Anatomy Of Tracheo-Bronchial Tree Dr. Supreet Singh Nayyar, AFMC for more presentations, visit www.nayyarENT.com www.nayyarENT.com 17-07-2012

Layout Embryology Respiratory Tree Structure www.nayyarENT.com 17-07-2012 Layout Embryology Respiratory Tree Trachea and main bronchi Segmental Bronchi Bronchopulmonary Segments Structure Vasculature , Lymphatic and Nerve Supply Applied Anatomy

www.nayyarENT.com 17-07-2012 EMBRYOLOGY Tracheobronchial Diverticulum below Hypobranchial Eminence – 4th wk IUL edges – oesophagotracheal septum fuses caudally endoderm lining cranial – Trachea / Larynx caudal – Bronchi / Lungs

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www.nayyarENT.com 17-07-2012 The Respiratory Tree

The Trachea Cartilaginous and Membranous tube Dimensions www.nayyarENT.com 17-07-2012 The Trachea Cartilaginous and Membranous tube Dimensions Length -10- 12 cm Ext Dia – 2.0 cm ( 1.5 cm) Extent – C6 – T4 Incomplete rings

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Relations Cervical Anteriorly Posteriorly On each side www.nayyarENT.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.nayyarENT.com 17-07-2012

Relations Thoracic Rt Side Anterior Lt Side Posterior www.nayyarENT.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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The main Bronchi and Branches www.nayyarENT.com 17-07-2012 The main Bronchi and Branches Rt and Lt Main Bronchi – T4 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

Bronchi, Bronchioles, & Alveoli www.nayyarENT.com 17-07-2012 Bronchi, Bronchioles, & Alveoli 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

The Respiratory Tree FG24_10D.JPG www.nayyarENT.com 17-07-2012 FG24_10D.JPG Title: The Bronchial Tree and Divisions of the Lungs, Anterior View Notes: (a)Gross anatomy of the lungs; bronchial tree and divisions. (b)Distribution of bronchopulmonary segments. (c)Bronchogram, slightly oblique, posteroanterior view. (d)Plastic cast of adult bronchial tree. Keywords: bronchopulmonary segments, distribution, bronchial tree, bronchus, apex of lung, diaphragm

www.nayyarENT.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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The Respiratory Tree Rt Upper Lobe Bronchus Rt Middle Lobe Bronchus www.nayyarENT.com 17-07-2012 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

The Respiratory Tree Rt lower lobe bronchus www.nayyarENT.com 17-07-2012 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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The Respiratory Tree FG24_10D.JPG www.nayyarENT.com 17-07-2012 The Respiratory Tree FG24_10D.JPG Title: The Bronchial Tree and Divisions of the Lungs, Anterior View Notes: (a)Gross anatomy of the lungs; bronchial tree and divisions. (b)Distribution of bronchopulmonary segments. (c)Bronchogram, slightly oblique, posteroanterior view. (d)Plastic cast of adult bronchial tree. Keywords: bronchopulmonary segments, distribution, bronchial tree, bronchus, apex of lung, diaphragm

www.nayyarENT.com 17-07-2012 The Respiratory Tree

www.nayyarENT.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

The Respiratory Tree Lt upper Lobe Bronchus Lt Lower Lobe Bronchus www.nayyarENT.com 17-07-2012 Lt upper Lobe Bronchus Anterolateral aspect 5.5cm 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 1cm below upper lobe orifice Anteromedial (Anterior Basal and Medial Basal ) PosterolateralLateral Basal and Post Basal)

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The Lungs Soft, spongy, cone- shaped Right lung Left lung 3 lobes www.nayyarENT.com 17-07-2012 The Lungs Soft, spongy, cone- shaped Right lung 3 lobes Left lung 2 lobes

Bronchopulmonary segments www.nayyarENT.com 17-07-2012 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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Structure of Trachea and Major Bronchi www.nayyarENT.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 1st Tracheal Cartilage Fibrous Membrane Perichondrium of cartilages Collgen with elastic fibres Non striated mus fibres

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Changes as the Respiratory Tree Branches www.nayyarENT.com 17-07-2012 Changes as the Respiratory Tree Branches As branching of bronchi becomes more extensive Rings of cartilage become plates Smooth muscle increases Columnar epithelium becomes cuboidal, then squamous (in alveoli

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Mucous Membrane Epith lining – thins and single layered www.nayyarENT.com 17-07-2012 Mucous Membrane Epith lining – thins and single layered Tubulo-racemose glands Not present in bronchioles

Vasculature and lymphatics www.nayyarENT.com 17-07-2012 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 HemiazygousV Pulmonary V

Vasculature and lymphatics www.nayyarENT.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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Nerve Supply Parasympathetic ( Vagus) Sympathetic www.nayyarENT.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. T2 – T5 Inhibitory to smooth muscle and glands

Applied Anatomy Tracheostomy Bronchoscopy Foreign Body In Respi Tract www.nayyarENT.com 17-07-2012 Applied Anatomy Tracheostomy Bronchoscopy Foreign Body In Respi Tract

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Thank you for more presentations, visit www.nayyarENT.com 17-07-2012 Thank you for more presentations, visit www.nayyarENT.com