Sx - Trachea Flashcards
When is a CERVICAL VENTRAL MIDLINE indicated ?
To access the cranial cervical trachea
Which vital structures do you have to be wary of when incising through the cervical ventral midline
Recurrent laryngeal nerve Vagosympathetic trunk Right and Left common carotid arteries Thyroid gland Esophagus
When is a median sternotomy indicated ?
Access the caudal cervical and cranial thoracic trachea
Using an intercostal thoracotomy, which ICS would you utilize to access the cranial thoracic trachea?
Right 3rd Intercostal Space
Using an intercostal thoracotomy, which ICS would you utilize to access the tracheal bifurcation ?
Right 4th intercostal space
What is tracheal collapse ?
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
What are the secondary causes of tracheal collapse ?
- obesity
- environmental allergens
- respiratory irritants
- kennel cough
What is the typical signalment for tracheal collapse ?
Small, toy breed dogs - middle aged dogs - signs at an earlier age consistent with more dz
What are the clinical signs of tracheal collapse ?
- Cough ‘Goose Honk’
- Waxing and waning dyspnea
- Exercise intolerance
- Cyanosis
- Syncope
What are the differentials of tracheal collapse ?
- Heart dz/cardiomegaly
- kennel cough
- bronchitis
- pneumonia
What imaging modality is the gold standard for dx tracheal collapse ?
TRACHEOSCOPY
- allows direct visualization of collapse
The confirmatory method of diagnosing tracheal collapse is to perform imaging.
TRUTH - you need to see the trachea collapse on imaging to confirm
Every 25% occlusion down –> increase in Grade
Grade 1 - 25%
Grade II - 50%
Grade III - 75%
Grade IV ~ 100%
When should Surgical treatment be considered ?
ONLY when MEDICAL MANAGEMENT fails.
Where can the External Prosthetic Tracheal Rings be placed? Where can it NOT be placed ?
It is FOR THE CERVICAL TRACHEA RINGS only through the ventral midline cervical approach.
It CANNOT be placed in the INTRATHORACIC Region
What are the complications of surgical treatment ?
- Laryngeal Paralysis
- Tracheal Necrosis
- Pneumothorax
What is the function of an intraluminal stent?
It is a self-expanding nitinol stent that provides circumferential support without affecting surrounding vessels or nerves.
What are the advantages of an intraluminal stent?
- minimally invasive
- shortened anesthesia time
- can be used in the cervical and thoracic trachea
- immediate improvement in clinical signs
What are the disadvantages of an intraluminal stent?
- requires fluoroscopy or endoscopy
- $$$$
- shorter lifespan than tracheal rings
- moderate to high complication rate
What are the complications of stenting ?
- stent fracture
- stent migration
- tracheitis
- collapse beyond stented region
- tracheal obstruction secondary to granuation tissue formation
- tracheal rupture
With tracheal collapse, there is no perfect treatment. Surgery should be avoided if at all possible.
TRUTH
There is currently no treatment for the collapse of mainstem bronchi.
TRUTH
Describe what is meant by an INTERNAL Tracheal Trauma
- Rupture or necrosis secondary to an ET tube
- Foreign Bodies
Internal Tracheal Trauma - rupture or necrosis to an ET tube is more common in cats or dogs?
Cats
What causes an external tracheal trauma?
Blunt or penetrating injuries - bite wounds or lacerations
How would you treat a patient with minor tears or ruptures
- cage rest
- oxygen supplementation
- sedatives
- thoracocentesis or thoracostomy tube for pneumothorax
- consider temp tracheostomy
What should you do if the surgical tear or rupture persists or worsens ?
- primary closure of tear
- simple continuous pattern with a fine,absorbable suture that is 4-0 or smaller
When is surgical intervention for severe tears/ruptures indicated
- Dyspnea persists or worsens with medical management
- If pneumothorax persists >2-3 days
- severe tracheal damage is visible
What are the complications for tracheal repair and resection and anastomosis ?
- SQ emphysema
- Pneumomediastinum and pneumothorax
- Infection
- STRICTURE
PERMANENT TRACHEOSTOMY is NOT a TREATMENT for TRACHEAL COLLAPSE
TRUTH
What is PERMANENT TRACHEOSTOMY an indication for ?
For the treatment of UNTREATABLE Upper Airway Obstruction –> Salvage Procedure –> creates a permanent opening at the level of proximal cervical trachea
What is the prognosis for permanent tracheostomy in dogs?
Good if the underlying disease is a benign prcess
What is the prognosis for permanent tracheostomy in cats? Why?
Poor - mucus plugs very common leading to acute death
