Anatomy of the trachea, carina, and bronchi

This article summarizes the pertinent points of tracheal and bronchial anatomy, including the relationships to surrounding structures. Tracheal and bronchial anatomy is essential knowledge for the thoracic surgeon, and an understanding of the anatomic relationships surrounding the airway is crucial to the safe performance of many thoracic surgical procedures. In addition, the more precise delineation of tracheal anatomy has contributed largely to the advancement of airway surgery in recent years. This article serves as a foundation for learning or reviewing this important topic.     

Extensive resection of the distal trachea and bilateral bronchi for the tumor arising from the carina: a successful reconstruction of the carina

This paper reports the case of an 8-year-old girl who successfully underwent tracheobronchial reconstruction for neoplastic obstruction at the carina. Reconstruction of the carina was performed using an end-to-end type anastomosis between the trachea and bronchi.     

Prosthetic reconstruction of the trachea and carina

We have performed prosthetic reconstruction of the trachea and carina in 12 patients since 1979. We used Neville's prosthesis in 7 patients and Katsura's prosthesis in 5 patients. Seven patients were operated on for lung cancer, 2 patients for adenoid cystic carcinoma of the trachea and the others for large cell carcinoma of the trachea, thyroid cancer and tuberculous granuloma, respectively. Prosthetic reconstruction of the trachea was performed in 4 patients. Carinal resection was performed in 8 patients: With right sleeve pneumonectomy in 4 patients, with right upper lobectomy in 2 patients and only carinal resection in 2 patients. Prosthetic reconstruction after the carinal resection was performed using 3 straight types, 1 curved type and 4 bifurcated types. With regard to the complications of the prosthetic reconstruction, dehiscence at the anastomotic site was seen in 5 patients, granulation in 4 patients, empyema in 3 patients, massive hemorrhage in 2 patients and migration of the prosthesis in 1 patient. Five patients survived more than 1 year. The longest survival time was 43 months. To prevent complications of the prosthetic reconstruction, we improved the anastomotic method, reinforced the anastomotic site with Marlex mesh and protected the surrounding vessels with Lyodura.     

Anatomy of the larynx,trachea and bronchi

The anatomy of the airway is a core topic in anaesthesia, and a detailed knowledge is expected for examinations as well as in everyday practice. This article presents the most important aspects of airway anatomy from the point of view of the anaesthetist, with particular emphasis on understanding the clinical implications of the relevant structures and how they interact. The anatomy of the larynx and its innervation is discussed in detail, and put into clinical context as appropriate. Bronchial anatomy is described to aid navigation during bronchoscopy. Where possible, diagrams are used to help understanding.     

Injuries of the trachea and bronchi

Traumatic rupture of the trachea or the bronchi is reported with increasing frequency. Such rupture may follow penetrating wounds, but the common cause is blunt trauma of the throat or thorax.     

Squamous papillomatosis of the trachea and bronchi

A squamous papilloma which occluded the trachea of a young man was managed by resection at tracheotomy. Thereafter it was possible further to examine the bronchi bronchoscopically, and widespread papillomatosis confined to the left bronchi was seen. Following bronchography, which showed left-sided bronchiectasis, left pneumonectomy was undertaken. Case details are presented and the literature which relates to bronchial papillomatosis is reviewed.     

Experience with primary neoplasms of the trachea and carina

From 1963 to 1983, 44 patients presented with a primary tracheal neoplasm that was amenable to surgical treatment. Forty-two of the 44 tumors were malignant. Thirty-three patients were managed by resection and primary anastomosis. The following resections were done: trachea only, 12; trachea plus carina, 13; trachea plus cricoid cartilage, four; and trachea plus larynx, four. There were two operative deaths in these 33 patients. Prosthetic reconstruction with heavy-duty Marlex mesh was done in six patients. Three of the six died of erosion of the innominate artery during the postoperative period. In three patients with nonresectable tumors, a silicone-coated Montgomery T-tube provided transient but worthwhile palliation. In two patients with nonobstructive adenoid cystic carcinoma involving the subglottis, irradiation was chosen as the initial treatment, since resection would necessitate laryngectomy. Resection, including laryngectomy, may be required in the future. The following points are emphasized: (1) A majority of operable neoplasms can be resected through a cervical collar incision and median sternotomy. Median sternotomy is the optimal operative exposure in most neoplasms necessitating resection of the carina. (2) Partial resection of the cricoid with sparing of the recurrent laryngeal nerves and larynx is possible in some patients with primary malignant tumors involving the proximal trachea and subglottic region. (3) In patients with adenoid cystic carcinoma, resection may afford excellent, long-term palliation even when the resection is incomplete. Pulmonary metastases are common in patients with adenoid cystic tumors. However, they usually progress slowly, may remain asymptomatic for many years, and are not necessarily a contraindication to resection of the primary tumor even when they are synchronous. Our experience suggests that adjunctive radiotherapy is beneficial in patients with adenoid cystic carcinoma.