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7 - The Respiratory Systen at University of Maryland - Baltimore County - StudyBlue interior portion of the nose nostrils external openings of the nose nasal septum wall of cartilage that divides the nose into two equal sections septum wall that separates two chambers cilia thin hairs located inside the nostrils, filter incoming air to remove debris mucous membranes line the nose, specialized tissues that also line digestive, reproductive, and urinary systems mucus slippery secretion produced by the mucous membranes that protects and lubricates these tissues - helps moisten, filter, and warm the air as it enters olfactory receptors nerve endings that act as the receptors for the sense of smell - also important in sense of taste - located in the mucous membrane in the upper part of the nasal cavity tonsils (palatine tonsils) ; adenoids (nasopharyngeal tonsils) help protect the body from infection coming through the nose or the mouth paranasal sinuses air filled cavitites lined with mucous memrane, located in bones of the skull; function - make bones of skull lighter, produce sound by giving resonance, produce mucus to provide lubrication for nasal cavity frontal sinuses located in the frontal bone just above the eyebrows - infection here can cause severe

 pain sphenoid sinuses located in sphenoid bone behind the eye and under the pituitary gland, close to optic nerve; infection here can damage vision maxillary sinuses larges of the paranasal sinuses, located in maxillary bones under the eyes; infection here can cause pain in the posterior maxillary teeth ethmoid sinuses located in ethmoid bones between the nose and the eyes - irregularly shaped air cells that are separated from the orbital (eye) cavity by a thin layer of bone pharynx (throat) - receives air after it passes through the nose or mouth, as well as food made up of 3 divisions nasopharynx first division of the pharynx; posterior to the nasal cavity and continues downward to behind the mouth - portion of pharynx used only by the respiratory system for transport of air; opens into the oropharynx oropharynx second division of pharynx; portion that is visible when looking into the mouth - shared by respiratory and digestive system; transports air, food, and fluid downwards into the laryngopharynx laryngopharynx third division of the pharynx; shared by both respiratory and digestive - leads to opening of trachea and epigl

ottis larynx (voice box) - triangular chamber located between the pharynx and the trachea - protected and supported by 9 separate cartilages - thyroid cartilage - largest, (Adams apple) - projects from front of throat when enlarged thyroid carilage largest cartilage of the throat, Adams apple) - projects from front of throat when enlarged vocal cords contained in larynx - during breathing, cords separate to let air pass, during speech, they close together and sound is produces as air is expelled from lungs epiglottis lid-like structure located at the base of the tongue, swings downward and closes off the laryngopharynx so food doesn't enter the trance and lungs trachea transports air to and from the lungs - commonly known as (windpipe)j - located directly in front of the esophagus - held open by flexible c-shaped cartilage that can compress to allow food to pass down the esophagus bronchi two large tubes (primary bronchi) - branch out from trachea and convey air into the two lungs (singular - bronchus) ; called bronchial tree due to it looking like an inverted tree brochioles smallest branch of the bronchi alveoli (air

 sacs) - very small, grape like clusters found at the end of each bronchiole - where CO2 and O2 transfer take place pulmonary relating to or affecting the lungs surfactant a detergent like substance produced by the alveoli - reduces surface tension of the fluid in the lungs - make alveoli stable so they do not collapse when exhaling lungs essential organs of respiration - divided into lobes (subdivision, or part of an organ) right lung large, has three lobes - upper, middle, and lower (superior, middle, and inferior) left lung has only two lobes (upper and lower) - restricted space due to heart, which is located on the left side mediastinum the middle section of the chest cavity, located between the lungs - cavity contains connective tissue and organs, including the heart and its veins and arteries, the esophagus, trachea, bronchi, thymus gland, and lymph nodes pleura thin, moist, and slippery membrane that covers the outer surface of the lungs and lines the inner surface of the thoracic cavity parietal pleura the outer layer of the pleura - lines the walls of the thoracic cavity, covers the diaphragm, and forms the

 sac containing each lung - parietal pleura attached to the walls of a cavity visceral pleura inner layer of the pleura that covers each lung, attached directly to the lungs (visceral - relating to the internal organs) pleural cavity (pleural space) - thin fluid filled space between the parietal and visceral pleural membranes ; fluid acts as lubricant, allowing membranes to slide easily over each other during respiration diaphragm (thoracic diaphragm) - dome shaped sheet of muscle that separates the thoracic cavity from the abdomen - contraction and relaxation of this muscle that makes breathing possible phrenic nerves stimulate the diaphragm and cause it to contract respiration breathing, the exchange of oxygen for carbon dioxide that is essential for life inhalation the act of taking in air as the diaphragm contracts and pulls outwards - causes thoracic activity to expand - produces vacuum within thoracic cavity that draws air into the lungs exhalation act of breathing out - as the diaphragm relaxes, it moves upward, forcing air out of the lungs external respiration the act of bringing air in and out of the lungs from the outside environment internal respiration cellular respiration - the exchange of gases within the cells of the blood and tissues

 otolaryngologist / ENT physiscian with specialized training in the diagnosis and treatment of diseases and disorders of the head adn neck pulmonologist a physician who specializes in diagnosing and treating diseases and disorders of the respiratory system thoracic surgeon CSD 343 Test 2- Tessa - StudyBlue Good to have you back!

If you've signed in to StudyBlue with Facebook in the past, please do that again. CSD 343 Test 2- Tessa CSD 343 Test 2- Tessa Tessa P. Biological and Non-Biological Function of the Laryngeal System Biological: -sound generator for speed production -adjust voice pitch, loudness, and quality What does the Hyoid Bone do? lifts larynx when you swallow Advertisement ) What is it and what does the Epiglottis do? -Elastic (flops down to protect air way when you swallow) -Leaf shaped -forms anterior and lateral walls -laryngeal prominence Cricoid (base of Laryngeal structure) -inferior to thyroid – Movement makes vocal folds move Laryngeal Musculature -Extrinsic muscles(one muscles on the outsides) -Intrinsic muscles EX: – Thyrohyoid (thyroid muscle- cartilage) – Sternothyroid (from sternum to thyroid) Intrinsic muscles -attachments anteriorly to thyroid and posteriorly to arytnoid.

-crocthyroid Adduction means closing (closes vocal cords- “adding” they bring them together) – Lateral cricoarytenoid -they are closed when speaking – Abductors (opening vocal cords) - when: you are not speaking, at rest, and breathing – Posterior cricoarytenoid -Variable space between vocal folds (there is not always space) Advertisement Is: them opening and closing really fast – Adduction (close vocal folds) – Vocal folds are closed (adducted) by muscles – LCA and Interarytenoids – Air pressure (subglottal) builds up (go to take a deep breath before yelling) – Air blows VF apart (don’t have to worry about air pressure for test- just know that to start your voice – adduction (has to bring the vocal cords together to start vibrating open and closed: it holds the air back from it all being released) abduction gets the air moving) – Decrease in pressure (now that air is flowing) and elastic recoil cause VF to vibrate (move together and apart) Articulatory Mechanism: a system by which we learn modified voice into recognizable speech (?

Look up again ?) Vocal Tract Cavities (with the articulatory and resonating system) IS:(resonate to where all the sounds are formed) – Nasal (nose) --- Pharyngeal (3 segments) (throat and neck behind mouth and nose) Pharyngeal – Alveolar ridge (right behind teeth on the roof) – Maxillae (bones that make up majority) – Palatine bones (top and back of throat) – Biological functions of hard palate – Separate nasal & oral cavities – Non biological functions of hard palate – Production of consonants alveolar- /t, d/ s/ z/ n/ l/ (tongue was in the same place by alveolar ridge) -palatal /f, 3, tf, d3, j, r/ /sh/ /j/ asia /sia/ j= /y/(tongue is further back) Velum Ø (soft part on the back of the top of your roof) (closes for all sounds except n/m nasal sounds) Velum Anatomy: – Velopharyngeal port (open vs.

closed)= affects speech production -what happens when it is open and closed – Movement (raise vs. lower) – Inadequate movements velopharyngeal port -velopharyngeal port consists of: Velum (soft palate), Lateral pharyngeal walls (sides of throat) and posterior pharyngeal wall (back of throat) Velum biological functions – Close off oral & nasal cavity during swallowing Non biological functions of Velum – Production of consonants ( /c/ /g/) – Allow nasal resonance /n/ /m/ – Close off oral cavity Muscles of the lips and cheeks: – Orbicularis oris (around your lips) – Buccinator (cheeks) Anatomy Study of the structures of the body and the relationship of these structures to one another. WHERE they are located Physiology Ø A branch of biology defined as a science concerned with the function of organisms and bodily structures. Function- WHAT they do Superior vs. Inferior -Caudal lower (away from the head) Inferior -Ventral toward front of body Posterior Dorsal toward back of body (spine) Medial toward or near midline vs.

Lateral toward side Lateral Ø toward side (e.g., lungs are lateral to heart) (noes are medial to the ears) Internal (Deep) toward inside or away from surface of body (e.g., lungs are internal to rib cage) External Ø (Superficial) toward outside or toward surface of body (organs are internal to your skin) (brain is interal to your skull) Respiratory System functions Ø Primary biological function is to Supply oxygen to the blood and Ø Remove excess carbon dioxide from the body Ø This system serves as the Generating source for speech production Air is inhaled into the lungs to become a potential energy source for sound production. The air then moves through the vocal folds in a controlled manner and is modified by the vocal folds and the articulators to produce speech sounds.

Vertebral Column -made up of 32 boney vertebrae joined together by ligaments Ø These vertebrae are arranged in 5 different areas Vertebral Column Diagram of Human Mouth and Throat (Cut View) | BIO NEWS UPDATE Home > Uncategorized > Diagram of Human Mouth and Throat (Cut View) Diagram of Human Mouth and Throat (Cut View) Bagan mulut dan rongga mulut Epiglottis The epiglottis is the flap of cartilage lying behind the tongue and in front of the entrance to the larynx (voice box). At rest, the epiglottis is upright and allows air to pass through the larynx and into the rest of the respiratory system. During swallowing, it folds back to cover the entrance to the larynx, preventing food and drink from entering the windpipe. The throat contains both an air passage (the wind pipe) and a food passage (the esophagus). If these passages were both open when a person swallowed, air could enter the stomach and food could enter the lungs.

Part of the safety hatch that seals off the windpipe is the “epiglottis,” a little valvelike cartilage, which works with the larynx to act as a lid every time we swallow. The larynx draws upward and forward to close the windpipe. This keeps solid food and liquid out of the respiratory tract. At the end of each swallow, the epiglottis moves up again, the larynx returns to rest, and the flow of air into the windpipe continues. The uvula (Latin for “little grape”) is a fleshy piece of muscle, tissue and mucous membrane that hangs down from the palate. It is the part that moves upward when we say, “Ah!” It flips up and helps close off the nasal passages when we swallow. Contrary to the depictions seen in cartoons, the uvula does not vibrate during singing and shouting and, in fact, has nothing to do with the voice. Esophageal Muscle Just above the point where the esophagus joins the stomach, some of the circular muscle fibers in its wall are thickened. These fibers are usually contracted, and function to close the entrance to the stomach.

In this way, they help prevent regurgitation of the stomach contents into the esophagus. When peristaltic waves reach the stomach, the muscle fibers that guard its entrance relax and allow the food to enter. Esophagus The esophagus is a muscular tube which carries food and liquids from the throat to the stomach for digestion after it has been chewed and chemically softened in the mouth. Food is forced downward to the stomach (or upwards, if one is standing on his head) by powerful waves of muscle contractions passing through the walls of the esophagus. Because these contractions are so strong in the throat and the esophagus, we can swallow in any position — even upside-down! If the food is bad, poison, or more than we can “stomach,” it may travel back by the same force to be thrown out through the mouth, which is called vomiting. The esophagus has a ring of muscle at the top and at the bottom. These rings close or contract after the food passes through and enters the stomach, where there is an abundance of churning acid waiting to digest the food.

If the bottom muscle weakens, stomach contents, along with the stomach acid, may return to the esophagus and cause an uncomfortable, burning sensation known as “heartburn”, although it is not connected with the heart at all, but be careful next time you are forced to swallow your pride. Genioglossus Muscle The genioglossus muscle is a flat, fan-shaped muscle that runs from the front of the lower jaw into the tongue from tip to base. Contraction of these muscles (on either side) makes the tongue stick out as its whole foundation is pulled forward. Genihyoid Muscle The geniohyoid muscle is a flat, straplike muscle, which passes from the side of the tongue down to one arm of the wishbone-shaped hyoid bone in the throat. Movement of these muscles pulls the sides of the tongue downward. Palate The palate forms the roof of the mouth and is made up of a hard surface in the front and a soft surface in the back. The “hard palate” is formed by the maxillary bones in the front and the horizontal portions of the palatine bones in the back.

The “soft palate” forms a muscular arch that extends back and down as a cone-shaped projection called the “uvula.” During swallowing, muscles draw the soft palate and the uvula upward. This action closes the opening between the nasal cavity and the pharynx, preventing food from entering the nasal cavity. Hyoid Bone Just under the mandible is a U-shaped bone called the hyoid. The hyoid is closely associated with the skull but is not strictly a part of it. It anchors muscles, especially those of the tongue, and is the only bone in the body which is not linked to another. The blood vessels into and out of the hyoid bone are small branches of the external carotid artery, and are called “superior thyroid arteries” and “superior thyroid veins.” Lingual Tonsil The lingual tonsil is the group of lymphnoid follicles which can be located at the base of the tongue. It is just anterior of the epiglottis. Lips The lips are highly mobile structures that surround the mouth opening. They contain skeletal muscles and a variety of sensory nerves that are useful in judging the temperature and texture of foods. Their normal reddish color is due to an abundance of blood vessels near their surfaces.

The external borders of the lips mark the boundaries between the skin of the face and the mucous membrane that lines the alimentary canal. Mandible The mandible (lower jawbone) consists of a horizontal horseshoe-like body with a flat “ramus” projecting upward at each end. The rami are divided into two processes: the “mandibular condyle” and a front “coronoid process.” The mandibular condyles unite with the mandibular tissues of the temporal bones, while the coronoid processes serve as attachments for muscles used in chewing. Other large chewing muscles are attached on the side surfaces of the rami. Maxillary Bones The maxillary bones form the upper jaw; together they are the keystone of the face, for all other immovable facial bones are connected to them. Portions of these bones make up the front of the roof of the mouth (hard palate), the floors of the orbits, and the sides and floor of the nasal cavity. They also contain the sockets of the upper teeth. Inside the maxillae, on the sides the nasal cavity, are the “maxillary sinuses” (antrum of Highmore).

These air-filled spaces are the largest of the sinuses, and they extend from the floor of the orbits to the roots of the upper teeth. During development, portions of the maxillary bones called “palatine processes” grow together and fuse along the middle to form the front section of the hard palate. Palatine Glands In the back of the mouth, on either side of the tongue and closely associated with the palate, are masses of lymphatic tissue called “palatine tonsils,” or sometimes just tonsils. These structures lie beneath the lining of the mouth and, like other lymphatic tissues, they help to protect the body against infections. These are common sites of infection, and when they become inflamed, the condition is called “tonsillitis.” Palate The palate forms the roof of the mouth and is made up of a hard surface in the front and a soft surface in the back. The “hard palate” is formed by the maxillary bones in the front and the horizontal portions of the palatine bones in the back. The “soft palate” forms a muscular arch that extends back and down as a cone-shaped projection called the “uvula.” During swallowing, muscles draw the soft palate and the uvula upward.

This action closes the opening between the nasal cavity and the pharynx, preventing food from entering the nasal cavity. Thyroid Cartilage The larynx (voice box) is composed primarily of muscles and cartilages that are bound together by elastic tissues. The thyroid cartilage was named for the thyroid gland that covers its lower part. This cartilage is the shieldlike structure that protrudes in the front of the neck and is sometimes called the “Adam’s apple.” The protrusion is usually more prominent in males than in females because of the effect of male sex hormones on the development of the larynx. Thyroid and Parathyroid Glands The thyroid gland is shaped like a butterfly and usually weighs less than one ounce. The thyroid cartilage covers the larynx and produces the prominence on the neck known as the “Adam’s Apple”. The thyroid gland controls the rate at which the body produces energy from nutrients. If the body does not get enough iodine, the thyroid gland cannot produce a proper amount of hormones for this conversion process. The result can be a goiter, an enlargement of the thyroid gland. In some parts of the world, iodine is so scarce that most of the population have goiters.

The parathyroid glands are four small oval bodies located on either side of and on the dorsal aspect of the thyroid gland. These glands control the level of calcium in the blood. The thyroid gland secretes hormones which regulate energy, and emotional balance may rely upon its normal functioning. When the rate of production is excessive, the results can be weight loss, nervousness, or even emotional disturbances. If the rate of production is excessively low, a slowing of bodily functions may result. The parathyroid glands, located behind the thyroid, control the blood-calcium level. Calcium is important, not only for bones and teeth, but also for nerve functioning, muscle contractions, blood clotting and glandular secretion. If we don’t have enough calcium for these functions, the body will take it from the bones, causing them to easily fracture. It may also cause twitching, spasms, convulsions and even death. Too much calcium may cause a weakening of muscle tone and kidney stones.

Tongue Anchored to the floor of the mouth and slung at the rear from muscles attached to a spiky outgrowth at the base of the skull, the tongue is a strong muscle that is covered by the lingual membrane, which has special areas which detect the flavor of food. The tongue is made up of muscles covered by mucous membranes. These muscles are attached to the lower jaw and to the hyoid bone (a small, U-shaped bone, which lies deep in the muscles at the back of the tongue) above the larynx. There are very small nodules, called papillae, from the top surface of the tongue, which give it its rough texture. Between the papillae at the sides and base of the tongue are small, bulblike structures that are sensory organs, called “taste buds,” which enable us to enjoy the sensations of flavor and warn us when food is unfit to eat. The muscle fibers are heavily supplied with nerves, so it can manipulate food in the mouth and place it between the teeth for chewing – without being bitten in the process. Babies have many more taste buds than an adult, and they have these almost everywhere in the mouth, including the cheeks.

Nevertheless, adults enjoy more flavors than babies, who dislike bitter tastes and prefer bland food. The tongue also aids in the formation of sounds of speech and coordinates its movements to aid in swallowing. It is especially helpful when we are forced to “eat our words.” Enjoy! The Tooth A tooth is a hard structure, set in the upper or lower jaw, that is used for chewing food. Teeth also give shape to the face and aid in the process of speaking clearly. The enamel that covers the crown (the part above the gum) in each tooth can be broken down by acids produced by the mouth for digestive purposes. This process is called “decay”. To prevent decay, good oral hygiene, consisting of daily brushing and flossing, is necessary. The hardest substance in the human body is one of the four kinds of tissue which make up the tooth. It is enamel and covers the crown (area above the gum line) of the tooth. A bony material called “cementum” covers the root, which fits into the jaw socket and is joined to it with membranes. “Dentin” is found under the enamel and the cementum, and this material forms the largest part of the tooth.

At the heart of each tooth is living “pulp,” which contains nerves, connective tissues, blood vessels and lymphatics. When a person gets a toothache, the pulp is what hurts. Trachea The trachea begins immediately below the larynx (voicebox) and runs down the center of the front part of the neck ends behind the upper part of the sternum. Here it divides to form two branches which enter the lung cavities. The trachea (windpipe) forms the trunk of an upside-down tree and is flexible, like a vacuum tube, so that the head and neck may twist and bend during the process of breathing. The trachea, or windpipe, is made up of fibrous and elastic tissues and smooth muscle with about twenty rings of cartilage, which help keep the trachea open during extreme movement of the neck. The lining includes cells that secrete mucus along with other cells that bear very small hairlike fringes. This mucus traps tiny particles of debris, and the beating of the fringes moves the mucus up and out of the respiratory tract, keeping the lungs and air passages free.

In Russian folk medicine, there is the thought that rubbing the chest with pork fat will cure a cold. Mustard plasters and boiled snails in barley water were thought to be effective by others, and nobody knows what the ingredients were for early “cure-all tonics” and “snake oil” kits. It is now believed that the best medicine is to rest, keep warm, drink plenty of fluids, and eat good, digestible meals. Sounds good to me…and certainly better smelling. Spine, Vertebra and Disk The spine is a column of bone and cartilage that extends from the base of the skull to the pelvis. It encloses and protects the spinal cord and supports the trunk of the body and the head. The spine is made up of approximately thirty-three bones called “vertebrae.” Each pair of vertebrae is connected by a joint which stabilizes the vertebral column and allows it to move. Between each pair of vertebrae is a disk-shaped pad of fibrous cartilage with a jelly-like core, which is called the “intervertebral” disk – or usually just the “disk”. These disks cushion the vertebrae during movement.

The entire spine encloses and protects the spinal cord, which is a column of nerve tracts running from every area of the body to the brain. The vertebrae are bound together by two long, thick ligaments running the entire length of the spine and by smaller ligaments between each pair of vertebrae. The anterior longitudinal ligament consists of strong, dense fibers, located inside the bodies of the vertebrae. They span nearly the whole length of the spine, beginning with the second vertebrae (or “axis”), and extending to the sacrum. The ligament is thicker in the middle (or “thoracic” region). Some of the shorter fibers are separated by circular openings, which allow for the passage of blood vessels. Several groups of muscles are also attached to the vertebrae, and these control movements of the spine as well as to support it. Quasimodo, the central character of Victor Hugo’s novel, “The Hunchback of Notre Dame,” is probably the most famous of all real or fictional sufferers of “kyphosis,” an abnormal, backward curvature of the spine.

Vocal Chord The vocal cords are two fibrous sheets of tissue that are stretched in the inner surface of the Adams apple, which are responsible for voice production. (part of larynx) The Trachea (Human Anatomy): Picture, Function, Conditions, and More Human Anatomy Picture of the Trachea © 2014 WebMD, LLC. All rights reserved. The trachea, commonly known as the windpipe, is a tube about 4 inches long and less than an inch in diameter in most people. The trachea begins just under the larynx (voice box) and runs down behind the breastbone (sternum). The trachea then divides into two smaller tubes called bronchi: one bronchus for each lung. The trachea is composed of about 20 rings of tough cartilage. The back part of each ring is made of muscle and connective tissue. Moist, smooth tissue called mucosa lines the inside of the trachea. The trachea widens and lengthens slightly with each breath in, returning to its resting size with each breath out.

Trachea Conditions Tracheal stenosis: Inflammation in the trachea can lead to scarring and narrowing of the windpipe. Surgery or endoscopy may be needed to correct the narrowing (stenosis), if severe. Tracheoesophageal fistula : An abnormal channel forms to connect the trachea and the esophagus. Passage of swallowed food from the esophagus into the trachea causes serious lung problems. Tracheal foreign body: An object is inhaled (aspirated) and lodges in the trachea or one of its branches. A procedure called bronchoscopy is usually needed to remove a foreign body from the trachea. Tracheal cancer: Cancer of the trachea is quite rare. Symptoms can include coughing or difficulty breathing. Tracheomalacia: The trachea is soft and floppy rather than rigid, usually due to a birth defect. In adults, tracheomalacia is generally caused by injury or by smoking. Tracheal obstruction: A tumor or other growth can compress and narrow the trachea, causing difficulty breathing. A stent or surgery is needed to open the trachea and improve breathing.

Trachea Tests Flexible bronchoscopy : An endoscope (flexible tube with a lighted camera on its end) is passed through the nose or mouth into the trachea. Using bronchoscopy, a doctor can examine the trachea and its branches. Rigid bronchoscopy : A rigid metal tube is introduced through the mouth into the trachea. Rigid bronchoscopy is often more effective than flexible bronchoscopy, but it requires deep anesthesia. Computed tomography ( CT scan ): A CT scanner takes a series of X-rays, and a computer creates detailed images of the trachea and nearby structures. Magnetic resonance imaging ( MRI scan ): An MRI scanner uses radio waves in a magnetic field to create images of the trachea and nearby structures. Chest X-ray : A plain X-ray can tell if the trachea is deviated to either side of the chest. An X-ray might also identify masses or foreign bodies. Tracheostomy Pocket Guide Tracheostomy Tracheostomy (sometimes called tracheotomy) is the creation of an opening directly into the trachea (windpipe) in the neck for the purpose of assisting breathing.

While tracheotomy used to be done as an emergency, it is now done more on an elective basis to protect the airway, better clean the airway and to provide more oxygen to the lungs. Anatomy and Physiology At the back of the mouth and nose the air passages form the pharynx, which continues into the larynx (voice box). The larynx may be felt as the Adam's apple in front of the neck (Figures 1 and 2) The trachea is a tube that runs from the bottom of the larynx into the chest where it divides into the bronchi, the tubes that go to each of the lungs The thyroid gland lies in front of the trachea. The esophagus (foodpipe) lies behind it The innominate artery passes in front of the lower tracheal rings of the trachea. This artery is a branch of the aorta (the major artery coming from the heart) and gives rise to the arteries to the right side of the brain and right arm The trachea is a rigid structure formed from rings of cartilage to ensure that the airway always remains open. Its function is to maintain and protect the airway.

The trachea is lined with mucus glands, which humidifies air as it passes through the trachea and catches small particles before they reach the lungs. The trachea also has specialized hair like structures called cilia that move rhythmically to sweep mucus and particles back up to the throat. The trachea also has many defensive cells that kill organisms that enter the trachea The trachea is supplied by nerves that are part of the cough reflex that helps get rid or irritants Figure 1 - The trachea as seen from in front. The trachea lies below the thyroid cartilage, which forms the front wall of the larynx. The thyroid isthmus crosses the trachea and the recurrent laryngeal nerve (to the vocal cords) lies on each side of the trachea. ï¿½ T. Graves Figure 2 - Section through the neck showing the relationships of the trachea to the larynx, esophagus and thyroid isthmus. ï¿½ T.

Graves Pathology Obstruction of the air passages may occur as a result of: Swallowing of a foreign material or improper swallowing of food Swelling of the air passages due to allergy Loss of trachea stiffness due to weakening of the tracheal rings, which may be either present at birth or from prolonged placement of a tube in the trachea (see Anesthesia) Injury to the face and upper airways Obstruction usually takes place in the larynx, which is the narrowest part of the air passages Patients on a ventilator (breathing machine) for a long time May be sedated and may not be able to cough to clear secretions from the lung and trachea which causes plugging of the air passages May vomit and aspirate food into the lungs causing pneumonia May need increased delivery of oxygen. A tracheotomy bypasses the larynx and delivers air directly into the trachea May develop ulcers around the mouth as well as weakness and narrowing of the larynx and upper trachea from prolonged pressure of the breathing tubes that pass through the mouth Cancers of the upper airway may cause obstruction that may require a tracheostomy.

Surgery for cancers of the upper airway also frequently require a tracheostomy Indications for surgery Emergent indications for a tracheostomy are few. In situations of acute obstruction of the airway due to trauma or allergic swelling, an immediate airway is better obtained by intubating (inserting a tube) the trachea by mouth or nose. Sometimes it may be necessary to guide the tube into the trachea using a flexible bronchoscope (a camera on a flexible tube). If necessary, a cricothyroidectomy, which is a small incision in the lower larynx, may be made to allow air passage. These measures may be temporary until the patient is stable enough to undergo a tracheostomy in the operating room A tracheostomy is advisable for patients who have been on a ventilator for over 5-7 days. A tracheostomy helps in suctioning of secretions, increased delivery of air to the lungs, prevention of aspiration in case the patient vomits and prevention of complications associated with endotracheal tubes through the mouth. Patients with cancers of the upper airway undergoing surgery may need bypass of their airway circuit, with creation of a permanent tracheostomy.

Surgical Procedure Before performing a tracheostomy the site of obstruction should be determined to be above the site of the tracheostomy. Patients with large or short necks may be difficult to operate upon Bleeding disorders or an enlarged thyroid gland should be evaluated The procedure is usually done under general anesthesia in the operating room. However, if the patient is sedated on a ventilator, it may be done under local anesthetic, even at the patient's bedside The patient is placed supine (on the back) with the head extended to expose the front of the neck (Figure 3) The incision is made over the second tracheal ring below the larynx. The incision may be made from side to side or up and down (Figure 4) Figure 3 - The patient is placed with the head and neck extended. ï¿½ T. Graves Figure 4 - The procedure can be carried out using either a vertical (up and down) or horizontal (side to side) incision. ï¿½ T.

Graves The underlying small muscles in front of the trachea are spread to the side Sometimes the isthmus (thin middle portion) of the thyroid may have to be cut to expose the second tracheal ring Once the trachea is exposed, an incision is made through the second and sometimes third tracheal cartilage rings. The incision may be in the form of a flap or a small segment the tracheal ring may be removed (Figure 5) The tracheostomy tube, the metal or plastic tube to be placed in the trachea, is measured for size to fit the trachea The anesthetist slowly withdraws the endotracheal tube through the mouth. As soon as the tube is pulled above the level of the second cartilage, the tracheostomy tube is pushed into the trachea and directed downwards. The tube contains an obturator (central portion) that has a cone shaped nose to guide the tube into the trachea. The obturator is removed after the tube is inserted (Figure 6) Figure 5 - The trachea is exposed and an incision made in the second tracheal ring. ï¿½ T.

Graves Figure 6 - The tracheostomy tube is inserted into the trachea. ï¿½ T. Graves The tracheostomy tube has a balloon at its end, which is inflated to prevent secretions from getting into the lungs (Figure 7) The tube from the breathing machine or oxygen tube is connected to the tracheostomy tube. Sutures are used to close the skin incision and a cloth tape is tied around the neck to secure the tube (Figure 8) Figure 7 - The position of the tracheostomy tube in the trachea. Note that the balloon on the tube is inflated to prevent secretions from going into the lungs. ï¿½ T. Graves Figure 8 - The wound is closed around the tracheostomy tube. ï¿½ T. Graves Complications Tracheostomies can become contaminated and improper care can lead to infection of the skin, trachea or lungs Bleeding may occur from injury to a high innominate artery, jugular veins or thyroid gland. Severe bleeding may occur if the tracheostomy tube erodes through the anterior wall of the trachea into the arteries that lie there or into the thyroid gland.

This may be a problem particularly in children where the tracheas are smaller. The bleeding may be life threatening and needs emergency surgery to control the bleeding Prolonged use of a tracheostomy tube may cause stenosis (narrowing) of the trachea from scarring or tracheomalacia (floppiness of the trachea). These may cause progressive obstruction of the trachea requiring surgery to remove the scarred or weakened portion of the trachea Pneumothorax (air between the lung and chest wall) may occur following tracheostomy. This occurs more frequently in children Obstruction of the tube can occur from a blood clot or mucous plug and if the end of the tube presses against the back wall of the trachea The tube may come out. This is a very serious complication since the patient may not be able to breath Tracheoesophageal fistula (connection between the trachea and the esophagus) can occur if the tube erodes through the back of the trachea and into the esophagus.

Surgery is necessary to separate the trachea and esophagus Dysphagia (difficulty in swallowing) may occur from pressure of the tube on the back of the trachea Poor laryngeal function may result from prolonged use of a tracheostomy Care After Surgery It is very important to keep the tracheostomy clear of secretions The tracheostomy tube has a double lumen (a tube within a tube) made of plastic. The inner tube may be removed for cleaning. It is also important to suction out the tracheostomy several times a day to clear secretions The air going through the tracheostomy is humidified to prevent the trachea from drying up The dressing around the tracheostomy opening is changed daily and kept dry As the patient recovers and does not need ventilator assistance, the patient may become apprehensive. It is not possible to talk with a tracheostomy tube in place as air is bypassed from the voice box and this may be distressing to a patient Fenestrated tubes (tubes with a side-hole through them) allow air to pass through the tube into the voice box.

As the patient recovers, the opening in the neck may be capped and the patient may be able to talk As the patient recovers, the tracheostomy tube may be changed at the bedside into a smaller size and eventually removed. The opening in the neck closes by itself in about a week Patients who have permanent tracheostomies are taught to care for their tubes. They should not to go swimming and should be careful while taking a bath to prevent water from entering the tube and causing aspiration pneumonia Site written and maintained by Cynthia Bissell, RN Questions, comments, suggestions always welcome. Copyright 1996- 2014 tracheostomy.com

Question: The Adam’s Apple helps to protect the walls and the front section of what bodily part?
Answer: LARYNX