Tracheobronchial tree (TBT)

By
Dr Hottor
 Learning objectives
• By the end of the lecture every student must be able to do
the ff:
– List the components of the TBT
– Describe the gross anatomy of trachea including its location,
relations, blood supply
– Describe the microscopic structure of the trachea
– Distinguish between bronchus, bronchioles and trachea
– Application of the knowledge of anatomy of trachea to intubation,
and tracheostomy
– Explain the pathophysiology of some airway diseases like asthma
•
Components of the tracheobronchial tree

• It is made of sub-laryngeal airway i.e;

– Trachea
– Main bronchi
– Bronchioles
– Terminal bronchioles
Trachea
 Trachea
• Located in the neck and thorax
(superior mediastinum in the
midline
• Begins below the cricoid
cartilage at the level of the C6
vertebra as a Continuation of the
larynx
• Attached to cricoid cartilage by
cricotracheal ligament
• Terminates by bifurcating into
right and left principal/main
bronchi at the upper border of
T5 vertebra
 Trachea: Dimensions
• Total length is 10 cm (5cm in the neck and the
rest in the thorax), 15 cm in full inspiration
with bifurcation at T6
• 2 cm in diameter
• Diameter is 3 mm in the first year of life
• In childhood it is equal in millimetre to the age
in years
 Trachea: Anterior relations
• Isthmus of the thyroid gland is adherent to the 2nd,
3rd and the 4th tracheal rings
• Manubrium
• Left brachiocephalic vein
• Brachiocephalic trunk
• Left common carotid
• Arch of aorta
 Trachea: posterior relations
• Oesophagus
• Recurrent laryngeal nerve
lies in the groove between
the trachea and oesophagus
 Trachea: lateral relations

• Carotid sheath containing

common carotid artery
• Lobes of the thyroid gland
 Trachea: left lateral relations
• Arc of aorta
• Left common carotid,
left subclavian
arteries
• Left recurrent
laryngeal nerve
• Left lung and pleura
 Trachea :right relations
• Right vagus
• Right lung and pleura
• Arch of azygos vein
• Right brachiocephalic
vein and SVC are
anterolateral
 Blood supply
• Branches of inferior thyroid artery and
bronchial arteries
• Veins drain into inferior thyroid vein
 Lymphatic drainage
• Lymph channels drain into the pre- and
paratracheal nodes and into deep inferior
cervical nodes
 Nerve supply
• Trachea is supplied by parasympathetic from
branches of vagi, recurrent laryngeal nerves
and sympathetic trunk
• Stimulation of parasympathetic nerve causes
bronchoconstriction, mucus secretion and
bronchial vasodilatation
• Stimulation of sympathetic nerve causes
dilatation
 Trachea: Structure

• Has 3 layers
– Mucosa lining
• Epithelium
(Pseudostratified
ciliated columnar
epithelium with
goblet cells called
Respiratory
epithelium)
• Lamina propria
– Submucosa
– Adventitia
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 Trachea: Cartilage
• It has a series of
16- 20 C-shaped
hyaline cartilages
• Trachealis muscle
complete the ring
posteriorly
• The lower border
of the last
cartilage is called
the carina
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 Function of the trachea
• Airway – cartilage rings maintains patency
• Mucous trap debris
• Cilia beat to move debris towards the larynx
for swallowing or coughing out
• Serous glands humidify air
• Coughing
 Clinical applications
• Tracheotomy- making an incision in the
trachea
• Tracheostomy- removing small part of the
wall of the trachea
• Laryngotomy
 Main bronchi
• Start at the transverse thoracic plain
• Right is shorter (2.5 cm), wider and vertical
• The right divides into 3
• Left is longer (5 cm), narrower and more
horizontal
• The left divides into 2
 Structure
• It has the same structure as the trachea
• Small diameter
 Bronchial division

• Secondary bronchi
• Tertiary bronchi
• Io Bronchioles
• Terminal bronchioles

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 Respiratory system-Respiratory portion

• Respiratory bronchioles

• Alveolar ducts

• Alveolar sacs

• Alveoli
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 Alveoli
• Are a small outpouching of
respiratory bronchiole, alveolar
ducts and alveolar sac
• 200 μm in diameter
• Type III collagen and elastic
fibres
• No glands
• Type I & II pneumocytes
• Alveolar macropahges
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 Alveolar
macrophage

Alveolar septum
Alveolar wall

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 Types I & II pneumocytes
• Type I (type I alveolar cells or squamous
alveolar cells)
– Covers 95% of alveolar surface
– Forms occluding junctions with each other
• Type II (great alveolar cells or septal cells)’
– More numerous than type I
– Occupies only 5 % of alveolar surface
– Located in region where type I cells are separated
– Secretes surfactant
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 Clinical correlates
• Immotile cilia syndrome due to deficiency of
protein dynein
• Neonatal respiratory distress syndrome
• Adult Respiratory syndrome
• Asthma

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Alveolus
Alveoli
Air-blood barrier
 Structural change in the airways
• As the bronchial tree divides the following
changes occur:
– Diameter of airways become smaller
– Amount of Cartilage reduces
– Smooth muscle increases
– Epithelium looses cilia and Goblet cells disappear
 Clinical applications
• Aspiration
• Asthma
• Emphysema
• Pneumonia