Summary Anatomy: Nose, Larynx, and Trachea Fadwa Elkordy

Anatomy of Nose, Larynx, and

Trachea

Table of Contents
1. NASAL CAVITY & PARANASAL SINUSES ---------------------------------------- 2
2. MEDIAL WALL OF NASAL CAVITY (NASAL SEPTUM) -------------------------3
3. LATERAL WALL OF NASAL CAVITY ---------------------------------------------- 4
4. THE PARANASAL AIR SINUSES --------------------------------------------------- 4
5. CORONAL SECTION OF MID-FACE ------------------------------------------------5
6. ANATOMY OF THE LARYNX --------------------------------------------------------6
7. PRINCIPLE CARTILAGES ------------------------------------------------------------7
8. MUSCLES OF THE LARYNX ---------------------------------------------------------7
9. EXTRINSIC AND INTRINSIC MUSCLES ------------------------------------------8
10. BLOOD SUPPLY OF THE LARYNX -------------------------------------------------9
11. THE TRACHEA AND BRONCHIAL TREE ------------------------------------------9
12.

Edited by Sayema Salim 11th batch Notes Committee

Summary Anatomy: Nose, Larynx, and Trachea Fadwa Elkordy

The two nasal cavities are the first component of the upper respiratory tract and
are responsible essentially for warming, humidifying and filtering inspired air,
and sampling it for odors (smell or olfaction). In that sense the nose functions as
an air conditioner & air sampler.

The nasal cavity, oral cavity and pharynx are essentially one continuous tube
with a series of horizontal and vertical partitions.

The nasal cavity communicates with the outside anteriorly through the nares
(nostrils) and posteriorly with the pharynx through the posterior nasal apertures
(nasal choanae)

The pharynx can be divided into 3 continuous segments:

Nasopharynx behind nasal cavity and above soft palate

Oropharynx behind oral cavity, above epiglottis

Laryngopharynx behind larynx, up to C6

(hypopharynx)

NASAL CAVITY & PARANASAL SINUSES

The nasal cavity is essentially an air conditioner and air sampler. Its major
functions are that it:
1. Cleans the air through cilia and mucous blanket
2. Humidifies the air through mucous
3. Warms the air through its rich arterial supply
4. Samples the air for odors through the olfactory nerve: cranial nerve 1

Edited by Sayema Salim 11th batch Notes Committee

Summary Anatomy: Nose, Larynx, and Trachea Fadwa Elkordy

The nasal cavity is shaped essentially like a tent with a partition in it. The
partition is called the nasal septum; it has a floor, roof and two lateral walls. The
lateral walls have shell-like bony projections called conchae, which are called
turbinate when covered in mucous membrane.
Meatus is an opening for the paranasal sinuses and the nasolacrimal duct.
The inside of the nasal cavity is lined by a mucous membrane which is made up
of respiratory epithelium.

Roof Forms part of the floor of anterior

cranial fossa
Floor (hard palate) Forms the roof of the oral cavity

Medial wall Formed by the nasal septum

Lateral walls Formed by the conchae

Opening into the nasal cavity are the paranasal air sinuses, which are air-filled
cavities within the skull that develop as outgrowths from the nasal cavity. The
mucosa (respiratory epithelium) is continuous between nasal cavity and
paranasal sinus. The paranasal air sinuses and nasolacrimal duct open into the
nasal cavity at the nasal meatuses.

MEDIAL WALL OF NASAL CAVITY (NASAL SEPTUM)

The medial wall consists of anterior boundary, posterior boundary, roof, and
floor

The frontal bone may fracture in frontal assaults to the face and in head-on
collisions. If the fracture extends posteriorly to the skull base it may tear the
dura mater which may result in a CSF leak: clear fluid leaking out through
the nose (CSF rhinorrhea). The risk of Infection (meningitis) in such a case is
extremely high. Deviated nasal septum (DNS) is quite common and some
degree of deviation is normal. It only needs to be corrected if it interferes
significantly with breathing.
Anterior Epistaxis: Bleeding from the superficial network of vessels in Little’s
area is fairly common and referred to as an anterior epistaxis. It is usually easily
treated by applying firm pressure over the nostril and cauterization if that

Edited by Sayema Salim 11th batch Notes Committee

Summary Anatomy: Nose, Larynx, and Trachea Fadwa Elkordy

doesn’t work

-Nasal bone frequently fractures from frontal trauma or punches to the face

LATERAL WALL OF NASAL CAVITY

The lateral wall consists of the:

1. Superior turbinate (concha); below it is the superior nasal meatus
2. Middle turbinate (concha); below it is middle nasal meatus
3. Inferior turbinate (concha); below it is the inferior nasal meatus

Hiatus Semilunaris:
 Ostiomeatal unit (OMU): curved opening in the middle meatus
underneath the middle turbinate
 Opening of the maxillary sinus opens into the middle meatus
 Opening of the frontal sinus
 Opening anterior and middle ethmoidal sinuses
 Opening of the nasolacrimal duct in the inferior meatus
 Opening of sphenoidal sinus
 Posterior ethmoidal sinuses open into the superior meatus

Modern convention divides the ethmoidal sinuses simply into two groups:
anterior and posterior. Those formerly designated ‘middle’ now belong to the
anterior group

THE PARANASAL AIR SINUSES

The paranasal sinuses are air-filled cavities within the skull on either side of the
nasal cavity that develop as outgrowths of the nasal cavity. They are
superimposed on a lateral, phantomized view of the head. They all open into the
lateral walls of the nasal cavity through small apertures in the nasal meatuses.

The maxillary sinus is the most important clinically. Due to its low location
in the cheek and high opening in the nasal cavity, drainage is made difficult and
not aided by gravity, increasing the frequency with which it gets infected,
resulting in maxillary sinusitis

Edited by Sayema Salim 11th batch Notes Committee

Summary Anatomy: Nose, Larynx, and Trachea Fadwa Elkordy

The superimposed paranasal sinuses:

1.Frontal sinus within frontal bone
2. Ethmoidal sinuses/air cells within ethmoid bone, medial to orbits
3. Sphenoidal sinus within body of sphenoid bone
4. Maxillary sinus within maxilla

Mastoid air cells within mastoid process: The mastoid air cells are not part of
the paranasal air sinuses as they do not drain into the nasal cavity but are
included as they are also air-filled spaces in the skull within the mastoid
processes

Coronal Section of Mid-Face

A sudden increase in intra-orbital pressure (slap on the eye) can result in a
blowout fracture involving the medial wall of the orbit or its floor, which also
forms the roof of the maxillary sinus.

The lamina papyracea is the egg-shell thin medial wall of the orbit and infection
from an ethmoidal sinusitis can easily spread through it into the orbit giving rise
to orbital cellulitis, a serious infection

Accumulation & stagnation of mucus in maxillary sinus predisposes it to

infection

Fracture of floor of maxillary sinus following difficult molar extraction may

create an Oroantral fistula (OAF)

Inflammation of the sinus mucosa causes congestion and swelling, blocking it’s
opening into the nasal cavity, leading to accumulation of mucus, which causes
an infection, which causes maxillary sinusitis

Referred pain from irritation of the superior alveolar nerves as they pass along
the wall of the infected sinus causes a maxillary molar toothache

Edited by Sayema Salim 11th batch Notes Committee

Summary Anatomy: Nose, Larynx, and Trachea Fadwa Elkordy

ANATOMY OF THE LARYNX

It’s a cartilaginous structure in the neck that guards the entrance to the trachea

Has 3 basic functions; in order of importance:

AIR PASSAGE: -most important function;

cartilaginous structure ensures
patency of airway

SPHINCTER: -regulates air & food passages to

ensure coordinated breathing &
swallowing
-provides valvular blockade for build-
up of intra-thoracic & intra-
abdominal pressure
-important for functions such a
coughing, sneezing, micturition,
parturition, etc.

ORGAN OF PHONATION -produces sound by intermittent

(VOICEBOX): release of high-pressure air between
closed
vocal folds causing their vibration

Made up of several cartilages that:

• articulate through synovial joints
• are connected by fibrous membranes and ligaments
• lined on the inside by mucous membrane, and
• moved by highly innervated skeletal muscles

Edited by Sayema Salim 11th batch Notes Committee

Summary Anatomy: Nose, Larynx, and Trachea Fadwa Elkordy

PRINCIPLE CARTILAGES

HYALINE CARTILAGES SECONDARY CARTILAGES

Thyroid cartilage Epiglottis

Cricoid cartilage Corniculate cartilages (2)

Arytenoid cartilages (2) Cuneiform cartilages (2)

MUSCLES OF THE LARYNX

1. EXTRINSIC MUSCLES -Join cartilages of the larynx to

neighboring structures in the neck.
-Divided into:
Suprahyoid muscles (elevators) &
infrahyoid muscles (depressors) of
the larynx

2. INTRINSIC MUSCLES -Regulate length and tension of the

vocal folds and aperture of the glottis

-All intrinsic supplied by CN XI via

X (vagus: external & recurrent
laryngeal nerves)

EXTRINISIC MUSCLES

Edited by Sayema Salim 11th batch Notes Committee

 Summary Anatomy: Nose, Larynx, and Trachea Fadwa Elkordy

Stylohyoid (CN VII): Suprahyoid muscles

Geniohyoid (C1): Suprahyoid muscles
Digastric (ant. belly: CN V3; post. belly: CN VII): Suprahyoid
ELEVATORS OF muscles
LARYNX Stylopharyngeus (CN IX)
Palatopharyngeus (CN XI via X)

Sternothyroid (ansa cervicalis): Infrahyoid muscles

Sternohyoid (ansa cervicalis): Infrahyoid muscles
Omohyoid (ansa cervicalis): Infrahyoid muscles
DEPRESSORS OF Thyrohyoid (C1)
LARYNX Inferior pharyngeal constrictor (XI via X)

INTRINSIC MUSCLES

supplied by XI via X
Adductors: Lateral cricoarytenoid
MUSCLES VARYING APERTURE OF Transverse arytenoid
GLOTTIS Oblique arytenoid

Abductors: Posterior cricoarytenoid

Cricothyroid
MUSCLES REGULATING TENSION OF Thyroarytenoid
VOCAL LIGAMENTS Vocalis
Posterior cricoarytenoid

Aryepiglotticus
MUSCLES MODIFYING LARYNGEAL Oblique arytenoid
INLET Thyroepiglottics
Thyroarytenoid

BLOOD SUPPLY OF THE LARYNX

Superior and inferior laryngeal arteries: from superior and inferior thyroid
Edited by Sayema Salim 11th batch Notes Committee
 Summary Anatomy: Nose, Larynx, and Trachea Fadwa Elkordy

arteries respectively
- Superior thyroid artery branch from external carotid artery
- Inferior thyroid artery branch from thyrocervical trunk from subclavian
artery

All intrinsic muscles supplied by

branches of the vagus nerve:
MOTOR INNERVATION:
-External laryngeal nerve (branch of
superior laryngeal nerve from vagus):
cricothyroid muscle

-Recurrent laryngeal nerve: all

remaining intrinsic muscles

-Above vocal folds: internal

laryngeal nerve (sensory br. of
SENSORY INNERVATION: superior laryngeal nerve)

-Below vocal folds: recurrent

laryngeal nerve

The Trachea and Bronchial Tree

(he didn’t speak about this part during our lecture)
The right principal bronchus is shorter, wider and more vertical than the left;
therefore, inhaled (aspirated) objects tend to lodge more frequently in the right
lung compared to the left.

The lobar bronchi divide into segmental bronchi, each supplying a

bronchopulmonary segment. There are 10 bronchopulmonary segments in each
lung. The segmental bronchi undergo further divisions into progressively
smaller airways called bronchioles, and terminal and respiratory bronchioles.

Edited by Sayema Salim 11th batch Notes Committee