ANATOMY AND PHYSIOLOGY

OF THE AIRWAY

CONTINUING PROFESSIONAL DEVELOPMENT

ANESTHESIOLOGY AND REANIMATION
INTRODUCTION

● A person can live for weeks without food and a few days
without water but only a few minutes without oxygen.

● Every cell in the body needs a constant supply of

oxygen to produce energy to grow, repair or replace itself,
and maintain vital functions.

● The oxygen must be provided to the cells in a way that

they can use.

● It must be brought into the body as air that is cleaned,

cooled or heated, humidified, and delivered in the right
amounts.
 THE BODY’S NEED FOR OXYGEN

• Living tissue must have oxygen to survive.

• Brain death in humans occurs within 6 to 10 minutes of
tissue anoxia.
• Rapid and safe airway control is paramount to the
successful management of critically ill and injured
patients.
AIRWAY ANATOMY
Upper airway structures include the:
● Mouth
● Nose
● Pharynx (throat)
- Oropharynx
- Nasopharynx
- Laryngopharynx
● Larynx (voice box)
Vocal cords
The lower airway structures include the:
● Trachea (windpipe)
● Bronchi (airways)
● Bronchioles
● Terminal bronchioles
● Alveoli
The upper airway functions to warm, filter, and humidify the air
before it enters the lower airway

The functions of the lower airway include air conduction, filtration,

warming, humidification, and removal of foreign particles.

Respiration occurs in the respiratory bronchioles of the lower

airway
RESPIRATORY TRACTS AND STRUCTURE
● Mouth
● Nose
● Pharynx
- Oropharynx
- Nasopharynx
- Laryngopharynx conducting zone
● Larynx - cavities and tubes
● Trachea - anatomic dead space
● Bronchi
● Bronchioles
● Terminal bronchioles
● Respiratory bronchioles
● Alveolar ducts respiratory zone
● Alveolar sacs
● Alveoli
EXTERNAL NASAL
STRUCTURES

BONY FRAMEWORK
frontal bone
nasal bone
maxilla

CARTILAGINEUS
FRAMEWORK
lateral nasal cartilages
septal catrilages
alar cartilages

external nares (nostril)

fibrous connective and
adipose tissue
NOSE
AND NASAL CAVITIES superior
concha
frontal sphenoid
sinus sinus
● Olfactory epithelium for
sense of smell middle
concha
internal
● Pseudostratified ciliated nares
columnar with goblet cells
inferior
lines nasal cavity concha

● Nose hairs at the entrance external

nares
to the nose trap large inhaled
particles.

● Nasal concha provide air turbulence and

promotes filtration and extra time for warming and humidifying air
PARANASAL SINUSES frontal sphenoid
sinus sinus

● to reduce the weight of the

skull,
● to produce mucus
● to influence voice quality by
acting as resonating chambers.
 hard palate
PHARYNX (THROAT)
external nares internal nares
nasal cavity

● connects nasal cavity with

larynx (± 5 inch) Soft
palate

uvula
● extends from the base of
the skull to 6th cervical pharynx
vertebrae

● serves both the respiratory

and digestive systems
epiglottis

● three regions according to glottis

location:
- nasopharynx
- oropharynx
trachea
- laryngopharynx
(hypopharynx).
 hard palate
NASO-PHARYNX
Soft
nasal cavity
palate
● from choanae to soft
palate
naso
pharynx
● openings of auditory
(Eustachian) tubes from
middle ear cavity uvula

● adenoids or
pharyngeal tonsil in roof
epiglottis

● area above where glottis

food enters thus towards

the nasal cavity

● during swallowing, uvula projects upwards trachea

closing off passage to the nasal cavity

 hard palate

Soft
OROPHARYNX nasal cavity
palate

uvula
● the portion of the
pharynx that is posterior
oro
to the oral cavity. pharynx

● extends from soft

palate to the epiglottis
epiglottis

● area where both food glottis

and air passes

trachea
 hard palate
LARYNGO-PHARYNX
Soft
nasal cavity
palate
● posterior to the epiglottis and
extends to the larynx uvula

● at larynx, food and air take

different passageways

laryngo
pharynx

epiglottis

glottis

Histology of the pharynx changes from

pseudostratified epithelium to stratified squamous
epithelium when going from naso-to oro-to laryngo- trachea
pharynx
LARYNX (VOICE BOX)
Epiglottis
Hyoid bone
Thyrohyoid membrane
Corniculate cartilage
Thyroid cartilage
(Adam’s apple)
Arytenoid cartilage
Crycothyroid ligament
Cricoid cartilage
Cricotracheal ligament
Thyroid gland
Parathyroid gland
Tracheal cartilage
BRONCHIALE TREE

The trachea and bronchi have

supporting cartilage to keep
airways open

Bronchiole walls contain

more smooth muscle,
a feature used in airflow
regulation
THE RESPIRATORY ZONE

● contains alveoli,
tiny walled sacs where
gas exchange occurs

● alveolar ducts end in

cluster of alveoli called
alveolar sacs

photomicrograph
 ALVEOLI AND PULMONARY CAPILLARIES
● The pulmonary artery carry
blood which is low in oxygen
from the heart to the lungs

● These blood vessel branch

repeatedly, forming dense
network of capillaries that
completely surround each
alveolus

● O2 and CO2 are

exchanged between the
aveoli and pulmonary
capillaries.

● Blood leaves the

capillaries via the pulmonary
vein which transport
oxygenated blood back to
the heart
alveolar macrophage

simple squamous epithelium

(type 1 cell)
surfactan secreting cell
(type 2 cell)

capillary
STRUCTURE OF THE RESPIRATORY
MEMBRANE

O2
CO2
O2

O2

CO2
VENTILATION AND RESPIRATION
IMPORTANT DEFINITIONS

Ventilation
the process of moving a volume of
gas in and out of the lungs

Respiration
● gas exchange (O2/CO2) across the
alveolar - capillary membrane
(external)
● or at the tissue/cellular level
(internal)
BOYLE’S LAW
relationship between pressure and volume

volume pressure volume pressure

pressure

volume
volume pressure
INSPIRATION

muscle contraction
EXPIRATION

Muscle relaxation
INTRAPULMONARY (INTRAALVEOLAR) PRESSURE
CHANGES
Intrapulmonary (intraalveolar) pressure is the pressure within the alveoli.
Between breaths, it equals atmospheric pressure (760 mmHg)
INTRAPULMONARY (INTRAALVEOLAR) PRESSURE
CHANGES
 INTRAPLEURAL PRESSURE

the pressure within the pleural cavity, always negatiive, and acts like a
suction to keep the lungs inflated

the negative intrapleural

pressure is due to:

• Surface tension of alveolar

fluid
• Elasticity of lungs
• Elasticity of thoracic wall
the negative intrapleural pressure is due to….

SURFACE TENSION OF ALVEOLAR FLUID

The surface tension of the alveolar

fluid tends to pull each of the alveoli
inward and therefore pulls the entire
lung inward. Surfactan reduce this
force
the negative intrapleural pressure is due to:

ELASTICITY OF LUNGS

the elastic tissue in the lungs tends

to recoil and pull the lungs inward.
As the lung moves away from the
thoracic wall, the cavity becomes
slightly larger, decreasing pressure
the negative intrapleural pressure is due to:

ELASTICITY OF THORACIC WALL

The elastic thoracic wall tends to

pull away from the lung, further
enlarging the pleural cavity and
creating this negative pressure

The surface tension of pleural

fluid resist the actual separation of
the lung and thoracic wall
INTRAPLEURAL PRESSURE CHANGES
INTRAPLEURAL PRESSURE CHANGES
FACTORS AFFECTING VENTILATION:

● resistance within the airways

● lung compliance
● thoracic wall compliance
RESISTANCE WITHIN THE AIRWAY

as air flow into the lungs, the gas molecules encounter

resistance when they strike the walls of the airway.
Therefore the diameter of the airway affects resistance

elastic fibres
smooth muscle
parasympatic neuron

histamin epinephrine
LUNG COMPLIANCE

The ease with which the lung expand is called lung compliance.
It is primary determined by two factors:
• The stretchability of elastic fibres within the lungs
• The surface tension within the alveoli
• Comp : Δ V / Δ P
the stretchability of elastic
fibres within the lungs

the surface tension within

the alveoli
THORACIC WALL COMPLIANCE

● obesity
● intraabdominal distension
…..thank you…..