Trachea

Question 1

surgical approaches to the trachea

Answer 1

cervical ventral midline

median sternotomy

intercostal thoracotomy (rt 3rd ICS - cranial thoracic trachea, rt 4th ICS - tracheal bifurcation)

Question 2

pathophysiology of tracheal collapse

Answer 2

progressive, irreversible degeneration of lower airway

increased weakness/pliability

progressive cough

cor pulmonale (pulmonary hypertension, RV enlargement)

Question 3

tracheal collapse signalment

Answer 3

small and toy breed dogs (yorkies, pomeranians, chihuahuas, pugs, poodles)

middle aged dogs

no evidence of sex predilection

Question 4

clinical signs of tracheal collapse

Answer 4

progressive, “goose honk” cough

waxing and waning dyspnea

exercise intollerance

cyanosis

syncope

Question 5

best way to diagnose tracheal collapse

Answer 5

imaging

rads, fluoroscopy, tracheoscopy

Question 6

gold standard diagnostic test for tracheal collapse

Answer 6

tracheoscopy

Question 7

when should surgery be considered with tracheal collpase

Answer 7

ONLY WHEN MEDICAL MANAGEMENT FAILS!

Question 8

external prosthetic tracheal rings are for __________ only

Answer 8

external prosthetic tracheal rings are for cervical trachea only

Question 9

complications with external prothetic tracheal rings

Answer 9

laryngeal paralysis

tracheal necrosis

pneumothorax

Question 10

intraluminal stent

Answer 10

size (diameter and length) based on imaging - esophageal measurement probe

placed fluoroscopically or endoscopically

provides circumferential support without affecting surrounding vessels or nerves

Question 11

advantages of intraluminal stent

Answer 11

minimally invasive

shortened anesthesia time

can be used in cervical and thoracic tracheal

immediate improvement in clinical signs

Question 12

disadvantages of intraluminal stent

Answer 12

requires fluoroscopy or endoscopy

$$$$$$

shorter life span than tracheal rings

moderal to high complication rate

Question 13

complications of stenting

Answer 13

stent fracture

stent migration

tracheitis

collapse beyond stented region

tracheal obstruction secondary to granulation tissue formation

tracheal rupture

Question 14

T/F there is no current treatment for collapse of mainstem bronchi or lower

Answer 14

true

Question 15

T/F there is no perfect treatment for tracheal collpase

Answer 15

true

progression of disease can happen in face of surgery

Question 16

internal tracheal trauma

Answer 16

rupture or necrosis secondary to ET tube (cats!)

foreign bodies

Question 17

external tracheal trauma

Answer 17

blunt or penetrating injuries - bite wounds, lacerations

Question 18

clinical signs of tracheal trauma

Answer 18

SQ emphysema

anorexia

lethargy

stridor coughing

dyspnea

severe cases: mediastinal emphysema, pneumothorax

Question 19

T/F minor tracheal tears/ruptures may respond to medical management

Answer 19

True

cage rest, O2 supplementation, sedativem thoracocentesis or thoracostomy tube for pneumothorax, consider temporary tracheostomy

Question 20

if dyspnea persists or worsen with a tracheal tear what should be done

Answer 20

surgical repair

• primary closure of tear, simple continous pattern with fine, absorbable suture*
• monitor for scarring, tracheal narrowing in long term*

Question 21

when is surgical intervention indicated with severe tears/ruptures

Answer 21

dsypnea persists or worsens with medical management

pneumothorax persists > 2-3 days

severe tracheal damage is visible

Question 22

surgical repair options for severe tracheal tears/ruptures

Answer 22

primary closure of tear

tracheal resention and anastomosis

Question 23

complications of trachea repair and anastomosis

Answer 23

SQ emphysema

pneumomediastinum and pneumothorax

infection

stricture

Question 24

what should be used as a salvage procedure for treatment of untreatable upper airway obstruction

Answer 24

permanent tracheostomy

Question 25

why should you create an oversized stroma at time of permanent tracheostomy surgery

Answer 25

stroma will decrease in size by 40-50%

Question 26

complications of permanent tracheostomy

Answer 26

infection

bleeding

stenosis

foreign body

increased risk of pneumonia and drowning

Question 27

prognosis for permanent tracheostomy

Answer 27

good for indoor dogs (if underlying disease is benign)

guarded to poor for cars (mucus plugs very common, leads to acute death)