Revisiting thoracic surface anatomy in an adult population: A computed tomography evaluation of vertebral level

Badshah, Masroor; Soames, Roger; Khan, Muhammad Khalid; Ibrahim, Muhammad Bello; Khan, Arshad Ahmad

doi:10.1002/ca.22817

Cited by 7 publications

(15 citation statements)

References 15 publications

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“…Some large studies, including more than 12 000 patients in total, describe the prevalence of anomalies of the aortic arch and branches, but without detailing relationships with the trachea. 15e18 Badshah and colleagues 19 reported variability in vascular and tracheal anatomy relative to the vertebral level in 215 individuals, but did not make observations about the relation between major vessels and the trachea in the neck. In a recent study, Cai and colleagues 20 reported the results of 829 CT scans correlated with intraoperative observations during anterior cervical surgery in a Chinese population.…”

Section: Discussionmentioning

confidence: 99%

“…This anomaly may cause severe morbidity 4,5 or near-miss incidents 6e14 if front-of-neck access is attempted. The variability of the aortic arch and branches, 15e18 and the relationship of these to the vertebral bodies, 19 have been systematically described. However, with the exception of a recent study in the setting of complex cervical surgery, 20 it is not known how frequently medical practitioners may expect to find major vessels anterior to the cervical trachea in a typical patient population.…”

Section: Editor's Key Pointsmentioning

confidence: 99%

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Prevalence of major vessels anterior to the trachea at sites of potential front-of-neck emergency airway access in adults

Weightman

Gibbs

2018

British Journal of Anaesthesia

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Background: Several case reports have described anatomical variations that can cause difficulty with front-of-neck airway access, such as major vessels anterior to the trachea. The prevalence of these anomalies is unknown. Methods: We screened 500 consecutive thoracic computed tomography (CT) scans in adult patients performed independently in any public hospital in Western Australia. The prevalence of major vessels anterior to the trachea in the anterior triangle of the neck was determined. Results: In the suprasternal notch, 264 CT scans (53%) demonstrated part of a major vessel anterior to the trachea, most commonly the brachiocephalic artery. At 10, 20, and 30 mm above the suprasternal notch, respectively, 126 (25%), 48 (9%), and 5 (1%) CT scans showed a major vessel anterior to the trachea. None showed a major vessel anterior to the cricothyroid membrane. In the suprasternal notch, a major vessel was anterior to the trachea in 10 of 120 CT scans (8%) that had a manubrio-cricoid distance <25 mm, and 108 of 116 CT scans (93%) that had a manubrio-cricoid distance >50 mm. In a logistic-regression model, increased length of trachea above the manubrium was a strong predictor of major vessels anterior to the trachea in the suprasternal notch, whilst sex, age, thoracic kyphosis, tracheal diameter, and the origin of the brachiocephalic artery were not strong predictors. Conclusions: It is common for patients to have some portion of a major vessel anterior to the trachea at sites where an emergency tracheostomy might be performed.

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Section: Discussionmentioning

confidence: 99%

Section: Editor's Key Pointsmentioning

confidence: 99%

Prevalence of major vessels anterior to the trachea at sites of potential front-of-neck emergency airway access in adults

Weightman

Gibbs

2018

British Journal of Anaesthesia

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“…Studies have reported that AAL is at the T4 level [4,5,9,14]. In another study, it was found over the T4 level in the age group of 0-1 year and under the T4 level in the age groups of 1-4 and 4-12 years [15].…”

Section: Discussionmentioning

confidence: 88%

“…The rate of it being observed in lower levels increased in older age (except for the individuals over 60 years of age) and in males. Knowing the level of the cardiac apex is especially important in the accurate evaluation of the dimensions of the heart and in the diagnosis of hypertrophy [4].…”

Section: Discussionmentioning

confidence: 99%

Examination of the levels of structures in the thorax in multidetector computerized tomography images

Bolatlı¹,

Ünver²,

Koplay³

et al. 2020

Journal of Surgery and Medicine

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of Medicine gave approval on 20.02.2017 with the decision numbered 2017/69. All procedures in this study involving human participants were performed in accordance with the 1964 Helsinki Declaration and its later amendments. Etik Kurul Onayı: Çalışma onayı Selçuk Üniversitesi Tıp Fakültesi, 20.02.2017 tarih ve 2017/69 sayı ile İnvazif Olmayan Klinik Araştırmalar Etik Kurulundan alınmıştır. İnsan katılımcıların katıldığı çalışmalardaki tüm prosedürler, 1964 Helsinki Deklarasyonu ve daha sonra yapılan değişiklikler uyarınca gerçekleştirilmiştir.

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“…Therefore, a better understanding of their anatomy as seen in the present study is important for spine surgeons who often depend on anatomical landmarks for avoiding vulnerable neurovascular structures during surgical approaches. [28][29][30][31] Our study revealed that these branches are always present on both sides and the anterior surface of the esophagus should be avoided while retracting it to minimize the risk of postoperative dysphagia.…”

Section: Resultsmentioning

confidence: 99%

Avoiding the Esophageal Branches of the Recurrent Laryngeal Nerve During Retractor Placement: Precluding Postoperative Dysphagia During Anterior Approaches to the Cervical Spine

Fisahn

Yılmaz

Iwanaga

et al. 2019

Global Spine Journal

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Study Design: Anatomical cadaver study. Objectives: Postoperative dysphagia is a significant complication following anterior approaches to the cervical spine and the etiology of this complication is poorly understood. Herein, we studied the esophageal branches of the recurrent laryngeal nerves to improve understanding of their anatomy and potential involvement in dysphagia. Methods: Ten fresh frozen cadaveric human specimens were dissected (20 sides). All specimens were adults with no evidence of prior surgery of the anterior neck. The recurrent laryngeal nerves were identified under a surgical microscope and observations and measurements of their esophageal branches made. Results: For each recurrent laryngeal nerve, 5-7 (mean 6.2) esophageal branches were identified. These branches ranged from 0.8 to 2.1 cm (mean 1.5 cm) in length and 0.5 to 2 mm (mean 1 mm) in diameter. They arose from the recurrent laryngeal nerves between vertebral levels T1 and C6. They all traveled to the anterior aspect of the esophagus. No statistical differences were seen between left and right sides or between sexes. Conclusion: The esophageal branches of the recurrent laryngeal nerve have been poorly described and could contribute to complications such as swallowing dysfunction following anterior cervical discectomy and fusion procedures. Therefore, a better understanding of their anatomy is important for spine surgeons. Our study revealed that these branches are always present on both sides and the anterior surface of the esophagus should be avoided while retracting it in order to minimize the risk of postoperative dysphagia.

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Revisiting thoracic surface anatomy in an adult population: A computed tomography evaluation of vertebral level

Cited by 7 publications

References 15 publications

Prevalence of major vessels anterior to the trachea at sites of potential front-of-neck emergency airway access in adults

Prevalence of major vessels anterior to the trachea at sites of potential front-of-neck emergency airway access in adults

Examination of the levels of structures in the thorax in multidetector computerized tomography images

Avoiding the Esophageal Branches of the Recurrent Laryngeal Nerve During Retractor Placement: Precluding Postoperative Dysphagia During Anterior Approaches to the Cervical Spine

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