Basic airway anatomy of adult & pediatric population ,,, for anesthesia

1. AIRWAY
ANATOMY
DR VEENA MOHAN
JR1 ANESTHESIA

2.  AIRWAY
UPPER AIRWAY
(filter,warm,moisten
the air & conduct it to
lung)
• Nose
• Paranasal sinus
• Oral cavity
• Pharynx
• larynx
LOWER AIRWAY
(gas exchange)
• Tracheobronchial tree
• Alveolar duct & sac
Passage through which air passess during respiration

4. ANATOMY OF THE UPPER AIRWAY

5. NOSE

6. NASAL SEPTUM
ITS
• 1/3 cartilaginous
• 2/3 bony
• Has
Collumellar septum
Membranous septum
Septum proper

7. LATERAL WALL
3 CONCHA
• Superior
• Middle
• Inferior
• Parts below each concha is meatus
1. Inferior meatus: receive nasolacrimal
duct
2. Middle meatus:frontal sinus
maxillary sinus
ant ethmoid sinus
Superior meatus: post
ethmoid

8. PARANASAL SINUSES
 Blind ended air containing cavity
 ANTERIOR
• Frontal
• Maxillary
• Anterior ethmoidal
 POSTERIOR
• Posterior ethmoidal
• sphenoid

9. ORAL CAVITY

Extend from lip to
oropharyngeal isthmus
it’s the
junction between
mouth &
pharynx

10. ORAL CAVITY
 TEETH: loose or buck affect laryngoscopy
 CHEEK: sinking of cheek cause difficult
Mask ventilation
 TUMOUR: Swellings in oral cavity, abscess,
Edema

11. PHARYNX
The pharynx is a fibromuscular tube
extending from the base of the skull to the
lower border of the cricoid
Anteriorly, it opens into the nasal cavity
(the nasopharynx), the mouth (the
oropharynx), and the larynx (the laryngo- or
hypopharynx

12. NASOPHARYNX
Extends from base of skull to hard
palate,corresponds to C1vertebrae
its side walls have eustachian tube opening on
either side.
The nasopharyngeal tonsils, called adenoids,
are present here
 Hypertrophied adenoids may cause obstruction
or hemorrhage while passing any device
through nose

13. OROPHARYNX
 extends from hard palate to hyoid bone
 includes the base of the tongue and epiglottis below, the soft palate above.
 It corresponds to C2 and upper part of C3
 In the lateral walls of the oropharynx are situated the palatine tonsil.
 Vallecula is the entire space between epiglottis and the base of the tongue.
 two layers of muscles,
 an external circularlayer and an internal longitudinal layer

14. LARYNGOPHARYNX
Extends from hyoid to lower border of
cricoid ,,ie from C3 lower part to C6
Also called hypopharynx

15. CARTILAGES OF THE LARYNX
 There are nine cartilages of the larynx,
 Three paired and three unpaired.
 Corniculate, Cuneiform and Arytenoid are paired.
 Thyroid, epiglottis and cricoid are unpaired.

16. SELLICKS
maneauver
Downward pressure
over cricoid, to prevent
risk of aspiration
Because cricoid is
complete ring

17. CARTILAGES

18. LARYNGEAL INLET
 BOUNDARIES
• FRONT: epiglottis
• SIDES : aryepiglottic fold
• POSTERIORLY:arytenoid
 Within corniculate
 PYRIFORM RECESS
 recess on either side of inlet
 medially: aryepiglottic fold
 laterally: thyroid &
 thyrohyoid membrane

19. THE LARYNGEAL INLET
guarded by epiglottis
either side has pyriform fossa

20. LARYNGEAL CAVITY
 Has
• Vestibular fold : overlie vestibular ligament
• Also known as false vocal cord
• Vocal fold: true vocal cord
• Vibrates and source of sound
• Overlie vocal ligament
• Glottis/Rima glottidis: vocal apparatus
 Between the vocal cord
 It’s the narrowest part of latynx in adult

21. LARYNGEAL CAVITY
 Vocal and vestibular fold divides larynx into 3parts

 VESTIBULE:
b/t laryngeal inlet
and vestibular fold
VENTRICLE
b/t vestibular
and vocal fold
SUBGLOTTIC SPACE

22. LARYNX

23. MUSCLES
1. Posterior cricoarytenoid: abductor
2. Lateral cricoarytenoid :adductor
3. Cricothyroid : tensor
4. Thyroarytenoid: relaxer
5. interarytenoid

25. NERVE SUPPLY
 The main nerves of the larynx are the recurrent laryngeal nerves and the internal
and external branches of the superior laryngeal nerves, both derivatives of the
vagus nerve.
 Motor: The recurrent laryngeal nerve for all
 ,EXCEPT cricothyroid (external branch of superior laryngeal nerve)
 Sensory: above vocal cord ,,by internal branch of superior laryngeal nerve
 : below vocal cord,, by RLN

27. LOWER
RESPIRATORY
TRACT

28. TRACHEA
from the inferior border of the cricoid cartilage at C6
• To tracheal carina(T4 posteriorly / sternal notch
• anteriorly)
• splits into theleft and right mainstem bronchi.
• R at 25 degree
• L at 45 degree
• 10-12cm long
• 2.5 cm diameter
• composed of 16 -20 Cshaped cartilages

29. Rt Bronchous
RIGHT BRONCHUS IS
WIDER ,SHORTER AND
MORE VERTICALTHAN
LEFT BRONCHUS
IT IS WIDER B/C IT
SUPPLIES MORE
VOLUMINOUS RT LUNG
IT IS MORE VERTICAL
B/CA
T ITS BIFURCA
TION
TRACHEADEVIATES MORE
TO THE RT SIDE

30. BRONCHIAL TREE
 Divided into
CONDUCTIVE PART
For gas movement
Include
• Main/ primary
bronchus
• Lobar/ secondary
bronchus
• Segmental/
teritiary bronchus
• terminal
bronchioles
TRANSITIONAL
PART
For conduction
and limited gas
exchange
• Respiratory
bronchioles
RESPIRATORY
For gas exchange
• Alveolar duct
• Alveolar sac

33. Def- The portion of the lungs aerated by each tertiary
or segmental bronchus.
Features-
- an independent respiratory district.
-covered by inter-segmental septa through which br of
pulmonary vein runs.
-the largest sub-divisions of the lobe and is surgically
resectable.
- supplied independently by segmental brochus and a
tertiary branch of pulmonary artery.

34. PEDIATRIC
AIRWAY

35. DIFFERENCES
1. Large head and tongue
2. Short neck
3. Epiglottis is longer & floppy
4. Larynx is more cephalod(C2 –C3)
5. Vocal cord is more cephalod ………..ETT caught by anterior
commissure
Difficult mask ventilation &
laryngoscopy
Use straight blade

36.  Prominent adenoid & tonsil
 Fewer smaller airways ……………Greater resistance to airflow especially
during edema
 Child larynx is conical in shape
 Narrowest point in children is cricoid cartilage{subglottic region} …….tight
ETT cause postextubation stridor
 trachea funnel shaped