1 Anatomy Of TracheoBronchial Tree Dr Supreet Singh
1 Anatomy Of Tracheo-Bronchial Tree Dr. Supreet Singh Nayyar, AFMC www. nayyar. ENT. com 17 -07 -2012 for more presentations, visit www. nayyar. ENT. com
2 www. nayyar. ENT. com 17 -07 -2012 Layout • Embryology • Respiratory Tree ▫ Trachea and main bronchi ▫ Segmental Bronchi ▫ Bronchopulmonary Segments • Structure • Vasculature , Lymphatic and Nerve Supply • Applied Anatomy
3 www. nayyar. ENT. com 17 -07 -2012 EMBRYOLOGY • Tracheobronchial Diverticulum below Hypobranchial Eminence – 4 th wk IUL • edges – oesophagotracheal septum • fuses caudally • endoderm lining • cranial – Trachea / Larynx • caudal – Bronchi / Lungs
4 www. nayyar. ENT. com EMBRYOLOGY 17 -07 -2012
5 www. nayyar. ENT. com EMBRYOLOGY 17 -07 -2012
6 www. nayyar. ENT. com The Respiratory Tree 17 -07 -2012
7 www. nayyar. ENT. com The Trachea • Cartilaginous and Membranous tube • Dimensions ▫ Length -10 - 12 cm ▫ Ext Dia – 2. 0 cm ( 1. 5 cm) • Extent – C 6 – T 4 • Incomplete rings 17 -07 -2012
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9 www. nayyar. ENT. com 17 -07 -2012 Relations • Cervical ▫ Anteriorly �Isthmus of thyroid with inf thyroid vessels �Pretracheal fascia �Sternothyroid & Sternohyoid �Investing layer of Deep Cervical Fascia �Skin & superficial fascia ▫ Posteriorly �Oesophagus; longus colli; RLN ▫ On each side �Thyroid �Common Carotid Artery
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Relation o cervical trachea at C 7 www. nayyar. ENT. com 17 -07 -2012 11
12 www. nayyar. ENT. com 17 -07 -2012 Relations • Thoracic ▫ Anterior �Manubrium Sterni �Sternothyroid �Thymus �Lt Brachiocephalic V �Aorta & Lt CCA �Deep Cardiac Plexus ▫ Posterior �Oesophagus �Vertebral Column ▫ Rt Side �Right Lung & Pleura �Rt Vagus �Azygous V ▫ Lt Side �Arch of Aorta �Lt Common Carotid �Lt Subclavian A �Lt RLN
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15 www. nayyar. ENT. com 17 -07 -2012 The main Bronchi and Branches • Rt and Lt Main Bronchi – T 4 level • Carina • The Right Bronchus (bronchus dexter), wider, shorter, and more vertical ▫ ▫ 5 cm. long Enters right lung opposite fifth thoracic vertebra Azygos vein arches over it from behind Right pulmonary artery lies at first below and then in front ▫ 2. 5 cm along course- Rt Upper Lobe Bronchus ▫ At Hilum of Lung – Middle & Lower Lobe Bronchi
16 Bronchi, Bronchioles, & Alveoli www. nayyar. ENT. com • Trachea divides into • Primary bronchii divide into • Secondary bronchi divide into • Tertiary bronchi divide into • Bronchioles divide into • Terminal bronchioles divide into • Respiratory bronchioles divide into • Alveolar ducts end in • Alveoli 17 -07 -2012
17 www. nayyar. ENT. com 17 -07 -2012 The Respiratory Tree
18 www. nayyar. ENT. com 17 -07 -2012 The Respiratory Tree Structure through the airways 1. Trachea 2. Bronchus (Right- or Left- Primary Bronchus) 3. Lobar Bronchus 4. Segmental Bronchus 5. Bronchus 6. Bronchiole 7. Terminal Bronchiole 8. Respiratory Bronchiole 9. Alveolar Duct 10. Alveolar Sac / Alveolus
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20 www. nayyar. ENT. com 17 -07 -2012 The Respiratory Tree • Rt Upper Lobe Bronchus ▫ ▫ ▫ Rt lat aspect of bronchus Superolaterally 3 segmental Bronchi ( Apical; Post; Ant ) Apical Segmental – Apical & Ant. Subsegmental Br Post Segmental – Lateral & Ant. Subsegmental Br Ant. Segmental – Lateral & Ant. Subsegmental Br • Rt Middle Lobe Bronchus ▫ ▫ 2. 5 cm beyond Rt Upper Lobe Bronchus Ant aspect Forwards Downwards and Laterally Lateral and Medial Subsegments
21 www. nayyar. ENT. com 17 -07 -2012 The Respiratory Tree • Rt lower lobe bronchus ▫ Apical Segmental – post aspect Medial ; Sup ; Lat subsegmental br ▫ Medial Basal ( Cardiac ) – Rt Border of heart ▫ Ant Basal ▫ Lateral Basal ▫ Post Basal
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23 www. nayyar. ENT. com 17 -07 -2012 The Respiratory Tree
24 www. nayyar. ENT. com 17 -07 -2012 The Respiratory Tree
25 www. nayyar. ENT. com 17 -07 -2012 The Respiratory Tree • Left Bronchus (bronchus sinister) smaller in calibre but longer than the right ▫ 5. 5 cm long ▫ Enters root of the left lung opposite sixth thoracic vertebra ▫ Passes beneath Aortic arch, ▫ crosses in front of oesophagus, thoracic duct, descending aorta ▫ Left pulmonary artery lies at first above then in front
26 www. nayyar. ENT. com 17 -07 -2012 The Respiratory Tree • Lt upper Lobe Bronchus ▫ Anterolateral aspect 5. 5 cm from carina ▫ Curves laterally then divides �Cranial divisions: Apico posterior and Anterior �Caudal divisions : anterolaterally Lingular area of lung Sup and Inf segmental • Lt Lower Lobe Bronchus ▫ Apical segmental �Originates posteriorly 1 cm below upper lobe orifice ▫ Anteromedial (Anterior Basal and Medial Basal ) ▫ Posterolateral. Lateral Basal and Post Basal)
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28 The Lungs • Soft, spongy, coneshaped • Right lung ▫ 3 lobes • Left lung ▫ 2 lobes www. nayyar. ENT. com 17 -07 -2012
29 www. nayyar. ENT. com 17 -07 -2012 Bronchopulmonary segments • Independent respiratory units • Sectors of lung with tertiary/ segmental bronchus ; separate Br of Pulmonary A • Pyramidal with apex to root of lung • Clinical Significance ▫ Restriction of infections ▫ Segmental resection ▫ Bronchoscopy
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31 www. nayyar. ENT. com 17 -07 -2012 Structure of Trachea and Major Bronchi • Cartilages ▫ 16 -20 ▫ Incomplete Rings (4 mm vertically and 1 mm thick) ▫ Union of 2 or more rings partially or completely ▫ Highly elastic ▫ 1 st Tracheal Cartilage • Fibrous Membrane ▫ Perichondrium of cartilages ▫ Collgen with elastic fibres ▫ Non striated mus fibres
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33 Changes as the Respiratory Tree Branches www. nayyar. ENT. com • As branching of bronchi becomes more extensive ▫ Rings of cartilage become plates ▫ Smooth muscle increases ▫ Columnar epithelium becomes cuboidal, then squamous (in alveoli 17 -07 -2012
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35 www. nayyar. ENT. com 17 -07 -2012 • Mucous Membrane ▫ Epith lining – thins and single layered ▫ Tubulo-racemose glands ▫ Not present in bronchioles
36 www. nayyar. ENT. com 17 -07 -2012 Vasculature and lymphatics • Blood Supply ▫ ▫ Inf Thyroid A Bronchial A – 1 for Rt lung ; 2 for Lt Lie against post wall of Bronchi 2 Bronchial Veins �Rt – Azygous V �Lt – Lt Sup Intercostal V or Hemiazygous. V ▫ Pulmonary V
37 www. nayyar. ENT. com 17 -07 -2012 Vasculature and lymphatics • Lymphatic Drainage ▫ Pretracheal and Paratracheal groups ▫ Superficial System- Tissue beneath pleura vessels round lung borders and fissures to reach hilum numerous Valves ▫ Deep System- Bronchial Tree; Pulm Vessels hilum- drain into Bronchopulmonary Nodes less no. of Valves ▫ Rt and Lt Paratracheal LN unite with Internal Thoracic and Brachiocephalic LN
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39 www. nayyar. ENT. com 17 -07 -2012 Nerve Supply ▫ Parasympathetic ( Vagus) �Motor to bronchial muscle – bronchospasm �Secretomotor to mucous gland �Sensory- stretch and Cough Reflex ▫ Sympathetic �Cervical Ganglion and Spinal N. T 2 – T 5 �Inhibitory to smooth muscle and glands
40 www. nayyar. ENT. com Applied Anatomy • Tracheostomy • Bronchoscopy • Foreign Body In Respi Tract 17 -07 -2012
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43 www. nayyar. ENT. com 17 -07 -2012 Thank you for more presentations, visit www. nayyar. ENT. com
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