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Clinical anatomy of the trachea and bronchi

The respiratory throat (trachea) is a continuation of the larynx, with which it is connected through the cricotracheal ligament (lig. Cricotracheale). Trachea - a long cylindrical tube (length 11-13 cm); it begins at the body level of Suz. and at the level of ThiV — Thv is divided into two main bronchi (bronchus principalis dexter et sinister). The beginning of the septum dividing the trachea is called the spur (carina; Fig. 3.6), and the division site is called bifurcation. In newborns, the lower end of the trachea is at the level of the ThIU — ThIV bodies, at the age of 2-6 years - at the level of the ThIv body.

The wall of the trachea consists of 16-20 hyaline cartilage (cartilagines tracheales) horseshoe-shaped, the free ends of which are directed posteriorly. Between them, the membranous part of the tracheal wall (paries membranaceus tracheae), consisting of a large number of collagen and elastic fibers, is stretched. In the deep layers there are smooth muscle fibers.

Cartilages are interconnected by annular ligaments (Iigg. Annularia). The lumen of the trachea expands upon inhalation and narrows upon exhalation. The lumen width of the trachea varies: in men it varies from 15 to 22 mm, in women from 13 to 18 mm, in a nursing infant it is 6-7 mm, in a child of 10 years old it is 8-11 mm. From the inside, the trachea is lined with mucous membrane and covered with a cylindrical ciliated epithelium. The working movement of the cilia is directed upward. In the mucous membrane of the trachea there are many glands that produce a protein-mucous secretion. In the area of ​​the posterior wall, the mucous membrane forms small folds.

In the loose connective tissue surrounding the trachea, there is a large number of lymph nodes, especially a lot of them in the area of ​​bifurcation.

The posterior membranous part of the tracheal wall is adjacent to the anterior wall of the esophagus. This ratio should be borne in mind when performing a tracheostomy, when it is possible to injure the wall of the esophagus and the formation of further tracheoesophageal fistula.

A large vessel (arcus aortae et a.anonyma) is adjacent to the anterior and lateral walls of the trachea, in addition, the isthmus of the thyroid gland lies in the cervical part on the front surface of the trachea, and the thymus (gl.thymus in children under the age of 14–16 years) ) At the bifurcation site, the spur (carina) is slightly deviated to the left. Of the two main bronchi, the right is shorter and wider than the left. The length of the right bronchus is 3 cm, the left is 5 cm. The diameter of the main bronchi is on average 10-16 mm. The right bronchus is almost a continuation of the trachea, so foreign bodies most often fall into it.
Entering the lungs

Fig. 3.5.

Innervation of the neck and larynx

.

1 - tip of the tongue; 2 - an internal jugular vein; 3 - stylo-lingual muscle; 4 - lingual-lingual muscle; 5 - sympathetic trunk; 6 - chin-hyoid muscle; 7 — hyoid bone; 8 - upper cardiac cervical nerve; 9 — vagus nerve; 10 - thyroid cartilage; 11 — upper cardiac branch; 12 - thyroid gland, 13 - recurrent laryngeal nerve; 14, 17 — lower infernal branch, 15 — communicative depressive-return branch; 16 - common carotid artery; 18 - subclavian artery; 19 - aortic arch; 20 - lower laryngeal nerve; 21 - pulmonary trunk; 22 - superior vena cava; 23 - ascending aorta; 24 - brachiocephalic trunk; 25 - I rib; 26 - lower throat nerve; 27 - subclavian artery; 28 - anterior scalene muscle; 29 - common carotid artery; 30 - brachial plexus; 31 — vertebral artery; 32 - recurrent laryngeal nerve; 33 - middle scalene muscle; 34 - posterior scalene muscle; 35 - muscle lifting the scapula; 36 - upper laryngeal nerve; 37 - the hyoid nerve; 38 - upper cervical ganglion; 39 - the lower node of the vagus nerve; 40 - glossopharyngeal nerve; 41 - a throat.



each of the main bronchi, branching, tapers, goes down and back to the base of the lung, branching tree-like in it.

The bronchial tree is characterized by movements similar to peristaltic (when inhaling, the bronchus lengthens and expands, when exhaling - vice versa).

The trachea and bronchial tubes are carried out due to the lower thyroid (a.thyroidea inferior) and bronchial (a.bronchialis) arteries, their branches run along the lateral wall of the trachea and bronchi, as well as in transverse direction between the cartilages in the annular ligament (lig. annularae) and form the plexus. The veins of the trachea and bronchi flow into the lower thyroid veins (w.thyroideae inferiores).

The trachea and bronchial neuritis occurs due to the recurrent nerve (n.recurrens), the vagus nerve (n.vagus) and its tracheal branches, which form the tracheal plexus (plexus trachealis) in the lower section of the respiratory tract.

The muscle fibers embedded in the bronchi are supplied with nerve fibers of the vagus and sympathetic nerves.
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Clinical anatomy of the trachea and bronchi

  1. Clinical anatomy of the trachea and bronchi
    The respiratory throat or trachea is a direct continuation of the larynx and refers to the initial section of the lower respiratory tract. The trachea is a hollow elastic tube, somewhat compressed in the anteroposterior direction. Above, through the cricoid-tracheal ligament, it connects to the larynx, below, in the bifurcation area, it is divided into two main bronchi. Distinguish in the trachea
  2. Clinical anatomy of the esophagus, trachea and bronchus
    Clinical anatomy of the esophagus, trachea and
  3. CLINICAL ANATOMY AND PHYSIOLOGY OF THE Larynx, Trachea, and BRONCH
    CLINICAL ANATOMY AND PHYSIOLOGY OF THE LARYNX, TRAJA AND
  4. Clinical physiology of the larynx, trachea and bronchi
    Resume function. The larynx is part of the airway; when inhaling, it conducts air to the lower sections - the trachea, bronchi and lungs, when exhaling, the air passes in the opposite direction. The act of breathing is provided by the respiratory muscles, and in the larynx by the contraction of the posterior cricoid muscles, which expand the glottis. When breathing, the glottis is always open,
  5. Malformations of the wall of the trachea and bronchi.
    Malformations of the structural elements of the wall of the trachea, bronchi and bronchioles are morphologically associated with the absence, deficiency or disorganization of cartilage or elastic and muscle tissue. Malformations of the wall of the bronchi can be divided into limited and common. Limited defects of tracheobronchial structures usually lead to local narrowing of a particular segment
  6. Physiology of the trachea and bronchi
    The main function of the trachea and bronchi is respiratory. During breathing, in connection with excursions of the chest, the trachea and bronchi make a number of movements, while the bifurcation of the trachea during inspiration moves down and anterior to 2 cm (Lepnev P.G., 1956). The volume of air in the tracheobronchial tree, the so-called "harmful space" is equal to 120 - 180 ml. Due to the presence, in the annular ligaments and
  7. Research methods of the trachea and bronchi
    The study of the lower respiratory tract, which include the trachea and bronchi, is carried out by endoscopic and radiological methods. With indirect laryngoscopy, you can see not only the sub-fold space of the larynx, but also the first rings of the trachea. With a deep breath, in individual patients it is possible to examine the trachea throughout the bifurcation area and even the beginning of the main bronchi. However,
  8. Damage to the bronchi and trachea
    Fractures of the first two ribs, sternum and collarbone are the most characteristic bone injuries that cause airway injuries. Hemoptysis, atelectasis, subcutaneous emphysema, pneumomediastinum or pneumothorax, which cannot be corrected by pleural drainage, are signs of possible damage to the main respiratory tract. (The presence of bilateral pneumothorax after blunt injury
  9. Foreign bodies of the trachea and bronchi
    Most often, foreign bodies of the respiratory tract are found in young children. This is because children, learning the world around them, take various objects into their mouths, and their protective reflexes are not sufficiently developed. The frequency of predominant localization of foreign bodies in the respiratory tract is as follows: in the larynx - 13%, in the trachea - 22%, in the bronchi - 65% (Rokitsky M.R., 1978). Other authors
  10. Physiology of the esophagus, trachea and bronchus
    Physiology of the Esophagus, Trachea and
  11. Injuries, foreign bodies of the esophagus, trachea and bronchus
    Injuries, foreign bodies of the esophagus, trachea and
  12. CLINICAL ANATOMY IN ANESTHESIOLOGY AND REANIMATOLOGY
    A doctor specializing in anesthesiology and resuscitation should not only study practical anesthesiology and resuscitation, but also replenish knowledge in the field of physiology, pathophysiology, pharmacology, as well as anatomy, knowledge of which is necessary during anesthesia and resuscitation. This chapter provides data on normal and topographic anatomy necessary for
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