Trachea Flashcards
surgical approaches to the trachea
cervical ventral midline
median sternotomy
intercostal thoracotomy (rt 3rd ICS - cranial thoracic trachea, rt 4th ICS - tracheal bifurcation)
pathophysiology of tracheal collapse
progressive, irreversible degeneration of lower airway
increased weakness/pliability
progressive cough
cor pulmonale (pulmonary hypertension, RV enlargement)
tracheal collapse signalment
small and toy breed dogs (yorkies, pomeranians, chihuahuas, pugs, poodles)
middle aged dogs
no evidence of sex predilection
clinical signs of tracheal collapse
progressive, “goose honk” cough
waxing and waning dyspnea
exercise intollerance
cyanosis
syncope
best way to diagnose tracheal collapse
imaging
rads, fluoroscopy, tracheoscopy
gold standard diagnostic test for tracheal collapse
tracheoscopy
when should surgery be considered with tracheal collpase
ONLY WHEN MEDICAL MANAGEMENT FAILS!
external prosthetic tracheal rings are for __________ only
external prosthetic tracheal rings are for cervical trachea only
complications with external prothetic tracheal rings
laryngeal paralysis
tracheal necrosis
pneumothorax
intraluminal stent
size (diameter and length) based on imaging - esophageal measurement probe
placed fluoroscopically or endoscopically
provides circumferential support without affecting surrounding vessels or nerves
advantages of intraluminal stent
minimally invasive
shortened anesthesia time
can be used in cervical and thoracic tracheal
immediate improvement in clinical signs
disadvantages of intraluminal stent
requires fluoroscopy or endoscopy
$$$$$$
shorter life span than tracheal rings
moderal to high complication rate
complications of stenting
stent fracture
stent migration
tracheitis
collapse beyond stented region
tracheal obstruction secondary to granulation tissue formation
tracheal rupture
T/F there is no current treatment for collapse of mainstem bronchi or lower
true
T/F there is no perfect treatment for tracheal collpase
true
progression of disease can happen in face of surgery
internal tracheal trauma
rupture or necrosis secondary to ET tube (cats!)
foreign bodies
external tracheal trauma
blunt or penetrating injuries - bite wounds, lacerations
clinical signs of tracheal trauma
SQ emphysema
anorexia
lethargy
stridor coughing
dyspnea
severe cases: mediastinal emphysema, pneumothorax
T/F minor tracheal tears/ruptures may respond to medical management
True
cage rest, O2 supplementation, sedativem thoracocentesis or thoracostomy tube for pneumothorax, consider temporary tracheostomy
if dyspnea persists or worsen with a tracheal tear what should be done
surgical repair
- primary closure of tear, simple continous pattern with fine, absorbable suture*
- monitor for scarring, tracheal narrowing in long term*
when is surgical intervention indicated with severe tears/ruptures
dsypnea persists or worsens with medical management
pneumothorax persists > 2-3 days
severe tracheal damage is visible
surgical repair options for severe tracheal tears/ruptures
primary closure of tear
tracheal resention and anastomosis
complications of trachea repair and anastomosis
SQ emphysema
pneumomediastinum and pneumothorax
infection
stricture
what should be used as a salvage procedure for treatment of untreatable upper airway obstruction
permanent tracheostomy
why should you create an oversized stroma at time of permanent tracheostomy surgery
stroma will decrease in size by 40-50%
complications of permanent tracheostomy
infection
bleeding
stenosis
foreign body
increased risk of pneumonia and drowning
prognosis for permanent tracheostomy
good for indoor dogs (if underlying disease is benign)
guarded to poor for cars (mucus plugs very common, leads to acute death)
