trachea with trans

7/30/2019 TRACHEA With Trans

1/56

TRACHEA

ANDESOPHAGUS

Jeriel John C. Majam, MD, FPSOHNS

Otorhinolaryngology Head and Neck Surgery


2/56

TRACHEA

TRACHEA AND ESOPHAGUS by JERIEL JOHN C. MAJAM, MD, FPSOHNS


3/56

ANATOMY

Extends from C6 T5/6 vertebrae

Nearly cylindrical, slightly flattenedposteriorly

16-20 rings or C-shaped bars,incomplete posteriorly



4/56

ANATOMY

Supplied mainly by the inferior thyroidarteries

Receives branches from the superiorthyroid, bronchial, and internal thoracicarteries

Drained by the inferior thyroid vein

Innervated by the vagus, sympathetic,and recurrent laryngeal nerves



5/56

CONGENITAL DISORDERS

Tracheal Agenesis or Atresia

Rare

There is no continuity between thelarynx and trachea

Fatal



6/56


Tracheal Webs

Thin band of tissue spanning thetracheal lumen without deformity ofthe underlying cartilage

Tx: Dilation, laser transection;resection and anastomosis



7/56


Tracheal Stenosis Assoc tracheoesophageal fistula,

pulmonary hypoplasia, vascular sling,

Trisomy 21 Cartilage is smaller and nonflexible, lacks

the posterior membranous portion

Dx: endoscopic evaluation

Tx: resection and reanatomosis,tracheoplasty



8/56


Tracheomalacia Weakness of the tracheal wall resulting

in marked exaggeration of movement

with respiration Symptoms:

Expiratory stridor, wheezing

Barking cough Hyperextension of neck

Reflex apnea



9/56


Primary Tracheomalacia

Esp in premature infants

Dx with rigid endoscopyshowing widened posterior

wall with expiratory collapse Resolves 18-24 months



10/56


Secondary Tracheomalacia

After surgical repair of

tracheoesophageal fistula External compression from

vascular anomalies



11/56


1/3000

livebirths

Drooling,

coughing,cyanosis,

abdominal

distention,

poor feeding



12/56

Clinical Considerations

Foreign body aspiration

More likely to enter right bronchus

Tracheoscopy/bronchoscopy



13/56

Ventilating Bronchoscope



14/56

TRACHEOSTOMY



15/56

Tracheostomy

Is an opening surgically created

through the neck into the trachea

through which air may pass to the

lungs, by-passing through the

upper airway.



16/56

Tracheostomy

Incidence (2002 PGH)

107 referrals 85% adults

Pneumonia and CVD

65 ENT ward tracheostomies Laryngeal masses

Oral cavity tumors

Anterior neck masses



17/56

BACTERIAL TRACHEITIS

Membranous laryngotracheobronchitis Antibiotis directed vs Staph aureus and H.

influenza



18/56

From cricoid cartilage (C6) to stomach(T10)

3 constrictions CricopharyngeusArch of the aorta & left main bronchus Gastro-esophageal junction

ESOPHAGUS



19/56

ESOPHAGUS


20/56

Blood supply inf. thyroid br. of thyrocervical trunk

small br. of thoracic aorta

bronchial aa.

ascending br. of left gastric a

ascending br. of left phrenic a.

Venous drainage Inf thyroid

Azygos, hemiazygos

Gastric


ANATOMY


21/56

Layers: Outer longitudinal muscle

Inner circular muscle

Submucosa Mucosa

Upper 1/3 skeletal muscle, distalportion is smooth muscle


ANATOMY


22/56

Gastroesophageal reflux 50% of infants; pathologic if it persists

beyond 18 months of age

Vomiting soon after or up to several hoursafter feeding

Dx: prolonged esophageal pH monitoring

Tx: positioning, dietary changes


Congenital


23/56

This Is A Piggy Bank



24/56

This Is A Human Piggy Bank



25/56

For Practice



26/56

Structural: DIVERTICULA

Caused in part by an area of anatomic weakness3 areas of constriction Killians dehiscence

Between cricothyroid & cricopharyngeus mm

Laimer-Haeckerman space Between cricopharyngeus & circular fibers of esophagus

Killian-Jamieson space Lateral dehiscence bet. cricopharyngeus & esophageal muscle

fibers through recurrent laryngeal n passes


The only esophageal problem in ENT is laryngopharyngeal reflux (MC)


27/56

Structural: ZENKERS DIVERTICULUM

Zenkers diverticulum (MC)

Barium swallow simply xray


28/56

Due to chronic spasm of the upper

esophageal sphincter with resultant

high pressures in Killiansdehiscence

80% of all diverticula (MC)




29/56

Symptoms

Dysphagia (MC)

Spontaneous regurgitation ofundigested food

Aspiration & cough

Halitosis




30/56

Diagnosis

Barium swallow

Esophagoscopy (flexible is recommended)

Treatment

Surgery



Rigid esophagoscopy removal of foreign body, usually used by ENT

Flexible esophagoscopy usually used by enterologist


31/56

Barium Swallow



32/56

AP View



33/56

Barium Swallow



34/56

Structural: ACHALASIA

Zonal reduction inganglion cells

Esophageal aperistalsisand LES dysfxn

Xray: absent primaryperistalsis, beak-liketapering at theesophageal hiatus



35/56

Structural: DIFFUSE ESOPHAGEAL SPASM

Intermittent abn esophageal motility

Manometry: presence ofsimultaneous contractions andintermittent N primary peristalsis


Can be diagnosed through manometry


36/56

Xray: absence ofprimary

peristalsis in thesmooth muscleportion,corkscrewappearance


Structural: DIFFUSE ESOPHAGEAL SPASM


37/56

Structural: PRESBYESOPHAGUS

Abnormal motility associated with aging

Decreased primary and increased

tertiary contractions

Rule out other concomitant illnesses

first



38/56

Structural: SCLERODERMA

Aperistalsis of the lower 2/3 of theesophagus

Marked decrease in lower esophagealsphincter pressure

Normal peristalsis in the upperesophagus

60% with symptomatic dysphagia



39/56


Structural: SCLERODERMA


40/56

Structural: POLYMYOSITIS

Muscle weakness secondary toinflammation and degenerative changes

in striated muscle

Peristalsis is diminished and poorlydiminished

Esophagus may be dilated


Affects lower esophagus


41/56

Structural: HIATAL HERNIA

Portion ofstomach

passing throughthe normalesophagealhiatus abovethe diaphragm

Normally associated with obesity, pregnancy etc


42/56

Obesity



43/56

Structural: REFLUX ESOPHAGITIS



44/56

Structural: STRICTURES

Caustic ingestion - common


45/56

Structural: SCHATZKIS RING

Concentric ring at the gastro-esophageal

junction

6-14% of routine barium swallows

Only 1/3 are symptomatic

Dysphagia if lumen < 13 mm



46/56

Schatzkis Ring



47/56

Structural: ESOPHAGEAL WEBS

Aberrant structure consisting of squamous

mucosa located anywhere along the

esophagus


Easy to treat

Dilate


48/56

Structural: ESOPHAGEAL WEBS



49/56

Others: BOERHAAVE SYNDROME

Results from a tear through all layers of

the esophageal wall just above the

diaphragm produced by a sudden

increase in esophageal pressure



50/56

Others: MALLORY-WEISS SYNDROME

Manifest by bleeding from lacerations of

the cardia of the stomach as a result of

prolonged or forceful vomiting


Most common benign tumor


51/56

LEIOMYOMAMost common benign tumor

L side smooth border

R sight irregular border


52/56

Inflammatory: PLUMMER-VINSON

Iron deficientanemia, upper

esophageal web,

hypothyroidism,glossitis, gastritis,

dysphagia

15% increaseincidence of

postcricoid SCCA



53/56

Inflammatory: BARRETTS ESOPHAGUS

Lower portion of esophagus is lined withcolumnar rather than squamous

epithelium

Progresses to adenoCA of esophagus in10-15%



54/56

ESOPHAGEAL CANCER

4% of cancer deaths

Male:female = 5:1

Chronic tobacco &alcohol use

Lower 1/3 of

esophagus 40-50%



55/56

ESOPHAGEAL CANCER


Fungating in appearance

Predisposing alcohol and smoking


56/56

trachea with trans

Documents