This document provides an overview of the respiratory tract and pharynx through a case-based learning approach. It details the gross anatomy of the nose, nasal cavity, paranasal sinuses, larynx, lungs, trachea, and pharynx. Clinical cases are presented on epistaxis, maxillary sinusitis, vocal cord damage, and their relationship to the relevant anatomy. The learning objectives are to relate clinical respiratory conditions to the underlying anatomy and understand the gross structures of the upper and lower respiratory tract.

1. Overview of Respiratory tract
and pharynx
Case Based Learning
By
Dr. Abdul Waheed Ansari
Chairperson &Prof. Anatomy,
RAKCOMS.
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2. Learning outcomes of the CBL are as follows:-
• Able to relate the clinical condition of respiratory system with the
disturbed anatomy in upper and lower respiratory tracts.
• Gross anatomy of nose, nasal cavity and paranasal sinuses.
• Gross anatomy of larynx and pharynx.
• Gross anatomy of lungs and pleurae.
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3. A clinical case of epistaxis
• A 34 year old female presents to ED at
2am, post waking up with blood all
over her pillow, and a continuous ooze
of blood from her right nostril.
• On examination the patient is alert
and oriented, BP 110/60, pulse 95,
respiratory rate 22, and has no past
medical history. The patient reports
having a sinus infection of late which
she’s has been using an antihistamine
nasal spray to treat.
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4. Epistaxis is a clinical term to describe the
bleeding from nose.
• Nose is an olfactory and respiratory
organ. It has a root, dorsum, alae and
nostrils.
• The floor of nose forms the roof of oral
cavity. The first cranial nerve arises from
the roof of nose from olfactory
epithelium.
• The Fila olfactoria enters the anterior
cranial fossa passing through cribriform
plate of ethmoid bone.
• An injury at the root/roof of nose may
damage these olfactory nerves and there
will be drainage of CSF associated with
loss of (smell) olfactory sensation-anosmia.
• Nose also has a median nasal septum and
lateral wall of nose having three conchae
and meatuses.
• The paranasal sinuses drain in these
meatuses.
• The paranasal sinuses provide
humidification and resonance to the
voice.
• Infection of these sinuses are called as
sinusitis.
• Our first patient was having sinusitis. It is
one of the reasons for epistaxis.
• The blood supply of nose comes from
internal carotid and external carotid
branches.
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5. Gross anatomy of lateral wall of nose
• Sp=supreme concha
• S= superior concha
• M= middle concha
• I=inferior concha
• Ss= sphenoid sinus
• F=frontal sinus
• Et= Eustachian tube
• V= vestibule
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6. The median nasal septum is partly bony, cartilaginous and mucocutaneous
septum, deflection to one side is one of the cause for sinusitis-
DNS( Deflected Nasal septum)
DNS
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7. A clinical case of maxillary sinusitis
• A 24 year old medical student, presents
to the office in August complaining of
ongoing upper respiratory cold
symptoms for almost 2 weeks now.
• She has used over-the-counter
medication without significant benefit.
• She has also taken a few antibiotic pills
his roommate had laying around last
week. This also provided little benefit.
• She lists her specific symptoms as runny
nose, worsening nasal congestion, mildly
productive cough, sore throat,
headache, subjective fever and chills,
decreased appetite, and overall malaise.
• Her radiograph of head indicates
bilateral maxillary sinusitis.
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8. There are paired and unpaired paranasal sinuses arising from the nasal
cavity. They provide air conditioning and humidification, resonance to voice
and lessen the weight of the skull.
• The paired sinuses are
• Ethmoidal air cells anterior/middle and
posterior groups; they are lodged in the
bony labyrinth-ethmoid.
• Frontal sinuses are present in the
frontal bone.
• Maxillary sinuses are present in the
maxillary bone
• The sphenoidal sinus is present
in the sphenoid bone, below
pituitary fossa. It is unpaired
sinus.
• The mastoid air cells are
connected with the middle ear
cavity through nasopharynx. The
mastoid air cells are present in
the mastoid process of temporal
bone.
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10. The larynx is the voice box and it is made up of paired and unpaired
cartilages, muscles, membranes and folds. It is lined by respiratory
epithelium. Laryngitis is the inflammation of larynx.
• Male larynx is longer when
compared to female larynx.
• The cartilages are:-
• Thyroid, cricoid, epiglottis,
arytenoids, corniculate and
cuneiforms.
• The muscles of larynx are intrinsic
and extrinsic.
• All intrinsic muscles are supplied
by recurrent laryngeal nerves
except- cricothyroid-that is
supplied by external laryngeal
nerve.
• The extrinsic muscles are supplied by
ansa cervicalis.
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11. Endoscopic view of larynx
• 1=true vocal cord
• 2=vestibular fold/false vocal cord
• 3=epiglottis
• 4=arypeiglottic fold
• 5=arytenoid
• 6=piriform fossa
• 7= dorsum of tongue
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12. Movements of vocal cord are adduction,
abduction
• It is completely closed in
adduction as seen during
swallowing.
• The vocal cords are abducted
widely when we breath quietly.
• The vocal cords vibrate when we
talk.
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13. Clinical case of vocal cord damage
• A female elementary school music
teacher in her 40s notes two years of loss
of singing capabilities for five months
after school starts.
• She has definite improvement over the
summer when she uses her voice less.
• She has had problems with high soft
singing for a longer period.
• She has voice fatigue.
• On a previous ENT exam, a physician told
her that she had nodules and
recommended Speech therapy.
• This did not help according to patient.
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14. Birds have syrinx instead of larynx
• Syrinx is the name for the vocal
organ of birds. Located at the
base of a bird's trachea
• Unlike humans, parrots do not
have vocal cords. Instead, they
learn to control the movement
of the muscles in their throat to
direct the airflow in a way to
reproduce certain tones and
sounds.
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15. The pharynx
• The oral cavity leads to pharynx.
• It has three parts associated with
tongue, nose and larynx.
• Oropharynx , nasopharynx and
laryngopharynx.
• Oropharynx is that part of pharynx
which lies posterior to the tongue.
It contains tonsillar pillars and
palatine tonsils- member of
Waldeyer’s ring of lymphoid tissue
around the oral cavity.
• The nasopharynx lies posterior to
posterior nares, having pharyngeal
opening of Auditory
tube/pharyngotympanic tube or
Eustachian tube.
• The laryngopharynx lies posterior
to the larynx. It continues as
esophagus.
• The musculature of pharynx are
constrictors of pharynx.
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16. Palatine tonsils
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17. Nasopharynx
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19. The trachea is the wind pipe below cricoid cartilage, it
divides at the sternal angle in to two principal bronchi
• The right principal bronchus is wide
and in line of the trachea.
• Foreign bodies inhaled will enter the
right bronchus.
• The thyroid gland and parathyroid
glands are encircling the trachea and
enclosed in pretracheal fascia.
• Internal carotid, common carotid
arteries and internal jugular vein and
sympathetic chain and vagus nerves
are related lateral to the trachea.
• The primary bronchus divides into
secondary bronchi and enters into
each lobe of lung.
• The tertiary bronchi along with the
lung parenchyma constitute the BP
segments.
• Each lung has 10 Broncho
pulmonary segments.
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22. References
• Essential Clinical Anatomy-4th Edition- Keith Moore.
• (pages 573-577)
• ( pages 623-635)
• (pages 71-79)
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