Surgical anatomy of the trachea

Furlow, Paul W.; Mathisen, Douglas J.

doi:10.21037/acs.2018.03.01

Cited by 82 publications

(52 citation statements)

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“…It is important to have in mind that as the trachea descends from the larynx, it moves posteriorly into the mediastinum. 15 This makes entry at the tracheal level more difficult, as does the narrower space between the tracheal rings compared with the cricothyroid space. This is borne out by the higher requirement for second or third passes with cannulation at levels below the cricothyroid.…”

Section: Discussionmentioning

confidence: 99%

Transtracheal jet ventilation in a general tertiary hospital: A 7-year audit

Barnes

2021

Anaesth Intensive Care

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Airway management in patients presenting with severe airway obstruction can present a challenge to the anaesthetist, as conventional difficult airway pathways are often inappropriate. The use of a transtracheal jet cannula is an alternative means of airway securement, but lack of familiarity has limited its use in general tertiary hospitals. We report a retrospective audit of the use of transtracheal jet ventilation in a general tertiary healthcare centre over the past seven years, with a total of 50 patients with severe airway compromise undergoing pharyngolaryngeal surgery. Transtracheal jet ventilation was successful in 98% of patients, and was the definitive means of airway management in 43 cases. In six cases, the technique was a useful temporising measure while the airway was secured by other means. Minor complications occurred in 12% of patients. No major morbidities or mortalities were recorded. We conclude that transtracheal jet ventilation for high-risk pharyngolaryngeal surgery can be performed using a high frequency jet ventilator, with a high rate of success and only minor complications. Cannulation of the trachea below the cricothyroid membrane is feasible but more challenging. Low-flow apnoeic oxygenation through the transtracheal jet ventilation cannula maintains oxygenation during initial surgical airway manipulation.

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Section: Discussionmentioning

confidence: 99%

Transtracheal jet ventilation in a general tertiary hospital: A 7-year audit

Barnes

2021

Anaesth Intensive Care

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“…3 It originates on the right anterior aspect of the trachea behind the manubrium sternum, and runs superiorly from left to right over the right anterolateral portion, before dividing at the level of right sternoclavicular joint into the right common carotid artery and right subclavian artery. 7 The possibility of an anomalous course of the brachiocephalic trunk is of cardinal importance in surgical procedures of the neck, and even more so in percutaneous dilatational tracheostomy. 8 Although developmental changes are known to occur in the anatomy of brachiocephalic trunk, it usually progresses to lie more towards the midline with increasing age.…”

Section: Discussionmentioning

confidence: 99%

Anomalous innominate artery complicating tracheal surgical procedures

et al. 2021

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Objective To highlight the importance of imaging in reducing an accidental injury to the anomalous brachiocephalic trunk and its branches during tracheal surgery. Case report This paper reports two cases of accidental injury to the great vessels in the neck during tracheal surgery. The first incident occurred during a repeat tracheostomy, when the right common carotid artery was injured. On reviewing the computed tomography images, the bifurcation of the brachiocephalic artery was seen to the left of the midline, and the right common carotid artery was adherent just below the tracheostomy site. The second incident happened during surgery for tracheal stenosis, when there was an inadvertent injury to the main brachiocephalic trunk, which was adherent to the trachea in the lower neck region. Conclusion For airway surgeons, radiological assessment of vascular structures in relation to the trachea prior to surgery is as important as the endoluminal airway assessment for the best outcome.

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“…The trachea begins after the cricoid cartilage (at the level of the sixth cervical vertebra) up to the carina at the level of the fourth thoracic vertebra (posteriorly), and at the level of the Louis angle (anteriorly); the trachea is approximately 15-10 cm in length [ 54 - 56 ]. The tracheal rings can be felt above the sternal notch for a maximum of 5 cm (the thyroid gland is higher up); inside the mediastinum, the trachea is slightly shifted to the right side, where it forms the carina and bifurcation of the bronchi [ 54 ].…”

Section: Reviewmentioning

confidence: 99%

“…The tracheal tract in the mediastinum is covered by the sternal manubrium [ 55 ]. With advancing age, the trachea tends to become less elastic, less mobile, and with calcification phenomena and morphological alterations (Figure 1 ) [ 56 - 57 ].…”

Section: Reviewmentioning

confidence: 99%

Palpation of the Respiratory System in Osteopathic Manual Medicine: From the Trachea to the Lungs

Bordoni¹,

Escher²

2021

Cureus

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There is a lack of published literature in osteopathic manual medicine on how to perform palpation of the lower respiratory tree such as the trachea, main bronchi, and lungs. Several authors have studied the osteopathic effect and respiratory response of palpation but have failed to demonstrate how to perform palpation of the visceral areas involved in breathing, either in the context of a clinical trial or as a case report. This paper reviews the innervation of these anatomical areas, the mechano-metabolic weight of the passage of fluids and air in the respiratory tract, the anatomical topography, and the movements involved in respiration. Drawing from current knowledge, this article illustrates, for the first time, how to place the hands for an effective osteopathic assessment of the tracheal, bronchial, and pulmonary structures. Understanding how to perform palpation of the lower areas is a fundamental tool in the clinic and potential therapy in osteopathic manual medicine.

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Surgical anatomy of the trachea

Cited by 82 publications

References 1 publication

Transtracheal jet ventilation in a general tertiary hospital: A 7-year audit

Transtracheal jet ventilation in a general tertiary hospital: A 7-year audit

Anomalous innominate artery complicating tracheal surgical procedures

Palpation of the Respiratory System in Osteopathic Manual Medicine: From the Trachea to the Lungs

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