trachea

Question 1

Cervical Ventral Midline

Answer 1

cranial cervical trachea
Sternohyoideus and sternothyroideus mm.
Recurrent laryngeal n.
Vagosympathetic trunks
R and L common carotid
arteries
Thyroid glands
Esophagus

Question 2

Median Sternotomy

Answer 2

Caudal cervical and cranial thoracic trachea

Question 3

Intercostal thoracotomy

Answer 3

Right 3rd ICS
- cranial thoracic trachea
Right 4th
- tracheal bifurcation

Question 4

Degenerative, Developmental

Answer 4

Tracheal collapse

Question 5

Anatomical/Anomalous, Acquired, Allergic, Auto-Immune

Answer 5

Esophagotracheal or esophagobronchial fistula

Question 6

Metabolic, Mechanical

Answer 6

Foreign Bodies

Question 7

Neoplastic, Nutritional

Answer 7

Osteosarcoma, osteochondroma, chondrosarcoma, leiomyoma,

rhabdomyosarcoma, AdCa, LSA, FSA, SCC

Question 8

Infectious, Inflammatory, Idiopathic, Iatrogenic

Answer 8

Spirocerca lupi/Onchocerca sp, Cuterebra

Tracheal Rupture secondary to ET tube (trauma) *

Question 9

Trauma Toxin

Answer 9

tears/ruptures *

hematomas

Question 10

When to do SX for tracheal collapse

Answer 10

ONLY WHEN MEDICAL MANAGEMENT FAILS

Question 11

tracheal collapse

External Prosthetic Tracheal Rings

Answer 11

for CERVICAL trachea only

Polypropylene
Ventral midline cervical approach
Secured to cartilaginous rings
Must start and end ring placement in area of normal
trachea
Good outcomes with immediate improvement in clinical signs

Question 12

tracheal collapse SX complications

Answer 12

Laryngeal paralysis
Tracheal Necrosis
Pneumothorax

Question 13

Complications: Laryngeal paralysis

Answer 13

Reported in 11-30% of surgical cases

Damage during surgery vs. continued trauma from implants

Question 14

Complications: Tracheal Necrosis

Answer 14

Secondary to damage to trachea’s segmental blood supply

Life threatening > Coughing, SQ emphysema

Question 15

Complications: Pneumothorax

Answer 15

Diffusion of air through mediastinum during surgery

Accidental penetration of thoracic cavity near caudal cervical trachea

Question 16

Tracheal Collapse SX

Intraluminal Stent

Answer 16

Self-expanding nitinol stents
Constrained on a delivery
system
Sizing (diameter and length)
based on imaging > Esophageal measurement probe
Placed fluoroscopically or
endoscopically
Provides circumferential
support without affecting
surrounding vessels or nerves

Question 17

Intraluminal Stent Advantages

Answer 17

Minimally invasive
Shortened anesthesia time
Can be used in the cervical and thoracic trachea
Immediate improvement in clinical signs

Question 18

Intraluminal Stent Disadvantages

Answer 18

Requires fluoroscopy or
endoscopy
\$\$\$\$$
Shorter life-span than tracheal rings (bc can break)
Moderate to high complication rate

Question 19

Complications on stenting

Answer 19

Stent fracture
Stent migration
Tracheitis in ~ 60% of patients
Collapse beyond stented region > Mainstem bronchi collapse
Tracheal obstruction secondary
to granulation tissue formation > Can respond to treatment with corticosteroids and colchicine
Tracheal rupture

Question 20

Tracheal trauma - Internal

Answer 20

Rupture or necrosis secondary to ET tube

Foreign bodies

Question 21

internal tracheal trauma (Rupture or necrosis secondary to ET tube) is more common in

Answer 21

cats

dental procedures

Question 22

Tracheal Trauma - External

Answer 22

Blunt or penetrating injuries
Bite wounds
Lacerations

Question 23

mild to severe clinical sings with tracheal trauma

Answer 23

Subcutaneous emphysema
Anorexia
Lethargy
Stridor
Coughing
Dyspnea

Question 24

Progression of pathology

in severe cases of tracheal trauma

Answer 24

Mediastinal Emphysema

Pneumothorax

Question 25

medical management for MINOR tears/ ruptures

Answer 25

``` Cage rest Oxygen supplementation Sedatives Thoracocentesis or thoracostomy tube for pneumothorax Consider temporary tracheostomy ```

Question 26

Tracheal Trauma MINOR tears/Ruptures If dyspnea persists or worsens surgical repair is indicated how to close, pattern, suture

Answer 26

Primary closure of tear Simple continuous pattern Fine, absorbable suture

Question 27

what should you monitor for with MINOR tears/ ruptures

Answer 27

scarring, tracheal | narrowing long term

Question 28

Tracheal Tears SEVERE Tears/Ruptures Surgical intervention indicated when:

Answer 28

Dyspnea persists or worsens with medical management If pneumothorax persists > 2-3 days Severe tracheal damage is visible (movement under ski)

Question 29

Tracheal Tears | SEVERE Tears/Ruptures how to close

Answer 29

Primary closure of tear | Tracheal resection and anastomosis

Question 30

Tracheal Resection/Anastomosis technique

Answer 30

spilt - cartilage technique

Question 31

spilt - cartilage technique results in difficult in suture

Answer 31

``` Results in least amount of stenosis postop Difficult in small dogs and cats tension reliving suture ```

Question 32

``` Can resect ____ of trachea in adult dogs and _____ in puppies but tension is obvious after resecting ____ ```

Answer 32

25% to 50% 20% to 25% 3-4 rings

Question 33

Tracheal Resection and Anastomosis: Complications which is most imp

Answer 33

``` SQ emphysema Pneumomediastinum and pneumothorax Infection Stricture *** - Poor apposition of mucosa - Tension - Inflammation ```

Question 34

Temporary tracheostomy Permanent tracheostomy

Answer 34

Tracheostomy tube Stoma

Question 35

Permanent Tracheostomy | Indications

Answer 35

Salvage procedure - Untreatable upper airway obstruction - Upper airway treatment failure

Question 36

Untreatable upper airway obstruction example

Answer 36

palliation for nonresectable laryngeal neoplasia; Stage III laryngeal collapse

Question 37

Upper airway treatment failure example

Answer 37

failed treatment of laryngeal paralysis or laryngeal | collapse

Question 38

Stoma will decrease

Answer 38

40-50% in size in most animals Make it big !!

Question 39

Accurate apposition of skin and tracheal mucosa reduces ____ and _____

Answer 39

inflammation and amount of stenosis

Question 40

Permanent Tracheostomy | Long-term Care

Answer 40

Excessive secretions for weeks post-op until squamous metaplasia of mucosa is complete Maintenance of opening > Clipping hair as needed No swimming Protection from foreign bodies > Plant material Harness

Question 41

Permanent Tracheostomy | Prognosis for indoor dogs

Answer 41

good if underlying disease is benignprocess Owners must be diligent with care May require symptomatic treatment for tracheitis

Question 42

Permanent Tracheostomy | Prognosis for cats

Answer 42

guarded to poor Mucus plugs very common leading to acute death Median survival times reported to be 20.5 and 42 days Soft tracheal cartilage may predispose trachea to collapse Consider placement of external rings adjacent to tracheostomy site