A layer of pseudostratified ciliated columnar epithelial cells that secrete mucus Found in nose, sinuses, pharynx, larynx and trachea Mucus can trap contaminants Cilia move mucus up towards mouth

1. Dr. NDAYISABA CORNEILLE
CEO of CHG
MBChB,DCM,BCSIT,CCNA
THE TRACHEA
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2. Respiratory mucosa
• A layer of pseudostratified ciliated
columnar epithelial cells that secrete
mucus
• Found in nose, sinuses, pharynx, larynx
and trachea
• Mucus can trap contaminants
–Cilia move mucus up towards mouth
7/17/2023 DR NDAYISABA CORNEILLE

3. Lower Respiratory Tract
• Conducting airways (trachea, bronchi, up
to terminal bronchioles).
• Respiratory portion of the respiratory
system (respiratory bronchioles, alveolar
ducts, and alveoli).
7/17/2023 DR NDAYISABA CORNEILLE

4. Trachea
• A flexible tube also called windpipe.
• Extends through the mediastinum and lies anterior to
the esophagus and inferior to the larynx.
• Anterior and lateral walls of the trachea supported by 15
to 20 C-shaped tracheal cartilages.
• Cartilage rings reinforce and provide rigidity to the
tracheal wall to ensure that the trachea remains open at
all times
• Posterior part of tube lined by trachealis muscle
• Lined by ciliated pseudostratified columnar
epithelium.
7/17/2023 DR NDAYISABA CORNEILLE

5. Trachea
• At the level of the sternal angle, the trachea
bifurcates into two smaller tubes, called the
right and left primary bronchi.
• Each primary bronchus projects laterally toward
each lung.
• The most inferior tracheal cartilage separates
the primary bronchi at their origin and forms an
internal ridge called the carina.
7/17/2023 DR NDAYISABA CORNEILLE

6. relations
• In the neck: Anteriorly: Skin, fascia, isthmus of
the thyroid gland (in front of the second, third,
and fourth rings), inferior thyroid vein, jugular
arch, thyroidea ima artery (if present), and the
left brachiocephalic vein in children, overlapped
by the sternothyroid and sternohyoid muscles
• Posteriorly: Right and left recurrent laryngeal
nerves and the esophagus
• Laterally: Lobes of the thyroid gland and the
carotid sheath and contents
7/17/2023 DR NDAYISABA CORNEILLE

7. • In the thorax
• The relations of the trachea in the superior mediastinum of
the thorax are as follows:
• Anteriorly: The sternum, the thymus, the left
brachiocephalic vein, the origins of the brachiocephalic and
left common carotid arteries, and the arch of the aorta
• Posteriorly: The esophagus and the left recurrent laryngeal
nerve
• Right side: The azygos vein, the right vagus nerve, and the
pleura
• Left side: The arch of the aorta, the left common carotid
and left subclavian arteries, the left vagus and left phrenic
nerves, and the pleura
7/17/2023 DR NDAYISABA CORNEILLE

8. Cont’n
• Nerve Supply of the Trachea
• The sensory nerve supply is from the vagi and the recurrent
laryngeal nerves.
• Blood Supply of the Trachea
• The upper two thirds is supplied by the inferior thyroid arteries and
the lower third is supplied by the bronchial arteries.
• Lymph Drainage of the Trachea
• Into the pretracheal and paratracheal lymph nodes and the deep
cervical nodes
7/17/2023 DR NDAYISABA CORNEILLE

9. Bronchial tree
• The primary bronchi enter the hilus of each lung
together with the pulmonary vessels, lymphatic vessels,
and nerves.
• Each primary bronchus branches into several secondary
bronchi (or lobar bronchi).
• The left lung has two secondary bronchi.The right lung
has three secondary bronchi.
• They further divide into tertiary bronchi.
• Each tertiary bronchus is called a segmental bronchus
because it supplies a part of the lung called a
bronchopulmonary segment.
7/17/2023 DR NDAYISABA CORNEILLE

10. Bronchial Tree
• Secondary bronchi tertiary bronchi bronchioles
terminal bronchioles
• with successive branching amount of cartilage decreases and
amount of smooth muscle increases, this allows for variation
in airway diameter
• during exertion and when sympathetic division active 
bronchodilation
• mediators of allergic reactions like histamine 
bronchoconstriction
• epithelium gradually changes from ciliated pseudostratified
columnar epithelium to simple cuboidal epithelium in
terminal bronchioles
7/17/2023 DR NDAYISABA CORNEILLE

11. Clinical significancy
• Compression of the Trachea
• A dilatation of the aortic arch (aneurysm) can compress the trachea.
With each cardiac systole the pulsating aneurysm may tug at the
trachea and left bronchus, a clinical sign that can be felt by
palpating the trachea in the suprasternal notch.
• Tracheitis or Bronchitis
• The mucosa lining the trachea is innervated by the recurrent
laryngeal nerve and, in the region of its bifurcation, by the
pulmonary plexus. A tracheitis or bronchitis gives rise to a raw,
burning sensation felt deep to the sternum instead of actual pain.
• Inhaled Foreign Bodies
• Because the right bronchus is the wider and more direct
continuation of the trachea , foreign bodies tend to enter the right
instead of the left bronchus. From there, they usually pass into the
middle or lower lobe bronchi.
7/17/2023 DR NDAYISABA CORNEILLE

12. Cont’n
• Bronchoscopy enables a physician to examine
the interior of the trachea; its bifurcation,
called the carina; and the main bronchi.
• Lodgment of a foreign body in the larynx or
edema of the mucous membrane of the larynx
secondary to infection or trauma may require
immediate relief to prevent asphyxiation. A
method commonly used to relieve complete
obstruction is tracheostomy
7/17/2023 DR NDAYISABA CORNEILLE

13. TRACHEOSTOMY
• An opening is made in the trachea between
the first and second tracheal rings or through
the second through fourth rings.
7/17/2023 DR NDAYISABA CORNEILLE

14. ANATOMICAL POSITIONING OF
A TRACHEOSTOMY TUBE
7/17/2023 DR NDAYISABA CORNEILLE

15. WHAT TO WATCH OUT FOR
• The inferior thyroid veins arise from a venous
plexus on the thyroid gland and descend
anterior to the trachea.
• A small thyroid ima artery is present in
approximately 10% of people; it ascends from
the brachiocephalic trunk or the arch of the
aorta to the isthmus of the thyroid gland.
7/17/2023 DR NDAYISABA CORNEILLE

16. • The left brachiocephalic vein, jugular venous
arch, and pleurae may be encountered,
particularly in infants and children.
• The thymus covers the inferior part of the
trachea in infants and children.
• The trachea is small, mobile, and soft in
infants, making it easy to cut through its
posterior wall and damage the esophagus.
7/17/2023 DR NDAYISABA CORNEILLE

17. END
DR NDAYISABA CORNEILLE
THANKS FOR LISTENING
By
DR NDAYISABA CORNEILLE
MBChB,DCM,BCSIT,CCNA
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7/17/2023