TRACHE

A
GUIDED BY-Dr Bishrita Swain
Lecturer,department of sharira rachana(Anatomy)
PRESENTED BY-Ankita Dash
1st year BAMS student
2019-2020
 TRACHEA
The word "trachea" is used to define a very different organ in invertebrates than in
vertebrates. Insects have an open respiratory system made up of spiracles, tracheae, and
tracheoles to transport metabolic gases to and from tissues.
The Trachea is also called windpipe and it is a fibrocartilaginous,noncollapseble tube that
creates the beginning.
.The trachea is a 4-4.5 inches (10-11cm)long tube.
.The diameter of trachea is 2cm in men and 1.5cm in females.
.The lumen is smaller in living human then that in cadavers.
.Its lumen is kept patient by 16-20 C shaped rings of the hyaline cartilage kept it’s lumen
patient.

.
 LOCATION
• The upper half of trachea lies in the neck(cervical part).
• Lower half in the superior mediastinum (thoracic part)
• Throught its whole course it is directly in front of oesophagus.
• Left recurrent laryngeal nerve lies in the groove between it &left
boarder of esophagus.
• It extent from the lower boarder of C6 to lower boarder of T4
vertebra in supine position ,where it ends by dividing into left and
right main bronchi,i.e larynx to two primary bronchi.
main carina.pdf

• At the top of the trachea the circoid cartilage attach it

to the larynx .This is the only complete tracheal
ring,the other being incomplete rings of reinforcing
cartilage.
• The trachealis muscle joins the ends of the rings and
these are joined vertically by bands of fibrous
connective tissue – the annular ligament of trachea.
• The epiglottis closes the opening to the larynx during
swallowing.
 ANATOMICAL POSITION
• The trachea marks the beginning of the
tracheobronchial tree.
• It arises at the lower boarder of cricoid cartilage in
the neck,as a continuation of the larynx.
• It travels inferiorly into the superior
mediastinum,bifurcating at the level of the sternal
angle(forming the right & left main bronchi)
• As it descends, the trachea is located anteriorly to
the oesophagus ,and inclines slightly to the right.
 CERVICAL PART OF TRACHEA
• The cervical part of trachea is all about 7cm
in length and stretches from the lower border
of cricoid cartilage to the upper boarder of
manubrium sterni (juglar notch)
• It goes downward and somewhat backward
in front of the esophagus following curvature
of the cervical spine and enters thoracic
cavity in the median plane with small
deviation on the right side
 RESPIRATORY TREE
• The overall structure of our major airways resembles an upside-down tree. (In fact, doctors often
refer to this system of tubes as the respiratory tree.) If we imagine our larynx as the root of the up-
ended tree, we can see how our trachea would represent the tree's trunk, and the bronchi and
smaller airways would represent the progressively smaller branches of the tree.
 NEAR BY STRUCTURES
• The trachea passes by many structures of the neck and thorax
along its course.
• In front of the upper trachea lies connective tissue and skin.
• The jugular arch, which joins the two anterior jugular veins, sits in
front of the upper part of the trachea.
• The sternohyoid and sternothyroid muscles stretch along its length,
and the thyroid gland sits below this.
• Behind the trachea, along its length, sits the oesophagus, followed
by connective tissue and the vertebral column. To its sides run the
carotid arteries and inferior thyroid arteries; and to its sides on its
back surface run the recurrent laryngeal nerves in the upper
trachea, and the vagus nerves in the lower trachea.
• The mediastinum contains the heart and its vessels, the esophagus, the trachea, the phrenic and
cardiac nerves, the thoracic duct, the thymus and the lymph nodes of the central chest.
 BLOOD & LYMPHATIC SUPPLY
• The upper part of trachea receives and drains blood through the inferior thyroid arteries
and veins.The lower trachea receives blood from bronchial arteries.

• As the branches approach the wall of the trachea, they split into inferior and superior
branches, which join with the branches of the arteries above and below; these then split
into branches that supply the anterior and posterior parts of the trachea.

• The lymphatic vessels of the trachea drain into the pretracheal nodes that lie in front of
the trachea, and paratracheal lymph nodes that lie beside it.
 NERVE SUPPLY

• This is by sympathetic and parasympathetic fibres.

• The parasympathetic fibres are originated from vagus via the recurrent laryngeal nerve.
(these are secretomotor and sensory to the mucus membrane and motor to the trachealis
muscle).
• The symphatetic fibres are originated from the middle cervical symphatetic ganglion.
(these are vasomotor in nature)
 FUNCTION OF TRACHEA
• The trachea plays a vital role as a passive air passageway.
• The trachealis muscle in the posterior wall allows the trachea to contract and reduce its diameter, which
makes coughs more forceful and productive.
• During the process of swallowing food, the esophagus expands into the space normally occupied by the
trachea.
• The incomplete cartilage rings of the trachea allow it to narrow and permit the esophagus to expand into its
space.
• Finally, the loose connection of the adventitia allows the trachea to move within the neck and thorax, aiding
the lungs in their expansion and contraction during breathing
 HISTOLOGY
• MUCOSA:
• It is composed of lining epithelium and lamina propia.
• Lining of epithelim is pseudostratified ciliated columnar with few goblet cells.
• Lamina propia is composed of longitudinal elstic fibres.
• Goblet cells produce sticky mucus to coat the inner lining of the trachea and catch any debris
present in inhaled air before it reaches the lungs.
• Mucus from the trachea, along with any trapped contaminants, makes its way to the larynx,
where it is either expelled during coughing or swallowed and digested in the stomach.
• SUBMUCOSA:
• It is composed of loose areolar tissue consist of large number of serous and mucous glands.
• Cartilage & smooth muscle layer:It is created from horseshoe shaped(C-shaped)hyaline cartilaginous
rings , that are deficient posteriorly .The posterior gap is filled up chiefly by the smooth muscle
(trachealis)and fibroelastic fibres.
• Perichondrium:It encloses the cartilage.
• Fibrous membrane:It is a layer of dense connective tissue,consisting of neurovascular structure
• There is no clear difference between lamina propia & submucosa.
 CLINICAL SIGNIFICANCE
• INFLAMMATION:
• Inflammation of the trachea is known as tracheitis. It can also occur with inflammation of the larynx and
bronchi, known as croup.It can be caused by viruses and bacteria, with typical bacterial causes including
staphylococcus aureus, haemophilus influenzae, streptococcus pneumonia, and pseudomonas aeruginosa.
Bacterial tracheitis occurs almost entirely in children.
• A person affected with bacterial tracheitis may start with symptoms that suggest an upper respiratory tract
infection; this may include a cough, sore throat, or coryzal symptoms (such as a runny nose). Fevers may
develop. Swelling of the airway may eventually progress to airway obstruction; when the airway is
narrowed, this may result in a hoarse breathing sound called stridor.
• Unfortunately, up to 80% of people affected by tracheitis require intubation, and treatment may include
endoscopy for the purposes of acquiring microbiological specimens for culture and sensitivity, as well as
removal (debridement) of any dead tissue associated with the infection. Treatment of the underlying cause
usually involves antibiotics.
 TRACHEAL STENOSIS
• NARROWING OF TRACHEA:
• It is also called Tracheal stenosis.
• A trachea may be narrowed of compressed, usually a result of enlarged nearby lymph nodes; cancers of
the trachea or nearby structures; large thyroid goitres; or rarely as a result of other processes such as
unusually swollen blood vessels.
• Scarring from tracheobronchial injury or intubation; or inflammation associated with granulomatosis
with polyangiitis may also cause a narrowing of the trachea (tracheal stenosis.
• Obstruction invariably causes a harsh breathing sound known as stridor.A camera inserted via the
mouth down into the trachea, called bronchoscopy, may be performed to investigate the cause of an
obstruction.
Congenital tracheal stenosis
• TRACHEAL INTUBATION:
• Tracheal intubation refers to the insertion of a catheter down the trachea. This procedure is
commonly performed during surgery, in order to ensure a person receives enough oxygen when
sedated. The catheter is connected to a machine that monitors the airflow, oxygenation and
several other metrics. This is often one of the responsibilities of an anesthetist during surgery.
The epiglottic vallecula is an important anatomical landmark for carrying out this procedure.
 TRACHEOSTOMY
• A tracheostomy is a medical procedure either
temporary or permanent that involves
creating an opening in the neck in order to
place a tube into a person's windpipe. The
tube is inserted through a cut in the neck
below the vocal cords. This allows air to
enter the lungs.
• INDICATIONS OF TRACHEOSTOMY
• There are four main reasons why someone would receive a tracheotomy.
• 1. Emergency airway access
• 2. Airway access for prolonged mechanical ventilation
• 3. Functional or mechanical upper airway obstruction
• 4. Decreased/incompetent clearance of tracheobronchial secretions
THANK YOU
Any question?
QUIZ TIME
1>Which of the following is a function of the tracheal smooth muscle fibres?
• A-To provide support and prevent the tracheal wall from collapsing
• B-Contract to narrow lumen when coughing to dislodge foreign particles
• C-Move a food bolus into the esophagus.
• ANSWER -B
2>The posterior trachea is loosely connected to:
A-Esophagus B-Diaphragm C-Liver
ANSWER-A
3>What is the outer layer of tracheal wall?
A-Hyaline cartilage B-The adventitia C-Submucosa
ANSWER - B
4>Which of the following is a function of the cartilaginous tracheal rings?
• A- Secrete a layer of mucous
• B-Prevent food from entering trachea
• C-Support tracheal wall and prevent air passage way from collapsing
• ANSWER-C
5>Approxmately how many cartilage rings are embedded in the wall of the trachea?
• A-16-20 B-20-25 C-5-10
• ANSWER-A
6>Identify the epithelium that lines the luminal surface of the trachea?
• A-Pseudostratified ciliated columnar cells & goblet cells
• B-Simple squamous cells
• C-Simple cuboidal cells
• ANSWER-A
7>The Trachea:
• A-lies deep to the oesophagus
• B-lies superficial to the oesophagus.
• C-is totally enclosed by cartilaginous rings.
• ANSWER-B
8>The extend of trachea is from
• A.C6-T4 B.C5-T6 C.C3-T5 D.C4-T6
• ANSWER-A
9>Creating an opening in the neck in order to place a tube is done in which case?
. A-Tracheal stenosis B-Tracheal intubation C- Tracheostomy D-Inflammation of trachea
ANSWER – C
10>Larynx is found at what vertebral level?
A.CV2-CV5 B.CV5-CV2 C.CV6-CV3 D.CV3-CV6
ANSWER-D
 FILL IN THE BLANKS
1>In thorax posteriorly the trachea connected to _______and________.
• ANSWER-Esophagus and left recurrent laryngeal nerve.
2>Trachea attach to the larynx by __________.
• ANSWER-Cricoid cartilage
3>Trachea bifurcates at the level of ___________.
• ANSWER-Sternal angle
4>The cervical part of trachea is about ________ cm in length.
• ANSWER-7cm
5>Along its length ____________muscle stretches the trachea.
• ANSWER-Sternohyoid & sternothyroid
6>The upper trachea receive & drains the blood through the ________ artery.
• ANS-Inferior thyroid artery
7>The lower trachea receive blood from ______ artery.
• ANS-Bronchial
8>The nerve supply to the trachea is by _____ & _______ Fibres.
• ANS-Sympathetic & parasympathetic nerve
9>The sternum & thymus present on________ side at the trachea.
• ANS- Anterior.
10>Narrowing of trachea is also called ___________ .
• ANS- Tracheal stenosis.