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surgery > trachea > Flashcards

trachea Flashcards

1
Q

Cervical Ventral Midline

A 
cranial cervical trachea
Sternohyoideus and sternothyroideus mm.
Recurrent laryngeal n.
Vagosympathetic trunks
R and L common carotid
arteries
Thyroid glands
Esophagus
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2
Q

Median Sternotomy

A

Caudal cervical and cranial thoracic trachea

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3
Q

Intercostal thoracotomy

A

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

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4
Q

Degenerative, Developmental

A

Tracheal collapse

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5
Q

Anatomical/Anomalous, Acquired, Allergic, Auto-Immune

A

Esophagotracheal or esophagobronchial fistula

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6
Q

Metabolic, Mechanical

A

Foreign Bodies

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7
Q

Neoplastic, Nutritional

A

Osteosarcoma, osteochondroma, chondrosarcoma, leiomyoma,

rhabdomyosarcoma, AdCa, LSA, FSA, SCC

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8
Q

Infectious, Inflammatory, Idiopathic, Iatrogenic

A

Spirocerca lupi/Onchocerca sp, Cuterebra

Tracheal Rupture secondary to ET tube (trauma) *

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9
Q

Trauma Toxin

A

tears/ruptures *

hematomas

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10
Q

When to do SX for tracheal collapse

A

ONLY WHEN MEDICAL MANAGEMENT FAILS

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11
Q

tracheal collapse

External Prosthetic Tracheal Rings

A

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

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12
Q

tracheal collapse SX complications

A

Laryngeal paralysis
Tracheal Necrosis
Pneumothorax

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13
Q

Complications: Laryngeal paralysis

A

Reported in 11-30% of surgical cases

Damage during surgery vs. continued trauma from implants

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14
Q

Complications: Tracheal Necrosis

A

Secondary to damage to trachea’s segmental blood supply

Life threatening > Coughing, SQ emphysema

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15
Q

Complications: Pneumothorax

A

Diffusion of air through mediastinum during surgery

Accidental penetration of thoracic cavity near caudal cervical trachea

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16
Q

Tracheal Collapse SX

Intraluminal Stent

A 
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
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17
Q

Intraluminal Stent Advantages

A

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

18
Q

Intraluminal Stent Disadvantages

A 
Requires fluoroscopy or
endoscopy
\$\$\$\$$
Shorter life-span than tracheal rings (bc can break)
Moderate to high complication rate
19
Q

Complications on stenting

A

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

20
Q

Tracheal trauma - Internal

A

Rupture or necrosis secondary to ET tube

Foreign bodies

21
Q

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

A

cats

dental procedures

22
Q

Tracheal Trauma - External

A

Blunt or penetrating injuries
Bite wounds
Lacerations

23
Q

mild to severe clinical sings with tracheal trauma

A 
Subcutaneous emphysema
Anorexia
Lethargy
Stridor
Coughing
Dyspnea
24
Q

Progression of pathology

in severe cases of tracheal trauma

A

Mediastinal Emphysema

Pneumothorax

25
Q

medical management for MINOR tears/ ruptures

A 
Cage rest
Oxygen supplementation
Sedatives
Thoracocentesis or thoracostomy tube for pneumothorax
Consider temporary tracheostomy
26
Q

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

A

Primary closure of tear
Simple continuous pattern
Fine, absorbable suture

27
Q

what should you monitor for with MINOR tears/ ruptures

A

scarring, tracheal

narrowing long term

28
Q

Tracheal Tears
SEVERE Tears/Ruptures
Surgical intervention indicated when:

A

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

29
Q

Tracheal Tears

SEVERE Tears/Ruptures how to close

A

Primary closure of tear

Tracheal resection and anastomosis

30
Q

Tracheal Resection/Anastomosis technique

A

spilt - cartilage technique

31
Q

spilt - cartilage technique

results in
difficult in
suture

A 
Results in least amount
of stenosis postop
Difficult in small dogs
and cats
tension reliving suture
32
Q 
Can resect \_\_\_\_ of
trachea in adult dogs and
\_\_\_\_\_ in puppies but
tension is obvious after
resecting \_\_\_\_
A

25% to 50%

20% to 25%

3-4 rings

33
Q

Tracheal Resection and
Anastomosis: Complications

which is most imp

A 
SQ emphysema
Pneumomediastinum and pneumothorax
Infection
Stricture ***
- Poor apposition of mucosa
- Tension
- Inflammation
34
Q

Temporary tracheostomy

Permanent tracheostomy

A

Tracheostomy tube

Stoma

35
Q

Permanent Tracheostomy

Indications

A

Salvage procedure

  • Untreatable upper airway obstruction
  • Upper airway treatment failure
36
Q

Untreatable upper airway obstruction example

A

palliation for nonresectable laryngeal neoplasia; Stage III laryngeal collapse

37
Q

Upper airway treatment failure example

A

failed treatment of laryngeal paralysis or laryngeal

collapse

38
Q

Stoma will decrease

A

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

39
Q

Accurate apposition of skin and tracheal mucosa reduces ____ and _____

A

inflammation and amount of stenosis

40
Q

Permanent Tracheostomy

Long-term Care

A

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

41
Q

Permanent Tracheostomy

Prognosis for indoor dogs

A

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

42
Q

Permanent Tracheostomy

Prognosis for cats

A

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

surgery (4 decks)

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