Sx - Trachea

Question 1

When is a CERVICAL VENTRAL MIDLINE indicated ?

Answer 1

To access the cranial cervical trachea

Question 2

Which vital structures do you have to be wary of when incising through the cervical ventral midline

Answer 2

Recurrent laryngeal nerve 
Vagosympathetic trunk
Right and Left common carotid arteries
Thyroid gland 
Esophagus

Question 3

When is a median sternotomy indicated ?

Answer 3

Access the caudal cervical and cranial thoracic trachea

Question 4

Using an intercostal thoracotomy, which ICS would you utilize to access the cranial thoracic trachea?

Answer 4

Right 3rd Intercostal Space

Question 5

Using an intercostal thoracotomy, which ICS would you utilize to access the tracheal bifurcation ?

Answer 5

Right 4th intercostal space

Question 6

What is tracheal collapse ?

Answer 6

It is a progressive degeneration of the lower airway due to the laxity of the trachealis muscle –> weakness of tracheal rings –> hypocellular tracheal cartilage .

The weakness/pliability is due to decreased water retention secondary to loss of glycoprotein and GAG –> decreased calcium and chondroitin

Question 7

What are the secondary causes of tracheal collapse ?

Answer 7

• obesity
• environmental allergens
• respiratory irritants
• kennel cough

Question 8

What is the typical signalment for tracheal collapse ?

Answer 8

Small, toy breed dogs - middle aged dogs - signs at an earlier age consistent with more dz

Question 9

What are the clinical signs of tracheal collapse ?

Answer 9

• Cough ‘Goose Honk’
• Waxing and waning dyspnea
• Exercise intolerance
• Cyanosis
• Syncope

Question 10

What are the differentials of tracheal collapse ?

Answer 10

• Heart dz/cardiomegaly
• kennel cough
• bronchitis
• pneumonia

Question 11

What imaging modality is the gold standard for dx tracheal collapse ?

Answer 11

TRACHEOSCOPY

- allows direct visualization of collapse

Question 12

The confirmatory method of diagnosing tracheal collapse is to perform imaging.

Answer 12

TRUTH - you need to see the trachea collapse on imaging to confirm

Question 13

Every 25% occlusion down –> increase in Grade

Answer 13

Grade 1 - 25%
Grade II - 50%
Grade III - 75%
Grade IV ~ 100%

Question 14

When should Surgical treatment be considered ?

Answer 14

ONLY when MEDICAL MANAGEMENT fails.

Question 15

Where can the External Prosthetic Tracheal Rings be placed? Where can it NOT be placed ?

Answer 15

It is FOR THE CERVICAL TRACHEA RINGS only through the ventral midline cervical approach.

It CANNOT be placed in the INTRATHORACIC Region

Question 16

What are the complications of surgical treatment ?

Answer 16

1. Laryngeal Paralysis
2. Tracheal Necrosis
3. Pneumothorax

Question 17

What is the function of an intraluminal stent?

Answer 17

It is a self-expanding nitinol stent that provides circumferential support without affecting surrounding vessels or nerves.

Question 18

What are the advantages of an intraluminal stent?

Answer 18

• minimally invasive
• shortened anesthesia time
• can be used in the cervical and thoracic trachea
• immediate improvement in clinical signs

Question 19

What are the disadvantages of an intraluminal stent?

Answer 19

• requires fluoroscopy or endoscopy
• $$$$
• shorter lifespan than tracheal rings
• moderate to high complication rate

Question 20

What are the complications of stenting ?

Answer 20

• stent fracture
• stent migration
• tracheitis
• collapse beyond stented region
• tracheal obstruction secondary to granuation tissue formation
• tracheal rupture

Question 21

With tracheal collapse, there is no perfect treatment. Surgery should be avoided if at all possible.

Answer 21

TRUTH

Question 22

There is currently no treatment for the collapse of mainstem bronchi.

Answer 22

TRUTH

Question 23

Describe what is meant by an INTERNAL Tracheal Trauma

Answer 23

• Rupture or necrosis secondary to an ET tube

- Foreign Bodies

Question 24

Internal Tracheal Trauma - rupture or necrosis to an ET tube is more common in cats or dogs?

Answer 24

Cats

Question 25

What causes an external tracheal trauma?

Answer 25

Blunt or penetrating injuries - bite wounds or lacerations

Question 26

How would you treat a patient with minor tears or ruptures

Answer 26

• cage rest
• oxygen supplementation
• sedatives
• thoracocentesis or thoracostomy tube for pneumothorax
• consider temp tracheostomy

Question 27

What should you do if the surgical tear or rupture persists or worsens ?

Answer 27

• primary closure of tear

- simple continuous pattern with a fine,absorbable suture that is 4-0 or smaller

Question 28

When is surgical intervention for severe tears/ruptures indicated

Answer 28

• Dyspnea persists or worsens with medical management
• If pneumothorax persists >2-3 days
• severe tracheal damage is visible

Question 29

What are the complications for tracheal repair and resection and anastomosis ?

Answer 29

• SQ emphysema
• Pneumomediastinum and pneumothorax
• Infection
• STRICTURE

Question 30

PERMANENT TRACHEOSTOMY is NOT a TREATMENT for TRACHEAL COLLAPSE

Answer 30

TRUTH

Question 31

What is PERMANENT TRACHEOSTOMY an indication for ?

Answer 31

For the treatment of UNTREATABLE Upper Airway Obstruction –> Salvage Procedure –> creates a permanent opening at the level of proximal cervical trachea

Question 32

What is the prognosis for permanent tracheostomy in dogs?

Answer 32

Good if the underlying disease is a benign prcess

Question 33

What is the prognosis for permanent tracheostomy in cats? Why?

Answer 33

Poor - mucus plugs very common leading to acute death