00:01
The next thing we're going
to talk about is the trachea.
00:04
Which is not purely
a thoracic structure,
because it does
originate in the neck,
and then comes down into the thorax
before it bifurcates at a point
called the carina into two bronchi.
00:17
A right mainstem bronchus
and a left mainstem bronchus.
00:23
And the trachea is made up of
about 15 to 20 cartilaginous rings
all the way down that
helped protect the airway
on its way to and from the lungs.
00:32
So, let's look a
little closer at this.
00:35
So here we see the trachea,
and these cartilaginous rings.
00:40
That we have in quotes
here, because
they're not rings in the sense
that they go
all the way around like a circle.
00:47
The cartilage actually
ends posterior early,
and then those two ends are
joined by smooth muscle instead.
00:56
Now, that's pretty useful,
for a couple reasons.
01:00
One, that smooth muscle could
contract and narrow the lumen
when you cough, and by doing
so making a narrower lumen
makes the air go out
faster and better
remove any debris or anything
that got caught up in the trachea.
01:15
The other advantage
is that just
posterior to the trachea
is the esophagus.
01:22
And this way, if you're
swallowing a bolus of food,
instead of rubbing up against
a firm and movable cartilage,
you have a little bit of give
up against this smooth muscle.
01:32
And they're very closely aligned.
And that's not a coincidence,
it's because they develop very
similarly embryologically.
01:42
So, the parts of the trachea.
01:45
As we mentioned, the trachea
doesn't exist only in the thorax.
01:49
In fact, there's a quite a bit
that's in the cervical area.
01:52
So we call that the cervical part
where it starts just after
the end of the larynx,
which is the cricoid cartilage,
the last bit of cartilage
of the larynx,
roughly about the C6 vertebra.
02:07
And then it goes down to reach
the superior thoracic aperture.
02:11
And that's where it will become
the thoracic part.
02:15
And then it will continue
down to the bifurcation
until about the T5 vertebra
where the carina is in
this that's the point
where it splits into the bronchi.
02:27
Let's go back and look at this
entire tracheal bronchial tree here.
02:31
So it comes down and then
branches into a right main
and then a left main bronchus.
02:39
And you'll notice there's
a bit of a symmetry here.
02:42
We have the
right main bronchus being
quite a bit more vertically
oriented and shorter
than the left main bronchus.
02:50
It's also a bit wider.
02:54
The left main bronchus is a bit
narrower, and quite a bit longer.
02:59
And it's definitely more
horizontal than the right.
03:04
And we can explain this asymmetry
by something we'll learn later,
which is the heart
because the heart doesn't sit
right in the center of the thorax,
it's somewhat off to the left.
03:12
So the left main has to deal
with the presence of the heart.
03:17
This is also why if someone were
to swallow or inhale actually
a foreign body
what we can say aspirate.
03:24
and it went down into the trachea.
03:27
It's going to be more likely to go
into the right main bronchus
than the left
because of this more
vertical orientation.
03:35
Now, each mainstem bronchus
is going to branch further.
03:40
The right main bronchus
is going to branch
into secondary or lobar bronchi,
namely the right superior, right
inferior, and right middle bronchi.
03:51
Whereas on the left,
it's going to branch
into the left superior low bar
and left inferior low bar
because there's no middle lobe
on the left side.
04:02
Those low bar branches
are going to branch again
into tertiary or segmental bronchi -
10 on the right, 8 on the left,
which are going to branch again
into sub segmental bronchi,
Eventually down into bronchioles
and eventually down
to the level of alveoli.
04:19
And that's going to be where
gas exchange takes place.
04:22
Let's look at some
of the relationships
that the trachea has
to surrounding features,
starting with some of the bones.
04:29
So anteriorly, we see we have
that manubrium of the sternum.
04:34
And there was that feature
we pointed out that little notch
there called the jugular notch.
04:39
And if you very gently
put your finger there
you might be able
to palpate your trachea.
04:45
If we remove the sternum so we
can get a little deeper view.
04:48
We can see the arch of
the aorta sitting here
and it's giving rise to
a brachiocephalic trunk
crossing anteriorly to the trachea.
04:58
Whereas,
the left common carotid artery
is coming up to the left of it.
05:03
In terms of venous structures,
we see the superior vena cava
off to the right of the trachea.
05:09
And it's receiving vein,
the left brachiocephalic vein
crossing the midline
crossing over the
trachea anteriorly.
05:18
We already mentioned the esophagus.
05:20
The esophagus is running
directly posterior to the trachea
for the entirety of its length.
05:26
And that's actually because the
trachea embryologically came off
of the primitive esophagus.
05:32
So that relationship has
always been a very close one.
05:36
If we look laterally
from the right,
we of course have
the right lung and pleura.
05:42
And if we remove that, we can see
some more venous structures
sitting to the right
of the trachea.
05:48
We have the right
brachiocephalic vein
going down into the
superior vena cava,
as well as the azygos vein.
05:56
We have some nerves.
We have the right vagus nerve
going down to the
right side of the trachea.
06:01
We also have on the left,
the same idea,
we have the lung occupying
the majority of the lateral surface
that we're going to have to remove
to see some other structures.
06:11
Namely,
this time the arch of the aorta.
06:14
So, we have more
arterial stuff on the left,
more venous stuff on the right.
06:19
And we see the
left subclavian artery here,
and we have the left common carotid
artery to the left of the trachea.
06:26
And then finally we have the
vagus nerve on the left side.
06:30
We also, only on the left, are we
able to see a recurrent branch,
a recurrent laryngeal branch
coming off of the left vagus
because this is where the aortic
arch is in there's some asymmetry
that makes this branching
different than it is on the right.
06:49
Now, let's move on to the
blood supply of the trachea.
06:52
And in terms of the
cervical trachea,
the blood supply is coming from the
inferior thyroid arteries and veins.
06:59
And that actually makes sense
if you've done head neck anatomy,
because the thyroid gland actually
sits on the upper tracheal rings.
07:08
As for the lower or more
thoracic portion of the trachea,
we have to look down here
at the descending aorta
coming off of
the arch of the aorta.
07:18
Because there are some branches
that come directly off of the
descending aorta in this area
and those are the
bronchial arteries.
07:26
As their name implies, they're
also going to supply the bronchi.
07:31
Similarly, the venous drainage
in this area comes from
what's called the as
Azygos system of veins.
07:38
On the left side, we have the
Hemiazygos and Accesory Hemiazygos,
and they drain over to the Azygos,
which in turn goes into
the superior vena cava.
07:49
And it's the bronchial veins
in this area
that will drain into
the azygos system.
07:55
On the left side,
they'll go into the
accessory hemiazygos
and the hemiazygos.
08:00
And on the right side,
they go directly into the azygos.
08:04
Now, some innervation.
08:06
The main nerve in this
area is the vagus nerve.
08:09
So, on the right,
the vagus nerve will come down
just past the
right subclavian artery,
and then give a branch called
the right recurrent laryngeal nerve
that will wrap around
and go back towards the trachea
on its way up to the larynx.
08:27
However, because of the
asymmetry of the aorta here,
on the left side,
the left vagus nerve
comes all the way down
to the arch of the aorta.
08:35
And that's where the recurrent
laryngeal nerve will branch off,
wrapped around the arch of the aorta
and go posteriorly
towards the trachea
on its way back up to the larynx.
08:46
We also have the sympathetic trunk
and it's forming some plexuses
with these vagus nerves
called the pulmonary plexus
to provide some
autonomic innervation as well.