THE RESPIRATORY SYSTEM
The parts of the respiratory system in the head and
neck are:
The nasal cavity
The larynx
The cervical part of trachea
The nasal cavity is the first part of the respiratory
tract. The nasal cavity is divided into two
halvesthe right and the leftby a median
nasal septum.
Each half of the nasal cavity opens on the
face through the external nare or nostril, a
piriform aperture 1.52.0 cm long and 0.5
1.0 cm wide.
It opens posteriorly in anterior wall of
nasopharynx by posterior nasal aperture
(choana) an oval opening about 2.5 cm long
and 1.25 cm wide.
Each half of nasal cavity hasa roof, a
floor, a lateral wall and a medial wall.
Fig. 41.1: Coronal section through nasal cavities
The roof is very narrow and has three parts:
(Fig. 41.1)
The anterior (fronto-nasal part) is sloping
forwards.
The middle (ethmoidal part) is horizontal and
formed by cribriform plate of ethmoid. It is
only few millimeters wide.
The posterior (sphenoidal part) slopes
backwards.
The floor is concave transversely and is almost
horizontal.
It is formed by superior surface of palatal
process of maxilla and horizontal plate of
palatine bone.
The medial wall is formed by nasal septum. It
is formed:
Antero-superiorly by the septal cartilage.
Postero-superiorly by the perpendicular plate
of ethmoid.
Postero-inferiorly by the vomer bone.
The nasal septum is usually deviated towards
one side, so that the two nasal chambers
are not equal in size.
The nasal septum is covered by a thick layer
of muco-periosteum (muco-perichondrium)
containing a plexus of minute veins and
many mucous glands.
The lateral wall has the following parts: (Fig.
41.2)
a. The vestibule of the nose lies just above
external nase, is lined by skin and has thick,
curved, sensitive hairs called vibrissae.
b. The atrium of the middle meatus lies above
the vestibule. It shows in upper part an
 The Viscera of the Head and Neck1
Fig. 41.2: The lateral wall of the nasal cavity
ill-defined swelling agger nasi representing
a rudimentary concha.
c. The region of conchae and meatuses is the
larger posterior part of nasal chamber.
There are three nasal conchaesuperior,
middle and inferior. These are curved
bony plates lined by muco-periosteum.
The three conchae separate the lateral
wall into four meatuses.
i. The spheno-ethmoidal recess is a
narrow space above superior con-
cha.
ii. The superior meatus lies between the
superior and middle concha.
iii. The middle meatus is the largest and
lies between middle and inferior
concha.
There is a round swelling bulla
ethmoidalis limited below by
curved gutter hiatus semilunaris
in the upper part of the meatus.
iv. The inferior meatus lies between the
inferior concha and the floor of the
nasal chamber.
The lateral wall of nose is also lined by muco-
periosteum containing a plexus of minute veins
453
and many mucous glands. The inhaled air
circulates through the meatuses. It is warmed,
moistened and purified (of dust particles) in the
nasal cavity.
The muco-periosteum is also continuous with
the lining of the paranasal air sinuses that open
in the lateral wall of nasal chamber.
The Openings in the Lateral Wall
The paranasal sinuses and the naso-lacrimal duct
open in the lateral wall of the nasal chamber. These
openings are:
a. Opening of sphenoidal air sinus is in the
spheno-ethmoidal recess.
b. Opening of posterior ethmoidal air sinuses
is located in the superior meatus.
c. Opening of middle ethmoidal air sinuses is
located above the bulla ethmoidalis.
d. Opening of fronto nasal duct from the frontal
air sinus is present in anterior part of hiatus
semilunaris.
f. Opening of maxillary air sinus is located in
the lower part of hiatus semilunaris.
g. Opening of nasolacrimal duct is located in
anterior part of inferior meatus of nose.
454 Essentials of Human Anatomy
The Blood Supply of the Nasal Cavity
The arteries: There is a rich anastomosis between
the branches of internal carotid and external carotid
arteries in the walls of nasal cavity.
i. The ethmoidal arteriesanterior and posterior
from the ophthalmic branch of internal carotid
artery supply the anterior and superior parts.
ii. The spheno-palatine artery, a branch of
maxillary artery supplies the posterior part.
iii. The greater palatine artery also a branch of
maxillary artery supplies anterior and inferior
parts.
iv. The superior labial branch of facial artery
supplies the lower part of septal cartilage and
lateral wall.
The veins: The veins form a rich submucus venous
plexus in the mucoperiosteum. The venous plexus
drains mainly in the pterygoid venous plexus.
The vasodilation of the venous plexus due to
infection or allergy causes blockage of the nasal
chamber.
The Nerve Supply of the Nasal Cavity
I. The nerves of special sense of smell, the olfactory
nerves, about twenty in number begin from the
special receptor cells in the nasal mucosa and pass
through the cribriform plate to end in the olfactory
bulb.
The olfactory nerves mainly supply the upper
part of the nasal cavity.
II. The nerves of general sensation
For the anterior part of nasal cavity the nerves
are branches from the ophthalmic division of
trigeminal nerve. These nerves are:
The anterior ethmoidal nerve.
The posterior ethmoidal nerve.
For the posterior part of nasal cavity the nerves
are the branches of maxillary division of
trigeminal nerve. These are:
The naso-palatine nerve that runs along the
nasal septum and enters the hard palate
through incisive canal to supply it.
The posterior superior nasal branches
medial and lateral supplythe nasal septum
and the lateral wall.
The anterior superior alveolar nerve
supplies a small area around anterior part of
the inferior concha.
PARANASAL AIR SINUSES
The paranasal air sinuses are air-filled spaces
in the cranial bones around the nasal cavities.
They open in the lateral wall of nasal cavity
and their lining epithelium is continuous with
the mucoperiosteum of nasal cavity.
They are rudimentary at birth and gradually
increase in size with age. They are smaller in
females.
The air sinuses make the cranial bones
pneumatic and lighter. They also help in the
resonance of voice (The male voice is deeper
due to same reason).
The different paranasal sinuses are
Frontal air sinuses - paired
Sphenoidal air sinuses - paired
Maxillary air sinuses - paired
Ethmoidal air sinuses - anterior, middle, and
posterior groups.
Frontal air sinusesare located in anterior part of
frontal bone just above the root of nose.
They are asymmetrical in size and separated by
a bony septum. They are about 2-3 cm in height
and width.
They are smaller in females. They open by a
funnel shaped - infundibulum - in middle meatus
of nasal cavity.
Sphenoidal air sinuses are inequal pair of air sinuses
separated by a deviated septum.
They lie within body of sphenoid and may
extend into base of greater wings and pterygoid
processes.
The sphenoidal sinus is related anteriorly to nasal
cavity, inferiorly to pharying and posteriorly to
posterior cranial fossa, basilar artery and pons.
 The Viscera of the Head and Neck1
Above the sphenoidal sinus lies the hypophysis
cerebri and cavernous sinuses on either side.
Each sinus opens by a small round opening in
spheno-ethmoidal recess above superior concha
in lateral wall of nasal cavity.
Maxillary air sinuses [Antrum of Highmore] are
the largest paranasal sinuses.
Each maxillary sinus occupies whole of body
of maxilla and has shape of an irregular three
sided pyramid.
Its apex extends into zygomatic process of
maxilla and the base is formed by lateral wall of
nasal cavity. The three sides are formed by
anterior, orbital and infra-temporal surfaces of
maxilla.
The lowest part of sinus is opposite the second
premolar and first molar tooth and is
approximately 1 cm below the level of floor of
nasal cavity.
The infra-orbital groove and canal lie in the
roof of sinus. The alveolar nerves and vessels
lie along its surfaces.
The sinus opens in middle meatus of nasal cavity
by a large openingmaxillary hiatus.
Ethmoidal air sinusesare then walled cavities or
cells that occupy whole of ethmoidal labyrinths on
either side.
They are about 10-16 in number and are
arranged in three groupsanterior, middle, and
posterior.
The anterior and middle groups open by
common openings in middle meatus and poste-
rior group opens in the superior meatus of nasal
cavity.
The middle ethmoidal sinuses bulge in the
middle meatus forming a round smelling bulla
ethmoidalis.
Applied Anatomy
The sinusitis or the infection of paranasal sinuses
are the complication of infection of nasal
cavities, as the muco-periosteum is common
for both.
455
The opening of maxillary air sinus is situated at
a higher level so the infected mucus collects in
the sinus. Sometimes a surgical procedure
Antral puncture is done to exacuate the infected
material from the sinus.
THE LARYNX
The larynx is the upper modified end of trachea
for the production of voice.
The larynx also acts as a compound sphincter
of the respiratory passage.
The Skeletal Framework
(Figs 41.3 and 41.4)
The skeleton of the larynx is formed by a rigid
framework of bones, cartilages, membranes and
ligaments.
I. The bones and the cartilages are:
a. The hyoid bone in uppermost part of neck,
gives attachment to the membranes and
extrinsic muscles of larynx. (Described in
Chapter 35).
b. The cartilages of the larynx are three large
unpaired cartilagesepiglottis, thyroid, and
cricoid and three small paired cartilages
arytenoid, corniculate, and cuneiform.
The epiglottis is a leaf-like elastic fibro-
cartilage.
It is attached to hyoid bone by hyo-
epiglottic ligament and angle of
thyroid cartilage by thyro-epiglottic
ligament.
The superior surface is connected
to the dorsum of tongue by one
median and two lateral glosso-
epiglottic folds.
The inferior surface faces the upper
part of the cavity of larynx.
The thyroid cartilage consists of two
laminae fused in median plane to form
an angle of nearly 90 in males (120 in
females).
456 Essentials of Human Anatomy
Fig. 41.3: The skeletal framework of the
larynxanterior aspect
The lateral surface of thyroid lamina
has an oblique line, a raised ridge for
attachment of muscles.
The posterior border of thyroid
lamina is thick and ends above in
superior cornu and below in inferior
cornu.
The cricoid cartilage is shaped like a
signet ring with narrow arch anteriorly
and broad lamina posteriorly.
The inferior horn of thyroid cartilage
makes a plane type of synovial joint
with the arch of cricoid cartilage.
The arytenoid cartilages are small,
triangular pieces with three angles and
three surfaces:
It has an apex, a thick muscular
process and a vocal process.
The surfaces arethe medial,
antero-lateral and posterior.
The base of arytenoid forms a plane
type of synovial joint with superior
border of lamina of cricoid cartilage.
The corniculate and cuneiform cartilages
are small cartilaginous nodules, attached
to the apex of arytenoid cartilage.
Fig. 41.4: The skeletal framework of the larynx
posterior aspect
c. The membranes and ligaments
Thyrohyoid membrane extends between
the superior border of thyroid cartilage
and inferior surface of greater cornu and
body of hyoid bone.
The membrane is thick anteriorly and
on two sides to form the median and
two lateral thyrohyoid ligaments.
The hyo-epiglottic and thyro-epiglottic
ligaments connect the epiglottis to
body of hyoid and angle of thyroid
cartilage.
The median cricothyroid ligament
connects the inferior border of thyroid
cartilage to arch of cricoid cartilage.
The fibro-elastic membrane lines the
walls of the larynx. It consists of two
parts:
Above vocal folds it is known as
quadrangular membrane and
extends between arytenoid cartilage
and the epiglottis.
Below vocal folds it is known as
cricovocal membrane and extends
from upper border of cricoid carti-
lage to the vocal folds.
 The Viscera of the Head and Neck1 457

Figs 41.5A to C: The intrinsic muscles of the larynx

The Muscles of the Larynx Inferiorly by interarytenoid fold

The muscles of the larynx are divided in two groups: On two sides aryepiglottic folds
a. The extrinsic muscles connect the cartilages of Corniculate and cuneiform tuber-
larynx with neighboring bones and lie outside cles
laryngeal wall. The cavity of the larynx is divided into three
These are infra-hyoid muscles.
parts: (Fig. 41.7)
[Described in Chapter 40]
b. The intrinsic muscles form a part of laryngeal a. The upper part above the vestibular fold, is
wall (Table 41.1 and Fig. 41.5). known as vestibule of larynx.
These are further divided into: b. The middle part is a small recess between
i. The cricothyroid, the only intrinsic muscle the vestibular and vocal folds.
that lies outside laryngeal wall, in the median
region of the neck.
ii. The rest of the intrinsic muscles lie inside
the laryngeal wall.
These muscles help in the movements
of vocal cords, and make the inlet
narrow or wide.

The Cavity of the Larynx

The laryngeal inlet is an oblong aperture in
the anterior wall of laryngeal part of pharynx (Fig.
41.6).
It is bounded:
Superiorly by epiglottis Fig. 41.6: The inlet of the larynx
458 Essentials of Human Anatomy

It is called the sinus of the larynx. A pouch of

mucous membrane, the saccule of larynx,
extends upwards in persons who have pro-
fession of air blowing.
c. The lower part of the cavity of larynx extends
from the vocal folds to the lower border of cricoid
cartilage.
This part is continuous below with trachea.

The Vocal Folds

The vocal folds are a pair of prominent folds in the
lateral wall of larynx, between the middle and lower
Fig. 41.7: The cavity of the larynxcoronal section subdivisions of the cavity of larynx.
Table 41.1: The intrinsic muscles of the larynx

S. Name Origin Muscle belly Insertion Nerve supply Main actions

No.
1. Cricothyroid Arch of cricoid Small triangular Lower border and External laryngeal 1. Tensor of vocal
cartilage muscle belly inferior cornu of nerve cord
thyroid cartilage
The rest of the intrinsic muscles
2. Posterior crico Posterior surface Flat muscle belly Posterior surface Recurrent laryn- 1. Only abductor of
arytenoid lamina of cricoid Fibers converge muscular process geal nerve vocal cords
cartilage above for arytenoid cartilage
insertion
3. Oblique Apex of Two muscle slips Muscular process Same 1. Adductor of
arytenoid arytenoid cross each other of opposite ary- vocal cords
like X tenoid
4. Transverse Posterior surface Muscle fibers Posterior surface Recurrent laryn- 1. Adductor of
arytenoid of one arytenoid pass transversely of opposite ary- geal nerve vocal cord
Muscle belly tenoid
lies in median
plane
5. Aryepi- Apex of ary- Muscle belly Side of epiglottis Same 1. Narrows the inlet
glotticus tenoid cartilage slender of larynx
Appears as
continuation of
oblique arytenoid
6. Lateral crico- Superior surface Muscle fibers con- Anterior surface Same 1. Adductor of the
arytenoid of arch of cricoid verge towards muscular process vocal cord
cartilage insertion of arytenoid
cartilage
7. Thyro- Inner surface Muscle belly fills Antero lateral Same 1. Relaxes the vocal
arytenoid thyroid cartilage the space deep to surface of ary- cords
near angle thyroid cartilage tenoid cartilage
8. Vocalis Is the part of thyro-arytenoid that lies within vocal folds.
9. Thyroepiglo- Inner surface Muscle belly Epiglotticus Same 1. Widens the inlet
ticus of thyroid carti- slender of larynx
lage near its
angle
 The Viscera of the Head and Neck1
Structure
i. The vocal folds are lined by stratified
squamous epithelium.
ii. They have no submucus coat so there can
be no edema or collection of fluid in vocal
folds.
iii. They have inside
The vocal ligament upper thick edge
of crico-vocal membrane.
The vocalis muscle part of thyroaryte-
noid.
There are no mucous glands in the vocal folds
also.
Rima glottidis (glottis) is the gap between two
vocal folds. It is the narrowest part of the
respiratory passage.
The vocal folds (true vocal cords) are subject
to different movements during respiration (quiet
and deep) and phonation.
The movements of the vocal folds are possible
due to movements of arytenoid cartilage.
These movements are adduction, abduction,
tension and relaxation.
The Blood Supply of the Larynx
The Arteries
There are two paired arteries supplying larynx.
i. The superior laryngeal artery is a branch of
superior thyroid artery. It enters larynx by
piercing thyrohyoid membrane.
ii. The inferior laryngeal artery is a branch of
inferior thyroid artery. It enters larynx at the
lower border of inferior constrictor muscle
of pharynx.
The Veins
The Veins accompany the arteries and end in
superior thyroid and inferior thyroid veins.
The Nerve Supply of the Larynx
The sensory nerves of the larynx are:
Above vocal cordsthe internal laryngeal nerve.
459
Below vocal cordsthe recurrent laryngeal
nerve.
The motor nerves of the larynx are:
The external laryngeal nerve supplies crico-
thyroid muscle.
The recurrent laryngeal nerve supplies the rest
of the intrinsic muscles.
Applied Anatomy
i. The two motor nerves are liable to be injured
during thyroidectomy operations (Described
in Chapter 40).
ii. The cancer of the larynx begins from the
stratified squamous epithelium of the vocal
folds.
THE CERVICAL PART OF TRACHEA
The trachea (windpipe) begins at the lower end of
cricoid cartilage (vertebral level sixth cervical
vertebra).
Position the trachea lies in median plane in the
lower part of the front of neck.
Relations
Anterior
Superficial and deep cervical fascia.
Jugular venous arch and anterior
thyroid veins.
Isthmus of thyroid gland (second to
fourth tracheal rings).
Inferior thyroid veins.
Overlapped by sternohyoid and
sternothyroid muscles.
Posterior esophagus separating it from
the bodies of sixth and seventh cervical
vertebrae.
Recurrent laryngeal nerve lies in
tracheo esophageal groove.
Lateral thyroid lobes
The trachea is kept patent by the semicircular,
cartilaginous tracheal rings.