called
the bronchopulmonary
segments (Figs.3-10,
11, 12). Each lung has
ten segments. The names
of the segments are as
follows:
Right
lung

Left lung
Superior
lobe Superior lobe
Apical segment (S1 ) Apical segment (S1 )
Posterior segment (S2) Posterior segment (S2)
Anterior segment (S3) Anterior segment (S3)
Superior lingual segment (S4)
Inferior lingual segment (S5)
Middle lobe
Lateral segment (S4)
Medial segment (S5)
Inferior lobe Inferior lobe
Superior segment (S6) Superior segment (S6)
Medial basal segment (S7) Medial basal segment (S7)
Anterior basal segment (S8) Anterior basal segment (S8)
Lateral basal segment (S9) Lateral basal segment (S9)
Posterior basal segment (S10) Posterior basal segment (S10)

In the left lung, the apical and posterior segments of superior lobe, and the medial basal
and anterior basal segments of inferior lobe are constantly united together into apicoposterior
segment and medioanterior basal segment respectively.

Section 7 The Pleura

The pleura (Fig.3-13) is a thin, glistening, slippery serous

membrane that lines the inner surface of the thorax (parietal pleura) and
the surfaces of lungs (visceral pleura).
I. Parietal Pleura

The serous membrane lining the inner surface of chest wall is called
the parietal pleura. According to regions the parietal pleura is divided
into four portions: the costal pleura, thediaphragmatic pleura,
the mediastinal pleura and the cupula of pleura.

II. Visceral Pleura

The pleura is reflected from the mediastinum to the surface of lung,

where it is called visceral pleura coveting the lungs and extending into
the fissures of lung. Below the root of lung the mediastinal pleura extends
as a double layer to the mediastinal surface of lung. This double layer is
called the pulmonary ligament.

Ⅲ. Pleural Cavity and Recesses

The potential space

between the parietal and
visceral pleurae is
called thepleural cavity,
containing a film of
serous fluid. Two pleural
cavities are separated
from each other by
the mediastinum. In deep
breathing the inferior
border of the lung does
not completely extend the
inferior margin of
the pleural reflection,
so that the costal and
diaphragmatic pleurae are
in contact with each other here, the intervening narrow slit termed
thecostodiaphragmatic recess. In quiet respiration the lower limit of lung
is about 5cm above the lower limit of the pleura. A similar condition
present behind the sternum, between the costal and mediastinal pleurae it
is termed the costomediastinal recess.

IV. Projection of the Inferior Margins of Lungs and Pleurae

On the surface of the body, the projection of the inferior margins of

the lungs and costodiaphragmatic lines of reflection of pleurae are shown
in table 1 and Fig.3-14:
Table 1 the inferior margins of lungs and costodiaphragmatic lines of
reflection of pleurae
Midclavicular Midaxillary Posterior
median
Line line
line
Inferior
margin
6th rib
8t
h rib
At
the level T10
of
lungs

spin
al process

costodiaphragmatic
At the level T12
lines of
reflection 8th rib 10th rib spinal
process
of pleurae
 Section 8 Mediastinum

The mediastinum
is generally defined
as the interval
between the right and
left pleural sacs. It
extends from the
sternum in front to
vertebral column
behind, and from the
thoracic inlet above
to
the diaphragm below.
Its lateral wall is
the mediastinal pleura
of both sides.
The mediastinum is divided into superior and inferior mediastina by the
line drawn horizontally from the sternal angle to the lower border of 4th
thoracic vertebra. The inferior mediastinum is subdivided into three parts
:
①an anterior mediastinum in front of pericardium,
②a middle mediastinum containing the pericardium with heart and great
vessels,
③ the posterior mediastinum between pericardium and vertebral column
(Fig.3-15) . The posterior mediastinum extends to the lower border of the
8th thoracic vertebra, its main contents are the bronchi, esophagus, vagus
and phrenic
nerves, thoracic
duct etc.

THE MAIN CONTENTS:

The organs of
respiratory system are
outlined except the
pharynx is described in
other digestive chapter.
This chapter is
put emphasis on position
and opening of the
paranasal sinuses,
structure and subdivision
of the trachea or
principal bronchi,
definition and landmark of the pleural cavity or recesses.

Sistem pernapasan berarti organ untuk pertukaran zat gas antara udara dan aliran
darah. Sistem pernapasan meliputi dua bagian: budidaya dan pernapasan. Bagian, atau
saluran udara melakukan, terdiri dari hidung, faring, laring, trakea dan bronkus utama
(Fig.3-1). Paru-paru kanan dan kiri adalah organ pernapasan penting (bagian
pernapasan). Fungsi utama dari sistem ini adalah untuk memasok tubuh dengan
oksigen dan menyingkirkan kelebihan karbon dioksida yang dihasilkan dari
metabolisme sel.

Bagian hidung
Hidung tidak hanya bagian pertama dari saluran pernapasan, tetapi juga organ
penciuman dan fonasi; itu termasuk hidung eksternal, rongga hidung dan sinus
paranasal. Hidung I. Eksternal Hidung eksternal berbentuk seperti piramida.
Memiliki akar, kembali, dan puncak hidung, dua alae nasi dan dua nares, yang
terpisah satu sama lain oleh septum median. Hidung eksternal terdiri dari tulang dan
tulang rawan ditutupi dengan kulit. II. Rongga hidung Hal ini dibagi menjadi kanan
dan kiri bagian oleh septum hidung. Rongga hidung kanan dan kiri terbuka di depan
melalui lubang hidung dan berkomunikasi dengan faring belakang melalui choanae
tersebut. Garis selaput lendir hidung rongga hidung dan mematuhi erat untuk
perichondrium tersebut.

I) Nasal ruang depan Bagian anterior dari rongga hidung disebut vestibulum
hidung, yang hanya di dalam nasi alae dan posterior dibatasi oleh nasi Limen
(Fig.3-2). Hal ini dilapisi oleh kulit yang mengandung rambut dan kelenjar
sebaceous. II) Proper rongga hidung Setiap rongga memiliki atap, lantai,
dinding medial dan dinding lateral. Atap dibentuk oleh tulang hidung, berkisi
sepiring tulang ethmoid. lantai dibentuk oleh permukaan atas palatum keras di
depan (dua pertiga) dan langit-langit lunak belakang (sepertiga). Ada yang
superior, menengah dan rendah conchae hidung, yang proyek dari dinding
lateral sampai ke bawah dan membagi rongga hidung ke superior, menengah
dan rendah meatuses hidung terletak di bawah sesuai concha. Di atas dan di
belakang concha nasal superior ada reses sphenoethmoidal (Fig.3-2).

Meatus hidung rendah menerima penghentian duktus nasolakrimalis. Meatus nasal

tengah, meatus nasal superior dan istirahat sphenoethmoidal menerima bukaan sinus
paranasal. Hidung garis selaput lendir seluruhnya rongga hidung, mengandung
banyak kelenjar lendir dan pembuluh darah, sehingga udara terinspirasi bisa
dihangatkan dan dilembabkan. Reseptor penciuman terletak pada selaput lendir yang
melapisi bagian atas rongga hidung (atas tingkat concha nasal superior) di mana
disebut wilayah penciuman (Gbr. 3-2). Sisa medial dan dinding lateral hidung tertutup
oleh kelenjar dan pembuluh darah selaput lendir tebal merupakan wilayah pernapasan.
Ⅲ. Paranasal (atau Aksesori) Sinus Pada tulang sekitar rongga hidung ada beberapa
sel udara yang disebut sinus paranasal, mereka adalah sinus frontal, sinus maksilaris,
sinus etmoidalis dan sinus sfenoidalis. Semua sinus ini bervariasi dalam ukuran,
terbuka ke dalam rongga hidung dan dilapisi oleh selaput lendir, yang terus-menerus
dengan yang dari rongga hidung. Jadi infeksi rongga hidung dapat menyebar ke sinus
paranasal, yang mengakibatkan sinusitis (Fig.3-3, 4).