Trachea Cholson Banjo E. Garcia

Suspended from the cricoid cartilage by the CRICOTRACHEAL LIGAMENT Length: cm From C6-C7 to T4-T5 Bifurcate at T4-T5 level into the right and left main bronchi

Lumen maintained by 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 mm  mm women, 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 osteochondroplastica  Malformation of the trachea and bronchial cartilages  Abnormal deposits of cartilaginous tissue in the endotracheal mucosa  can cause progressive airway obstruction  Wheezing, 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 superinfection Symptoms 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 PE Treatment  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 abnormailities Found 4x more often on the right main bronchus Symptoms depends on the size, shape and composition Complete 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