can be used to circumvent the upper airways whileawaiting remission of obstruction during radiationtherapy or during long-term ventilatory support of crit-ically ill patients.Indications for a permanent tracheostomy include la-ryngeal paralysis or collapse, radiation therapy of theupper airways or oropharynx, laryngotracheal resec-tions, staged laryngeal reconstruction, nasal neoplasia,or severe secretory respiratory disease.
Permanent tra-cheostomy can be either lifelong or surgically closed af-ter resolution of the primary disease.
NORMAL TRACHEAL ANATOMY
The trachea is a semirigid, flexible air conduit thatextends from the cricoid cartilage to the tracheal carina, where it divides to form the mainstem bronchi.
Thetracheal lumen is maintained by 35 to 45
-shapedhyaline cartilage rings (the actual number varies by species, breed, and individual).
The width of the av-erage canine cartilage is 4 mm at its thickest point ven-trally and tapers dorsally. The first tracheal ring, whichis complete in dogs, resembles and is partially coveredby the cricoid cartilage.
The remaining rings are unit-ed longitudinally by interspersed 1-mm-wide fibroelas-tic annular ligaments.
The tracheal rings are joined dorsally by the smoothtransverse fibers of the tracheal muscle and, together with the mucosa, submucosa, and adventitia, form thedorsal tracheal membrane.
The cervical trachea isbounded dorsally by the esophagus (cranially) and thelongus colli muscles (caudally) and ventrally by the ster-nohyoid muscles (cranially) and sternocephalic and ster-nothyroid muscles (caudally).
The trachea is bound-ed laterally on both sides by large neurovascular bundlesthat contain the vagosympathetic trunk, commoncarotid artery, internal jugular vein, and recurrent laryn-geal nerve (which lies outside the common sheath onthe left).
The cervical portion of the trachea ends at thecranial mediastinum and becomes the thoracic trachea.The tracheal mucosa is composed of pseudostratifiedciliated columnar epithelium, which contains basal, cil-iated columnar, goblet, and nonciliated columnarcells.
Mostof the epithelium contains a ratio of approximately five ciliated cells per goblet cell.
Thesubmucosa contains elastic fibers, fat cells, and seromu-cinous tubular glands,
the latter of which can secreteas much mucus as 40 goblet cells.
The hyaline cartilagerings, annular ligaments, and tracheal muscle form themusculocartilaginous layer, whereas the adventitia is aloosely enclosing sleeve of fascia that blends the muscu-locartilaginous layer to surrounding connective tissue.
The trachea is supplied by branches of the cranialthyroid, caudal thyroid, and bronchoesophageal arter-ies. The cranial and caudal thyroid arteries anastomosein the lateral pedicles and have branches that segmen-tally supply the ventral and lateral aspects of the tra-chea.
The dorsal tracheal membrane is supplied by branches of the bronchoesophageal arteries.
After thearterial branches have penetrated the annular ligaments,they arborize in the submucosa and communicate witha dense capillary net beneath the epithelium.
Venousdrainage occurs through the thyroid and internal jugu-lar and bronchoesophageal veins.
Lymphatic drainagecontinues to the deep cervical, cranial mediastinal, me-dial retropharyngeal, and tracheobronchial lymphnodes.
The trachea is innervated by the sympathetic systemvia the sympathetic nerve trunk and the parasympa-thetic system via the recurrent laryngeal nerve.
Sym-pathetic stimulation inhibits tracheal muscle contrac-tion and glandular secretions, whereas parasympatheticstimulation has an opposing action.
NORMAL TRACHEAL PHYSIOLOGY
The primary purposes of the trachea are conductionof air to and from the lower airways and removal of particulate material from the bronchial tree.
Patentflexibility is achieved during normal cervical move-ments by joining rigid cartilage rings with flexible an-nular ligaments.
Although tracheal diameter changesslightly during normal respiration, the diameter of thelumen decreases by 50% during coughing.
This dra-matic reduction results from tracheal muscle contrac-tion, which reduces dead space, increases the velocity of air, and is believed to aid in mucosal expulsion duringthe cough reflex.
Inhaled particulate material and excessive bronchialsecretions are cleared from the respiratory tract by themucociliary escalator (a continuous layer of mucus pro-duced by the goblet cells and seromucinous glands) andpropelled toward the larynx by the ciliated epithelialcells at approximately 12.6 mm/min.
The flow of mucus is most rapid in cats and younger dogs and is ac-celerated when warm, dry air is inspired.
TRACHEAL WOUND HEALING
Tracheal mucosa responds to irritation by increasingthe production of mucus.
Trauma to only the trachealmucosa heals by migration, mitosis, and differentiation, which lead to complete epithelial regeneration.
Asearly as 2 hours after injury, marginal epithelial cellslose their cilia, flatten, and begin migrating across theinjury. These migrating epithelial cells, guided by theunderlying elastic lamina, secrete enzymes that dissolvethe fibrinous clot covering the denuded mucosa. Unlikein the epidermis, migration is limited to the marginal
January 199920TH ANNIVERSARYSmall Animal/Exotics
CHANGES IN TRACHEAL DIAMETER
INCREASED MUCUS PRODUCTION