Exposure of cervical trachea and esophagus

Question 1

What are PE signs c/f tracheal and laryngeal injury?

Answer 1

-stridor
-hoarseness
-hemoptysis
-subcutaneous emphysema

Question 2

What are PE signs c/f esophageal injury?

Answer 2

-dysphagia
-odynophagia
-blood in the oropharynx
-subcutaneous emphysema

Question 3

What type of incision is used to access the cervical trachea?

Answer 3

collar incision made 1-2cm above the sternal notch and extended laterally beyond the medial border of the SCM.
can extend into chest if injury also involves thoracic trachea.

Question 4

What type of suture should be used to repair a tracheal injury?

Answer 4

absorbable monofilament
-don’t forget to buttress repair

Question 5

In which plane does the blood supply enter the trachea?

Answer 5

laterally
-so if need to mobilize for a repair to not be under tension do so in an anterior and posterior fashion

Question 6

What incision should be used to access the thoracic trachea, right mainstem bronchus, and proximal left mainstem bronchus?

Answer 6

right posterolateral thoracotomy via the 4th intercostal space

Question 7

What incision should be used to access the distal left mainstem bronchus?

Answer 7

left posterolateral thoracotomy

Question 8

What is the ideal incision to expose the cervical esophagus?

Answer 8

left sided incision anterior to the SCM (but can use collar if also worried about a tracheal injury)

Question 9

What muscles form the superior most portion of the esophagus?

Answer 9

cricopharyngeal

Question 10

What direction should you not retract the thyroid to avoid a stretch injury to the recurrent laryngeal nerve during exposure of the cervical esphagus?

Answer 10

superior