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25 Cards in this Set
- Front
- Back
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what are the most common tracheal tumors?
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SCC
adenoid cystic |
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how common are tracheal tumors?
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rare. 0.2% of respiratory malignancies
M> F 7:3 |
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when should you be suspicious of a tracheal tumor?
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adult onset asthma
hemoptysis |
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whats important about infection in the airway at the time of resection?
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it's better to drain the infection, i.e. relieve the obstruction and allow the inflammation to calm down.
this leads to a better healed anastamosis after surgery. |
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what do carcinoid tumors do with contrast?
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light up. they're very vascular
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why do we see fewer trachea SCC's? compared to laryngeal and bronchial?
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laminar flow. the evils don't settle on the walls here
better mucociliary clearance |
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adenoid cystic ca. what are the stats?
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50's
m= f responds well to XRT so resection with positive margins is acceptible. |
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whats the difference between the behavior of typical and atypical carcinoid tumors?
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typical - slow growing, resected with negative margins has good prognosis
atypical - aggressive, highly malignant both don't respond well to XRT. atypical responds some chemo. best treatment is to resect. |
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what is the first think you want to know when treating a mucoepidermoid carcinoma?
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what's the grade.
low grade have good prognosis with surgery. high grade can advance quickly. typically present in younger individuals. can be treated with palliative XRT if not resectable |
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is there a role for neoadjuvant chemoRT in tracheal tumors?
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overall, no. they just cause problems with healing in surgical candidates
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whats the blood supply to the trachea?
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first and second bronchial arteries inferiorly. inferior thyroid arteries superiorly - 3 branches to different levels of the trachea
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what the average tracheal length? diameter?
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12 cm
1.5-2 cm |
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describe the path of the RLN's.
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right, comes off vagus, wraps from posterior to anterior around the subclavian and runs lateral to media to the CT joint.
on the left it wraps around aorta and runs in the TE groove |
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what are the two major points of tracheal fixation, hence two sites of disjunction deceleration injuries?
what other type of injury is seen with chest wall compression (like in an MVC)? |
laryngotracheal junction. or tracheobronchial junction
membranous wall tears and ruptures due to high pressures in the trachea |
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which penetrating wounds cause more damage: bullet or stab wound?
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bullet.
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for surgical repair of tracheal damage, what incision gives you nearly complete exposure?
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collar incision
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what is the best diagnostic tool for a TI fistula? how do you avoid them?
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bronch
place your trach between the 2-3rd tracheal rings avoid awkwardly angled traches or sharp tips to trachs avoid intubation or cuff up for > 2 weeks |
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how do you surgerize a TI fistula? whats the survival?
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sternotomy with ligation above and below the fistula.
the tracheal segment is resected with end to end anastomosis. strap muscle is interposed between the vessel and airway 50% survival. .......did not discuss stenting in this text |
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what places a patient at high risk for developing a TEF?
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long term trach/ETT and NG tube
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whats going on in a patient with a known esophageal cancer with gastric secretions being suctioned from the airway?
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malignant TEF
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repairing a Non malignant TEF?
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double layered closure with placement of a strap in between the esoph and airway.
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repair a malignant TEF?
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author choice for Lalwani is esophageal stenting..
consider esophageal exclusion, esophageal bypass, fistula resection and repair, chemotherapy, and radiation therapy. |
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what the common causes of tracheal stenosis?
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trach - causes A frame narrowing at the trach site
intubation - transmural ischemia then scarring while healing subglottic - intubation injury, oversized ETT. |
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how do you initially treat a sx patient.
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humidification
heliox steroids PPI |
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a dynamic CT of the chest is ordered to evaluate for trachemalacia? what degree of compression is normal? abnormal?
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normal is 14%. usually tracheomalacia you see s/t like 44%
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