Upper Respiratory System

Nasal Cavity

External Structures of the Nose

● Root of the Nose

● Dorsum of Nose
● Apex of Nose
● Ala of Nose / Wing of nose
● Nostrils

Nasal Cartilage

● Nasal Bones – right and left nasal bones.

● Lateral Nasal Cartilages
● Accessory Nasal Cartilage – in between the major alar cartilage and the lateral
cartilage.
● Major Alar Cartilage
● Minor Alar Cartilage
● Alar Fibrofatty Tissue – makes up the rest of the nose, which aids by giving the nasal
wings more flexibility.
● Nasal septum – divides the nose.
➢ Cartilaginous part – a little bit more flexible than the bony part, which is
essentially good, giving the nose little bit of flexibility without breaking
➢ Bony part.

Anatomy of the Nasal Cavity

- In front of the pharynx, above the hard palate, divided by the nasal Limen into:

Nasal Vestibule
- Inside the nostril.
- Supported by the nasal cartilage.
- Lined with tissue containing hair (only found in the nasal vestibule).

Nasal Cavity Proper

- Lined by mucosa (no hair).
1. Olfactory Part
- Senses smell due to CN I.

● Olfactory Tract
● Olfactory Bulb – numerous nerves pierce through the ethmoid bone, which are…
● Olfactory Nerves – reach down towards the nasal mucosa, with epithelial cells
supporting them as they reach down with their olfactory receptors.

2. Respiratory Part

● Choanae / Turbinates – bumps on the nasal mucosa.

➢ Superior Conchae
➢ Middle Conchae
➢ Inferior Conchae

● Meatuses – spaces that have openings for the sinuses.

➢ Superior Meatus – between superior and middle conchae.
➢ Middle Meatus – between middle and inferior conchae.
➢ Inferior Meatus – below inferior conchae.

● Spheno-Ethmoidal Recess – above the superior conchae, right at the junction

between the sphenoid bone and the ethmoid bone.

Sinuses and Meatuses

● Sphenoid Sinus – opens into sphenoethmoidal recess.

● Frontal Sinus – opens into Middle Meatus.
● Ethmoidal Sinus – in between the Sphenoid and the Frontal bone
➢ Anterior Ethmoidal Air Cells – open into Middle Meatus.
➢ Middle Ethmoidal Air Cells – open into Middle Meatus.
➢ Posterior Ethmoidal Air Cells – open into Superior Meatus.

* The ethmoid sinus has numerous walls within the sinus, making air compartments →
ethmoid air cells; numerous thin-walled cavities.

● Maxillary Sinus – open into Middle Meatus.

● Nasolacrimal Duct – open into Inferior Meatus.

- Function of Sinuses:
1. Decrease relative mass of the skull.
 2. Resonance.
3. Humidification and warm-up inhaled air.
4. Produce Mucus to keep the nose from drying out.

➔ Sinusitis – increased mucus in the sinuses that may block them.

● May be caused by:
1. Common Cold 3. Nasal Polyps
2. Allergic Rhinitis 4. Deviated Septum

Nasal Mucosa

● Olfactory Mucosa
➢ Olfactory Epithelium
➢ Sustentacular Cells (Covid-19 damages these cells causing loss of smell)
➢ Basal Cells
➢ Tela Submucosa – contain olfactory glands (Bowman's glands)

● Respiratory Mucosa
➢ Respiratory Epithelium (Pseudostratified Columnar Epithelium)
➢ Goblet Cells
➢ Cilia
➢ Tela Submucosa – contain mixed mucus glands

Pharynx

- 12 to 15 cm long.

- 3 parts: nasopharynx, oropharynx, and laryngopharynx.

- Continues downwards as the esophagus.

- Control point for breathing and swallowing, so the esophagus is usually closed off
when you're breathing.

- But when you swallow, the soft palate blocks for the nasopharynx so the food doesn't
end up in your nasal cavity.

- The larynx gets blocked by the epiglottis, and the tongue pushes the food further
down by going up to the palate.
Nasopharynx

- Connected with the nasal cavity.

- Level of C1-C2.

● Vault of Pharynx – where the mucosa, which is the wet surface in the Pharynx, is
firmly attached to specific regions on the base of the skull.

● Choana (internal nose) – border between the nasal cavity and the pharynx.

● Auditory Tube – connects the middle ear to the nasopharynx / equalizing the
pressure.
➢ Ear Structures: Outer Ear, Middle Ear (ossicles (malleus, incus, and stapes) and
tympanic membrane), Inner ear.
➢ Functions:
1. Equalizing the pressure.
2. Draining the middle ear.

- When the pressure difference is stabilized, the tympanic membrane can vibrate and
this will convert into words through the whole auditory pathway.

- At rest, the auditory tube is always completely closed.

- When swallowing, the auditory tube opens, and releases some pressure in the middle
ear.

- An increase in the pressure in the middle ear will push the tympanic membrane
outwards.

- A decrease in the pressure in the middle ear will suck the tympanic membrane
inwards.

● Pharyngeal Opening of the Auditory Tube – the point where the auditory tube opens
into the pharynx.

● Cushion of the Auditory Canal (torus tubarius) – cartilage protruding above the
opening of the auditory tube.

● Pharyngeal Recess – small groove behind the auditory tube.

 ● Pharyngeal Tonsils / Adenoids – if inflamed and enlarged → block the auditory tube.

● Tubal Tonsils – behind the auditory tube.

Oropharynx

- Connected with the oral cavity.

- Level of C3-C4.

- Bordered by Soft Palate and Epiglottis

● Oropharyngeal Isthmus (Isthmus faucium) – an opening at the back of the mouth into
the throat that connects with the oral cavity to the pharynx.

Laryngopharynx

- Connected with the larynx through Laryngeal Inlet.

- Level of C5-C6.

● Pharyngeal Opening of the Oesophagus – opesn into the esophagus.

● Piriform Fossa – a depression on either side of the laryngopharynx.

- When swallowing, the epiglottis will close the laryngopharynx so the food can enter
the esophagus and down to the stomach instead of the lungs.

External Pharyngeal Muscles

● Pharyngeal Constrictors
➢ Superior Pharyngeal Constrictor
➢ Medial Pharyngeal Constrictor
➢ Inferior Pharyngeal Constrictor

● Pharyngeal Elevators
➢ Stylopharyngeus Muscle
➢ Palatopharyngeus Muscle
➢ Salpingopharyngeus Muscle
Larynx

- Located between the hyoid bone and the trachea and in front of the esophagus.

- C4-5 to C6-7.

- Function:
1. Air passage.
2. Produces sound through phonation (VOCAL BOX).

Laryngeal Cartilage

● 3 Unpaired Cartilages

➢ Epiglottis
- Lies behind the cartilage and hyoid bone.
- Attached to the thyroid cartilage.
- Function: closing off for the respiratory system when you swallow and
opening up the respiratory pathway when you breathe.

➢ Thyroid Cartilage
- Made up of right and left lamina that meet and front the laryngeal
prominence → Adam's apple.
- Each lamina has a: 1) Superior horn 2) Inferior horn.

➢ Cricoid Cartilage
- Arch (anteriorly)
- Plate (posteriorly): 1) Arytenoid articular surface 2) Thyroid articular
surface.

● 3 Paired cartilages

➢ Arytenoid Cartilage – triangular shape (side view):

- Apex
- Base (cricoid articular surface): 1) Anterior process (vocal process) 2)
Posterior process (muscular process).

➢ Corniculate Cartilage
- Lies on top of the arytenoid cartilage.
- Serves as an attachment point for muscles.
 ➢ Cuneiform Cartilage
- Aryepiglottic Fold.
- Cuneiform Tubercle.

Laryngeal Ligaments and Laryngeal Joints

- Connections in the Larynx (Juncturae Laryngis)

● Continuous Articulation (Synarthroses)

➢ Cartilaginous (Synchondroses)
- Between the Corniculate Cartilage and Apex of Arytenoid Cartilage.

➢ Fibrous (Syndesmosis)
- Thyrohyoid Membrane – between hyoid bone and thyroid cartilage
(median and lateral parts).
- Cricothyroid Membrane – between cricothyroid cartilage and thyroid
cartilage (median and lateral parts).
- Cricotracheal Ligament – between cricothyroid cartilage and trachea.
- Thyroepiglottic Ligament – between thyroid cartilage and epiglottis.
- Hyoepiglottic Ligament – between hyoid bone and epiglottis.

● Discontinuous Articulation (Synovial)

➢ Synovial Articulation (Articulation)

- Cricothyroid Articulation – between cricothyroid cartilage and inferior horn
of thyroid cartilage.
- Cricoarytenoid Articulation – between cricothyroid cartilage and base of
arytenoid cartilage.

Laryngeal Wall

● Tunica Mucosa
➢ Vestibular Fold – lined by respiratory epithelium.
➢ Vocal Fold – lined by stratified squamous epithelium.
➢ Laryngeal Glands
➢ Lymph Nodules

● Tela Submucosa
➢ Fibroelastic Membrane
 - Quadrangular Membrane – between the vestibular fold and epiglottis.
1) Upper margin – form aryepiglottic fold.
2) Lower margin – form vestibular ligament.
- Lateral Cricothyroid Ligament – has a free margin forming the vocal
ligament, which is a part of the vocal folds.

● Muscles (and cartilage)

➢ Muscles that open and narrow the laryngeal inlet
➢ Muscles that open and narrow the rima glottidis
➢ Muscles that act on the vocal cord
- Tenses Vocal Cord: Cricothyroid Muscle.
- Decrease Tension of vocal cord: Vocalis Muscle.

● Tunica Adventitia
➢ Tough connective tissue consisting mainly of dense collagen fibers

Blood Supply to Nasal Cavity

Innervation of Nasal Cavity

➔ Epistaxis – nosebleed.
● Rich blood supply to the nasal mucosa.
● Cause: trauma and bleeding is from an area in the anterior 1/3 of the nose.
● Associated with infections and hypertension.
● Spurting of blood from the nose results from rupture of arteries.
● Mild epistaxis may result from nose picking which tears veins in the vestibule of
the nose.