بسم الله الرحمن الرحيم

1. بسم الله الرحمن الرحيم والصلاة والسلام علي نبينا محمد وعلي اله وصحبه اجمعين

2. Nasal cavityLarynx Trachea ANATOMY DEPARTMENT

3. Objectives • At the end of this lecture the students must know ; • The nasal cavity and the important structures in the lateral wall. • Brief knowledge about the paranasal sinuses. • Laryngeal cartilages, interior of the larynx, and important muscles acting. • Identification of the trachea, level of beginning, termination, important relations of the cervical and thoracic parts, the main bronchi, and their relation to foreign bodies.

4. اولا : Nasal cavity • It extends تمتد from nostrils منخر anteriorly to choanaeفتحه بين الانف الخلفي والبلعوم posteriorly. • It is divided into right and left parts by the nasal septum. غشاء يفصل الانف لجزئين • Each contains, roof floor, lateral and medial walls تفصل لاحقا.

5. 1-Floor الجزء السفلي من الانف • It is formed by the nasal surface of the hard palate :عظمه الحنك التي تتكون من : • 1- Palatine process نتوء حنكي of maxilla. • 2- Horizontal plate of palatine bone.

6. Roof سقف الانف posterior anterior • It is formed by; • Body of sphenoid. الاصفر في الرسمه • Cribriform plate of ethmoid. • Frontal bone, and nasal bones. السهم يشير لترتيب العظام من الامامي Anterior الى الخلفي posterior

7. Lateral wall الجدار الجانبي للانف • It is marked by three projections;بروزات (nasal conchae) : عددها 3 • Superior, middle, and inferior nasal conchae • The space below يوجد تحتها each concha is could (meatus); :عددها 3 • Superior, middle, and inferior meatuses.

8. Lateral wall • Sphenoethmoidal recess جييب,يوجد فوق البروزات التي في الشريحه السابقه • opening of sphenoid air sinus • :مكان صب الجيوب الانفيه • Superior meatus;receives • openings of posterior ethmoidal sinuses. • Middle meatus; contains • bulla ethmoidalis for opening of middle ethmoidal sinus. • hiatus semilunaris, for openings of maxillary sinus. • Infundibulum for frontal and anterior ethmoidal sinus. • Inferior meatus; receives opening of nasolacrimal duct قناه دمعيه. الجيوب الانفيه تفصل لاحقا

9. الجدار الوسطيMedia wall • يتكون من : • The nasal septum; • Vertical plate of ethmoid. • Vomer. اسم عظم • Septal cartilage.

10. Nerve supply • Nerves of smell : • Olfactory nerves, :ياتي من (Cr 1) : cranial nerve no. 1. • Nerves of general sensation: • Ophthalmic and Maxillary divisions of Trigeminal nerve, (Cr 5).

11. Blood supply • Arterial supply; • Sphenoalatine artery (maxillary) . • Ethmoidal anterior and posterior (ophthalmic). • Superior labial (facial) • Venous drainage; • Plexus in sub mucosa by veins accompany the arteries والاورده مصاحبه للشرايين ( اعرف هذه المعلومه )

12. Lymph drainage • :الغدد اللمفاويه في الانف • Submandibular nodes • Upper deep cervical nodes.

13. الجيوب الانفيه Paranasal Sinuses • They are cavities in bones of skull which contain air, they surround the nose and open into nasal cavity. • They are : frontal, maxillary, sphenoidal, & ethmoidal sinuses. • Function of sinuses : 1- Decrease weight of skull. 2- Increase size of face & skull. 3- Increase resonance ترنيم of voice

14. ثانياTrachea • It is a mobile متحرك tube, formed of fibroelastic wall with series of U shaped hyaline cartilage. • ويوجد في منطقتين من الجسم1-It has a cervical part lies in the neck and 2-a thoracic part lies in the superior mediastinum. • Its bifurcation نقطه التفرع is known as carina.

15. Trachea • It is about 13 cm long and 2.5 cm diameter. • It commences تبدا من below cricoid cartilage (C6) and bifurcates تنتهي عند at level of sternal angle (T4) into right and left principal bronchi . موضع سؤال مكان البدايه والنهايه

16. معلومات مفيده للجراحه في هذه الشريحه يعلمك المناطق المجاوره للقصبه الهوائيه Important relation of cervical part of trachea • Anteriorly : skin, fascia, isthmus of thyroid gland (in front of 2nd ,3rd ,and 4th rings). • Posteriorly : recurrent laryngeal nerves, esophagus. • Laterally : lobes of thyroid gland (down as far as 5th or 6th ring ), and carotid sheath.

17. Important relation of thoracic part of trachea • Anteriorly : sternum, thymus, arch of aorta. • Posteriorly : esophagus, recurrent laryngeal nerve. • right side : right vagus nerve, and pleura. • Left side : arch of aorta, left vagus , and phrenic nerves, and pleura.

18. Arterial supply • : تزود بـ • Inferior thyroid arteries. • Broncheal arteries.

19. Nerve supply • Vagi. • Recurrent laryngeal. • Sympathetic.

20. Lymphatic drainage • العقد اللمفاويه في القصبه الهوائيه هي : • Pretracheal L.N. • paratracheal L.N. • Deep cervical L.N.

21. ثالثا : Principal bronchi • Right main bronchus is wider shorter and moor vertical than left one. • It is more prone ميلا الى to be affected by foreign body.

22. Principal bronchi • Left main bronchus is narrower, longer and moor horizontal than right one . • It is less prone to be affected by foreign body. بالله عااد ؟؟ شيء جديد

23. رابعا : Larynx • It is an organ that provides protective sphincter : من القاموس(a ringlike muscle which closes a natural orifice or passage) at inlet مدخل of air passage and responsible for voice production. • Above, it opens into the laryngeal part of the pharynx. الجزء الاخير من البلعوم • Below, it is continuous with trachea.

24. Larynx • It is situated يقع below the tongue and hyoid bone, between great blood vessels, at level of 4th,5th, and 6th, cervical vertebrae

25. Larynx • It is formed of framework of cartilages connected by membranes and ligaments, moved by muscles.

26. Cartilages of larynx • Single cartilages; غضاريف توجد بشكل مفرد • Thyroid, (largest). • Cricoid. • Epiglottis. • Paired cartilages; بشكل ازواج • Arytenoid. هرمي الشكل • Corniculate. • Cuniforms.

27. Membranes and ligamentsتصل الغضاريف ببعضها • Thyrohyoid membrane; من الاسم تعرف مكانها • Cricotracheal ligament. • Quadrangular رباعي membrane مسؤول عن الاحبال الصوتيه .(fibroelastic). • Cricothyroid ligament. يوجد بنهايه الاحبال الصويته

28. Membranes and ligaments *Thyrohyoid membrane; -median وسطي thyrohyoid ligament. -lateral جانبي thyrohyoid ligament

29. Membranes and ligaments *Cricotracheal ligament.

30. Membranes and ligaments *Quadrangular membrane. • Vestibular ligament. الرباط الدهليزي • Cricothyroid ligament

31. Membranes and ligaments *Cricothyroid ligament.

32. المداخل Inlet of larynx • It looks backward and upward into laryngeal part of pharynx • It is bounded by; • Upper margin of epiglottis لسان المزمار, in front. • Aryepiglottic fold, laterally. • Mucous membrane between arytenoid cartilages. • Corniculate and cuneiform cartilages on upper border of aryepiglottic fold.

33. Cavity of the larynx • It extends from inlet to lower border of cricoid cartilage. • It is divided into; • The vestibule that lies between inlet and vestibular folds. • Middle region, lies between vestibular and vocal folds. • Lower region, lies between vocal folds and lower level of cricoid cartilage

34. Cavity of the larynx • Sinus of larynx, is a small recess جييبات, lies between vestibular and vocal folds • Saccule of larynx, is a small diverticulum, passes upward between veastbular folds and thyroid cartilage. • Rima vestibuli, is the gap المسافه between vestibular folds. • Rima glottidis, is the gap المسافه between vocal folds in front and arytenoid cartilage behind.

35. Cavity of the larynx

36. Muscles of the larynx Extrinsic خارجيه muscles; • Elevator of the larynx • Depressor of the larynx .

37. Extrinsic muscles • Hyoid and laryngeal Elevators • Stylohyoid • Mylohyoid • Geniohyoid • Genioglossus • Hyoglossus • Inferior pharyngeal constrictor • Digastricus anterior and posterior • Hyoid and laryngeal Depressors • Sternothyroid • Sternohyoid • Omohyoid • Thyrohyoid

38. Muscles of the larynx Intrinsic داخليه muscles; • Control the inlet into the larynx. • Move the vocal folds.

39. Intrinsic muscles • Narrowing inlet; oblique arytenoid. • Widening inlet. Thyroepiglottic. • Approximates the arytenoid cartilages transverse arytenoid • Tensing of vocal cords; cricothyroid. • Relaxing of vocal cords; thyroarytenoid,(vocalis). • Adducting of vocal cords; lateral cricoarytenoid. • Abducting of vocal cords; posterior cricoarytenoid. يسالك عن الوظيفه ويقول اختر العضله التي تقوم بها

40. Intrinsic muscles • Narrowing inlet; oblique arytenoid.

41. Intrinsic muscles • Widening inlet. Thyroepiglottic.

42. Intrinsic muscles • Approximates the arytenoid cartilages; transverse arytenoid

43. Intrinsic muscles • Tensing of vocal cords; cricothyroid.

44. Intrinsic muscles • Relaxing of vocal cords; thyroarytenoid,(vocalis).

45. Intrinsic muscles • Adducting of vocal cords; lateral cricoarytenoid.

46. Intrinsic muscles • Abducting of vocal cords; posterior cricoarytenoid.

47. Nerve supply موضع اسئله Sensory; • Above the vocal cords; • Internal laryngeal nerve . • Below the vocal cords; • Recurrent laryngeal nerve .

48. سيم سيم Nerve supply Motor; • All intrinsic muscles • Recurrent laryngeal nerve. • Cricothyroid • External laryngeal nerve.

49. Arterial supply • Upper half; • Superior laryngeal of superior thyroid . • Lower half; • Inferior laryngeal of inferior thyroid.

50. Lymph drainage • Deep cervical L.N.