TracheaCholson Banjo E. Garcia

Suspended from the cricoid cartilage by the CRICOTRACHEAL LIGAMENT

Length: 10-13 cmFrom C6-C7 to T4-T5Bifurcate at T4-T5 level into the right and

left main bronchi

Lumen maintained by 12-20 hyaline cartilage rings

Horseshoe shape interconnected by strong cartilagenous and elastic connective tissue fibers- Annular ligaments

Cervical part 6-7 cm long, 6-8 cartilaginous rings

Membranous posterior wall- foreign bodies and tumors of the esophagus may impinge upon the posterior surface of the trachea constricting the airway lumen

Transverse diameter 13-20 mm 13-16 mm women, 16-20 mm men

Lined by two rows of CILIATED EPITHELIUM with GOBLET CELLS

Blood Supply- Inferior Thyroid Artery and Superior thyroid artery

Lymphatic- Vertical lymphatic chain of the Neck and Paratracheal and Mediastinal group of LN

Nerve Supply- Vagus and Symphatetic trunk

Malformations

Symptoms: Airway obstruction with inspiratory and

expiratory stridor Wheezing Cyanosis Gasping for breath

Tracheal Tumors

Chondroma, Osteochondroma, Osteoma

Appear as thickening of trachel or bronchial cartilage

Grow slowly and cause extensive bronchopulmonary destruction

Tx: Surgical Removal

Tracheopathia osteochondroplasticaMalformation of the trachea and

bronchial cartilagesAbnormal deposits of cartilaginous

tissue in the endotracheal mucosacan cause progressive airway

obstructionWheezing, coughing, hemoptysis,

respiratory distress

Adenoid Cystic Carcinoma Tx: surgical, radiotherapy

and chemotherapy Palliative: tumor

debulking, stent insertion, tracheotomy

Infectious Diseases

Acute Subglottic Laryngitis Synonym: acute laryngotracheobronchitis Cause: Viral Infants and small childre 6 months- 3years Peaks spring and fall Develop 1-3 days during th course f UR viral

disease

Symptom Horse voice Dry, harsh barking cough Stridor loudest during inspiration

Dx Body temp- elevated or normal Leukocytosis- absent Laryngoscopy: inflammatory swelling below the vocal

cords and in the upper part of the cervical trachea

Treatment Airway humidification and fluid intake

Bacterial Laryngotracheatis Sporadically and without seasonal incidence Viral etiology with subsequent bacterial

superinfectionSymptoms and Dx

Gradual onset with rhinitis and pharyngitis + expiratory and inspiratory stridor, rales over the lungs, other pulmonary complications

Mucosal redness, vocal cords red and swollen on PETreatment

Antibiotic with mucolytic agents ( ambroxol) Airway humidification Adequate fluid intake

Foreign Body aspiration

Most prevalent in children under 3 years of age 2:1 boys over girls

Oropharyngeal swallowing abnormailitiesFound 4x more often on the right main

bronchusSymptoms depends on the size, shape and

compositionComplete obstruction: cyanotic, aphonic

patient with spasmodic breathing movements

Bolus death: acute cardiac arrest caused by a vasovagal reflex evoked by obstrction of upper airways

Radiographs: key in the diagnosis Heimlich maneuver