The Nose and Its Adjacent Structures

The major entrance and exit for the respiratory system is through the nose. When discussing the nose, it is helpful to divide it into two major sections: external nose and internal nose.

The nares open into the nasal cavity, which is separated into left and right sections by the nasal septum (Figure 11.2). The nasal septum is formed anteriorly by a portion of the septal cartilage and posteriorly by the perpendicular plate of the ethmoid bone and the thin vomer bones.

Each lateral wall of the nasal cavity has three bony projections: the inferior conchae are separate bones, and the superior and middle conchae are portions of the ethmoid bone. Conchae increase the surface area of the nasal cavity, disrupting the flow of air as it enters the nose, which causes air to bounce along the epithelium, where it is cleaned and warmed. The conchae and meatuses trap water during exhalation, preventing dehydration.

The floor of the nasal cavity is composed of the hard palate and the soft palate. Air exits the nasal cavities via the internal nares and moves into the pharynx.

Paranasal sinuses serve to warm and humidify incoming air and are lined with a mucosa that produces mucus. Paranasal sinuses are named for their associated bone:

• frontal sinus
• maxillary sinus
• sphenoidal sinus
• ethmoidal sinus

The nares and anterior portion of the nasal cavities are lined with mucous membranes containing sebaceous glands and hair follicles that serve to prevent the passage of large debris, such as dirt, through the nasal cavity. An olfactory epithelium used to detect odors is found deeper in the nasal cavity.

The conchae, meatuses, and paranasal sinuses are lined by respiratory epithelium composed of pseudostratified ciliated columnar epithelium (Figure 11.3). The epithelium contains specialized epithelial cells that produce mucus to trap debris. The cilia of the respiratory epithelium help to remove mucus and debris with a constant beating motion, sweeping materials toward the throat to be swallowed.

This moist epithelium functions to warm and humidify incoming air. Capillaries located just beneath the nasal epithelium warm the air by convection.

Pharynx

The pharynx is divided into three major regions: the nasopharynx, the oropharynx, and the laryngopharynx (see Figure 11.4).

At the top of the nasopharynx are the pharyngeal tonsils. The function of the tonsil is not well understood, but it contains a rich supply of lymphocytes and is covered with ciliated epithelium that traps and destroys invading pathogens that enter during inhalation. The pharyngeal tonsils are large in children but tend to regress with age and may even disappear. The uvula and soft palate move like a pendulum during swallowing, swinging upward to close off the nasopharynx to prevent ingested materials from entering the nasal cavity. Auditory (Eustachian) tubes that connect to each middle ear cavity open into the nasopharynx. This connection is why colds often lead to ear infections.

The oropharynx is bordered superiorly by the nasopharynx and anteriorly by the oral cavity. The oropharynx contains two distinct sets of tonsils: the palatine tonsils and the lingual tonsils.

Similar to the pharyngeal tonsil, the palatine and lingual tonsils are composed of lymphoid tissue and trap and destroy pathogens entering the body through the oral or nasal cavities.

The laryngopharynx is inferior to the oropharynx and posterior to the larynx. It continues the route for ingested material and air until its inferior end, where the digestive and respiratory systems diverge. The stratified squamous epithelium of the oropharynx is continuous with the laryngopharynx. Anteriorly, the laryngopharynx opens into the larynx, whereas posteriorly, it enters the esophagus.

Larynx

The structure of the larynx is formed by several pieces of cartilage. Three large cartilage pieces form the major structure of the larynx:

• Thyroid cartilage (anterior):
  • The thyroid cartilage is the largest piece of cartilage that makes up the larynx. The thyroid cartilage consists of the prominence, or “Adam’s apple,” which tends to be more prominent in males.
  • Three smaller, paired cartilages—the arytenoid, corniculate, and cuneiform cartilages—attach to the thyroid cartilage and the vocal cords and muscles that help move the vocal cords to produce speech.
• Epiglottis (superior)
• Cricoid cartilage (inferior):
  • The thick cricoid cartilage forms a ring with a wide posterior region and a thinner anterior region.

When the epiglottis is in the “closed” position, the unattached end of the epiglottis rests on the glottis. A vestibular fold, or false vocal cord, is one of a pair of folded sections of mucous membrane. A true vocal cord is one of the white, membranous folds attached by muscle to the thyroid and arytenoid cartilages of the larynx on their outer edges. The inner edges of the true vocal cords are free, allowing oscillation to produce sound.

The act of swallowing causes the pharynx and larynx to lift upward, allowing the pharynx to expand and the epiglottis of the larynx to swing downward, closing the opening to the trachea. These movements produce a larger area for food to pass through while preventing food and beverages from entering the trachea.

Similar to the nasal cavity and nasopharynx, this specialized epithelium produces mucus to trap debris and pathogens as they enter the trachea. The cilia beat the mucus upward toward the laryngopharynx, where it can be swallowed down the esophagus.

Trachea

The trachea is formed by 16 to 20 stacked, C-shaped pieces of hyaline cartilage that are connected by dense connective tissue. The trachealis muscle and elastic connective tissue together form the fibroelastic membrane. The fibroelastic membrane allows the trachea to stretch and expand slightly during inhalation and exhalation, whereas the rings of cartilage provide structural support and prevent the trachea from collapsing. The trachealis muscle can be contracted to force air through the trachea during exhalation. The trachea is lined with pseudostratified ciliated columnar epithelium, which is continuous with the larynx. The esophagus borders the trachea posteriorly.

Bronchial Tree

The trachea branches into the right and left primary bronchi at the carina. These bronchi are also lined by pseudostratified ciliated columnar epithelium containing mucus-producing goblet cells. The carina is a raised structure that contains specialized nervous tissue that induces violent coughing if a foreign body, such as food, is present. Rings of cartilage, similar to those of the trachea, support the structure of the bronchi and prevent their collapse. The primary bronchi enter the lungs at the hilum. The bronchi continue to branch into the bronchial tree. Bronchial tree (or respiratory tree) is the collective term used for these multiple-branched bronchi. The main function of the bronchi, like other conducting zone structures, is to provide a passageway for air to move into and out of each lung. The mucous membrane traps debris and pathogens.

A bronchiole branches from the tertiary bronchi. Bronchioles, which are about 1 mm in diameter, further branch until they become the tiny terminal bronchioles, which lead to the structures of gas exchange. There are more than 1,000 terminal bronchioles in each lung. The muscular walls of the bronchioles do not contain cartilage like those of the bronchi. This muscular wall can change the size of the tubing to increase or decrease airflow through the tube.

Respiratory Zone

In contrast to the conducting zone, the respiratory zone includes structures that are directly involved in gas exchange. The respiratory zone begins where the terminal bronchioles join a respiratory bronchiole, the smallest type of bronchiole (see Figure 11.8), which then leads to an alveolar duct, opening into a cluster of alveoli.

Alveoli

An alveolar duct opens into a cluster of alveoli. An alveolus is one of the many small, grapelike sacs that are attached to the alveolar ducts. An alveolar sac is a cluster of many individual alveoli that are responsible for gas exchange. An alveolus is approximately 200 μm in diameter with elastic walls that allow the alveolus to stretch during air intake, which greatly increases the surface area available for gas exchange. Alveoli are connected to their neighbors by alveolar pores, which help maintain equal air pressure throughout the alveoli and lung (see Figure 11.9).

Gross Anatomy of the Lungs

The lungs are pyramid-shaped, paired organs that are connected to the trachea by the right and left bronchi; on the inferior surface, the lungs are bordered by the diaphragm. The lungs are enclosed by the pleurae, which are attached to the mediastinum. The right lung is shorter and wider than the left lung, and the left lung occupies a smaller volume than the right. The cardiac notch allows space for the heart (see Figure 11.10). The apex of the lung is the superior region, whereas the base is the opposite region near the diaphragm. The costal surface of the lung borders the ribs. The mediastinal surface faces the midline.

Each lung is composed of smaller units called lobes. Fissures separate these lobes from each other. The right lung consists of three lobes: the superior, middle, and inferior lobes. The left lung consists of two lobes: the superior and inferior lobes. A pulmonary lobule is a subdivision formed as the bronchi branch into bronchioles. Each lobule receives its own large bronchiole that has multiple branches. An interlobular septum is a wall, composed of connective tissue, which separates lobules from one another.

Pleura of the Lungs

Each lung is enclosed within a cavity that is surrounded by the pleura. The pleura (plural = pleurae) is a serous membrane that surrounds the lung. The right and left pleurae, which enclose the right and left lungs, respectively, are separated by the mediastinum.

The pleurae consist of two layers:

1. The visceral pleura is the layer that is superficial to the lungs and extends into and lines the lung fissures (see Figure 11.11).
2. The parietal pleura is the outer layer that connects to the thoracic wall, the mediastinum, and the diaphragm.

The visceral and parietal pleurae connect to each other at the hilum. The pleural cavity is the space between the visceral and parietal layers.

The pleurae perform two major functions:

1. The pleurae produce pleural fluid that lubricates surfaces, reduces friction to prevent trauma during breathing, and creates surface tension that helps maintain the position of the lungs against the thoracic wall. This adhesive characteristic of the pleural fluid causes the lungs to enlarge when the thoracic wall expands during ventilation, allowing the lungs to fill with air.
2. The pleurae also create a division between major organs that prevents interference due to the movement of the organs while preventing the spread of infection.

Image Descriptions

Figure 11.1 image description: This figure shows the upper half of the human body. The major organs in the respiratory system are labeled. [Return to Figure 11.1].

Figure 11.2 image description: This figure shows a cross section view of the nose and throat. The major parts are labeled. [Return to Figure 11.2].

Figure 11.3 image description: This figure shows a micrograph of pseudostratified epithelium. [Return to Figure 11.3].

Figure 11.4 image description: This figure shows the side view of the face. The different parts of the pharynx are color-coded and labeled (from the top): nasal cavity, hard palate, soft palate, tongue, epiglottis, larynx, esophagus, trachea. [Return to Figure 11.4].

Figure 11.5 image description: The top panel of this figure shows the anterior view of the larynx, and the bottom panel shows the right lateral view of the larynx. [Return to Figure 11.5].

Figure 11.6 image description: This diagram shows the cross section of the larynx. The different types of cartilages are labeled (clockwise from top): pyriform fossa, true vocal cord, epiglottis, tongue, glottis, vestibular fold, trachea, esophagus. [Return to Figure 11.6].

Figure 11.7 image description: The top panel of this figure shows the trachea and its organs. The major parts including the larynx, trachea, bronchi, and lungs are labeled. [Return to Figure 11.7].

Figure 11.8 image description: This image shows the bronchioles and alveolar sacs in the lungs and depicts the exchange of oxygenated and deoxygenated blood in the pulmonary blood vessels. [Return to Figure 11.8].

Figure 11.9 image description: This figure shows the detailed structure of the alveolus. The top panel shows the alveolar sacs and the bronchioles. The middle panel shows a magnified view of the alveolus, and the bottom panel shows a micrograph of the cross section of a bronchiole. [Return to Figure 11.9].

Figure 11.10 image description: Diagram of the lungs with the major parts labeled (from top, clockwise): trachea, superior lobe, main bronchus, lobar bronchus, segmental bronchus, inferior lobe, inferior lobe, middle lobe, superior lobe of the left lung. [Return to Figure 11.10].

Figure 11.11 image description: This figure shows the lungs and the chest wall, which protects the lungs, in the left panel. In the right panel, a magnified image shows the pleural cavity and a pleural sac. [Return to Figure 11.11].