Tracheostomy

Describe the anatomy relevant to the performance of a naso, or endo, tracheal intubation, a cricothyroidotomy or tracheostomy

Trachea

The trachea is fibrocatilagenous tube which:

  • Extends from the larynx superiorly to the Plane of Louis inferiorly
  • Terminates by division into the right and left mainstem bronchi
  • Runs at 15 degrees parallel to the surface of the neck, such that the distal trachea is deeper than the proximal trachea
  • Has a D-shaped cross section
    • Anterior wall is formed by 18-22 incomplete cartilaginous rings which maintain tracheal patency
    • Posterior wall of the trachea is spanned by longitudinal smooth muscle known as trachealis
  • Is typically:
    • 10cm long
    • 2.3cm wide
    • 1.8cm in AP diameter

Relationships

  • Lateral to the trachea are the:
    • Carotid sheaths
      Contains the carotid artery, internal jugular vein, and vagal nerves.
    • Thyroid lobes (and inferior thyroid arteries)
    • Recurrent laryngeal nerves.
  • Inferior to the thyroid isthmus lies the thyroid veins
  • Posterior to the trachea are the:
    • Oesophagus
    • Vertebral column

Surface Anatomy

Midline neck structures are relevant surface anatomy:

  • Layngeal structures
    Including: Hyoid, thyroid cartilage, cricothyroid membrane, cricoid cartilage.
  • Sternal notch
  • Thyroid lobes
    Lie lateral to trachea.

Layers of Dissection

  • Skin
  • Subcutaneous fat
  • Superficial and Deep Pretracheal fascia
  • Tracheal wall
    • Ideally between 1st and 2nd rings

References

  1. McMinn, RMH. Last's Anatomy: Regional and Applied. 9th Ed. Elsevier. 2003.
Last updated 2017-09-22

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