Length Of Trachea Research Articles

Measurement of the lengths of different sections of the upper airway and their predictive factors.

No studies have been conducted to define the lengths of the upper airway's different segments in normal healthy adults. This study aimed to determine the length of the subglottis and extrathoracic trachea and the factors affecting it. This was an observational retrospective review study. Included 102 adult patients who underwent CT scan during the quiet inspiration phase of the upper airway. The results revealed significant positive linear relationships between height and both anterior and posterior subglottic measurements (p < 0.001). Additionally, a statistically significant, moderately strong negative correlation between age and extrathoracic tracheal measurements (p > 0.001) was observed. Men exhibited longer anterior (p < 0.001) and posterior (p > 0.001) subglottic measurements. In both sexes, the average length of the anterior subglottis was 14.16 (standard deviation [SD]: 2.72) mm, posterior subglottis was 14.51 (SD: 2.85) mm and extrathoracic trachea was 66.37 (SD: 13.71) mm. We concluded that a normal healthy adult's anterior subglottis length is 6.3-19.3 mm (mean: 14.16 [SD: 2.72] mm), posterior subglottis length is 6.1-20.0 mm (mean: 14.51 [SD: 2.85] mm) and extrathoracic trachea length is 25.2-98.5 mm (mean: 66.37 [SD: 13.71] mm). Age, height and sex affected the upper airway length.

Vocal tract shape variation contributes to individual vocal identity in African penguins.

Variation in formant frequencies has been shown to affect social interactions and sexual competition in a range of avian species. Yet, the anatomical bases of this variation are poorly understood. Here, we investigated the morphological correlates of formants production in the vocal apparatus of African penguins. We modelled the geometry of the supra-syringeal vocal tract of 20 specimens to generate a population of virtual vocal tracts with varying dimensions. We then estimated the acoustic response of these virtual vocal tracts and extracted the centre frequency of the first four predicted formants. We demonstrate that: (i) variation in length and cross-sectional area of vocal tracts strongly affects the formant pattern, (ii) the tracheal region determines most of this variation, and (iii) the skeletal size of penguins does not correlate with the trachea length and consequently has relatively little effect on formants. We conclude that in African penguins, while the variation in vocal tract geometry generates variation in resonant frequencies supporting the discrimination of conspecifics, such variation does not provide information on the emitter's body size. Overall, our findings advance our understanding of the role of formant frequencies in bird vocal communication.

Investigation of Subcarinal Angle and Tracheobronchial Morphology in Patients with COVID 19: A Retrospective Computed Tomography Study

Objective: Morphological features of the trachea are very important in choosing the correct endotracheal tube size for intubation. In this study, it was proposed to reveal the effect of SARS-CoV-2 on tracheobronchial morphology and subcarinal angle. &#x0D; Method: 56 (26 female, 30 male) COVID-19 and 48 (24 female, 24 male) healthy individuals aged 40 and over were included in the study. The mean age of female patients with COVID-19 was 51.30±12.78 years, while the women in the control group were 45.00±11.89 years. The mean age of male patients with COVID-19 was 48.73±13.99 years, while the mean age of men in the control group was 43.76±8.45 years. The trachea length (TL), proximal, middle and distal levels anteroposterior (AP) and transverse (TR) trachea diameters (TD), subcarinal angle (SA), proximal right main bronchus (RMB) and left main bronchus (LMB) diameters were also measured on computed tomography (CT) images. &#x0D; Results: The RMB angle was higher in men with COVID-19 than in the control group (p=0.005). TL was lower in women with COVID-19 than in the control group (p=0.030). Proximal AP-TD was higher in men with COVID-19 than in the control group (p=0.006). Proximal TR-TD was lower in men with COVID-19 than in the control group (p=0.029). TL, proximal, middle, and distal levels of AP and TR-TD,SA, RMB, and LMB angles, and proximal RMB and LMB diameters were found to be lower in women with COVID-19 than in men with COVID-19 (p=0.001). &#x0D; Conclusion: It was deduced that tracheobronchial morphology might change in patients infected with SARS-CoV-2.It is clinically important that this situation should not be overlooked, especially in the indication of endotracheal intubation.

CT measurements of tracheal diameter and length in normocephalic cats.

The aim of this study was to measure the tracheal dimensions of normocephalic cats using CT. CT images of 15 client-owned normocephalic cats were retrospectively evaluated to measure the length of the feline trachea. Transverse and vertical inner diameters were measured in five different tracheal regions, and the cross-sectional area of the tracheal lumen was calculated for each point of measurement. Descriptive statistics were applied using a two-tailed t-test. The mean ± SD length of the trachea was 125.13 ± 14.41 mm. Male cats had significantly larger tracheas than female cats. The transverse diameter first increased by 0.94 mm between the most cranial point of measurement and the middle of the trachea. It then decreased by 1.38 mm between the middle of the trachea and the most caudal point of measurement. The vertical diameter decreased by 1.16 mm between the first point of measurement and the penultimate point, and then increased by 0.06 mm between the penultimate point of measurement and the end of the trachea. The two different diameters resulted in an elliptical trachea shape. The feline trachea was circular only at its cranial and caudal ends, and elliptical with a dorsoventral flattening along the rest of its length. Vertical and transverse diameters varied along the entire length. Tracheal shape differences should be considered when performing permanent tracheostomy, tracheal anastomosis or stenting in cats.

Cricoid Augmentation by Costal Cartilage Graft in the Treatment of Complex Crico-Tracheal Stenosis in Adults.

We present herein our results of cricoid augmentation with costal cartilage in complex crico-tracheal stenosis in adults. This is a retrospective analysis of a prospectively maintained data of patients who underwent surgery for crico-tracheal stenosis at a tertiary care centre from March 2012 to September 2019. Finding of subglottic stenosis with cricoid narrowing was taken as an indication for cricoid split and costal cartilage graft augmentation. Their demographic and clinical data, pre-operative work up, intra-operative details and post-operative course was recorded. Ten patients underwent cricoid split with costal cartilage graft augmentation and crico-tracheal anastomosis between March 2012 and November 2019. The mean age was 29years (range, 22-58years). There were 6 males (60%) and 4 females (40%). All 10 patients underwent circumferential resection of stenosed tracheal segment, cricoid split, interposition of costal cartilage graft and an anastomosis between augmented cricoid and trachea. Eight patients (80%) anterior cricoid split and 2 (20%) had anterior as well as posterior split. Average resected length of trachea was 2.39 cms. Cricoid split with costal cartilage augmentation is a feasible option to expand cricoid lumen in crico-tracheal stenosis. None except one of our patients required any further intervention in mean follow up of 42months and all are free from primary symptoms. The functional results of the surgery were also excellent in 90% of the patients.

Sliding tracheoplasty of complete tracheal cartilage rings in children

IntroductionComplete tracheal rings are a rare malformation that occurs in 1 out of 100,000 live births. It is rare, isolated tracheal or tracheobronchial anomaly developed due to abnormal cartilage growth with formation of complete ring and often resulting in airway stenosis. Slide tracheoplasty, as it was originally described by Tsang et al. and popularized by Grillo et al., overlaps stenotic segments of trachea, shortening trachea itself, thus, doubling the circumference and diameter of the stenotic area. Materials and methodsWe have performed slide tracheoplasty in 12 children during the period of 2019–2021 in thoracic surgery department of our center. Median age was 15 ± 21,1 months (2 months-6 years),median weight – 8,04 ± 4,75 kg (3–20,7 kg),tracheal lumen varied from 2.5 to 3.0 mm, stenosis length – from 40 to 70% of the trachea length. ResultsSlide tracheoplasty was performed using central veno-arterial extracorporeal membrane oxygenation in 7 cases and using cardiopulmonary bypass in 5 cases. Concomitant heart disease was revealed in 5 children (pulmonary artery sling in 3 cases, ventricular septal defects – 1, aberrant subclavian artery −1). 5 children underwent one-stage correction of VSD: plastic VSD –1; left pulmonary artery reimplantation – 3; subclavian artery reimplantation – 1. All patients were on mechanical ventilation for 4,3 ± 2,78 days at postoperative period. Patients were discharged 16,3 ± 5,14 days after surgery. Satisfactory result of treatment in the form of respiratory failure relief was achieved in 10 patients. It was possible to increase the trachea lumen from 1.5 to 2 times in all cases. There were 2 (16,6%) fatal cases due to sepsis and multi-organ failure development. ConclusionsChildren with complete tracheal rings are very complicated patients with various comorbidities. Despite the advances in medicine, sometimes it is impossible to save lives of these children. The use of extracorporeal circulation (ECMO and bypass) allows us to safely perform reconstructive surgery on the trachea and save the child from respiratory failure manifestations. If needed, simultaneous correction of heart and tracheal defects is possible. Slide tracheoplasty allows to increase trachea lumen at least in 1.5–2 times. Mechanical ventilation is an unfavorable predictive factor for the outcomes of congenital tracheal stenosis management. Level of evidenceIII.

Automatic segmentation and measurement of tracheal collapsibility in tracheomalacia

PurposeTo assess feasibility of automated segmentation and measurement of tracheal collapsibility for detecting tracheomalacia on inspiratory and expiratory chest CT images. MethodsOur study included 123 patients (age 67 ± 11 years; female: male 69:54) who underwent clinically indicated chest CT examinations in both inspiration and expiration phases. A thoracic radiologist measured anteroposterior length of trachea in inspiration and expiration phase image at the level of maximum collapsibility or aortic arch (in absence of luminal change). Separately, another investigator separately processed the inspiratory and expiratory DICOM CT images with Airway Segmentation component of a commercial COPD software (IntelliSpace Portal, Philips Healthcare). Upon segmentation, the software automatically estimated average lumen diameter (in mm) and lumen area (sq.mm) both along the entire length of trachea and at the level of aortic arch. Data were analyzed with independent t-tests and area under the receiver operating characteristic curve (AUC). ResultsOf the 123 patients, 48 patients had tracheomalacia and 75 patients did not. Ratios of inspiration to expiration phases average lumen area and lumen diameter from the length of trachea had the highest AUC of 0.93 (95% CI = 0.88-0.97) for differentiating presence and absence of tracheomalacia. A decrease of ≥25% in average lumen diameter had sensitivity of 82% and specificity of 87% for detecting tracheomalacia. A decrease of ≥40% in the average lumen area had sensitivity and specificity of 86% for detecting tracheomalacia. ConclusionAutomatic segmentation and measurement of tracheal dimension over the entire tracheal length is more accurate than a single-level measurement for detecting tracheomalacia.

Morphometry of Adult Human Trachea and its Clinical Implications: A Cadaveric Study in Northern India

Introduction: There is a wide variation in different dimensions of trachea in same age group as well as in different age groups in both sexes. Besides anthropometry, the study of these morphometric variations is of profound clinical importance as it may help the pulmonologists to understand the aetiology of several pulmonary diseases like bronchitis, emphysema, pulmonary fibrosis and tuberculosis. Aim: To determine the variations in the dimensions of human trachea in the cadavers of age group 20-70 years in Northern India. Materials and Methods: This cross-sectional study was conducted in the Department of Anatomy, Sri Guru Ram Das Institute of Medical Sciences and Research, Amritsar, Punjab, India, during March 2019 to December 2021. A total of 40 tracheas were obtained from adult human cadavers which were included in present study by convenience sampling. The trachea was dissected with the larynx and principal bronchi and measurements were taken. Data collected was saved on Microsoft excel and was analysed by calculating percentages, mean and Standard Deviation (SD). Results: Mean length of trachea was 109.25 mm, mean subcarinal angle was 75.45°. Mean anteroposterior diameter, transverse diameter, mean height and distance between posterior ends of rings was 16.70 mm and 18.10 mm, 4.53 mm and 12.15 mm respectively and mean of inter-ring distance between 1st-2nd, 5th6th, 10th-11th, 15th-16th Tracheal rings was 1.12 mm. Conclusion: The present study revealed a wide variation in different dimensions viz. length, transverse and anteroposterior diameters, mean height, inter-tracheal ring distance and the subcarinal angle. Accurate anatomical knowledge of the variations is essential for understanding the pathophysiology and management of different airway disorders and in reconstructive surgery of tracheobronchial tree.

Surgical Treatment of Patients with Full Tracheal Rings: Our Experience.

Introduction: Complete tracheal rings are a rare pathology occurring in 1 out of 100,000 live births. It is rare isolated tracheal or tracheobronchial anomaly resulting from abnormal cartilage growth, forming a complete ring, and leading to airway stenosis. A sliding tracheoplasty, primarily described by Tsang et al. and later widely presented by Grillo et al., overlaps the tracheal stenosing segments and shortens the trachea itself, and thus increases the diameter and circumference of the stenosing area double up. Materials and Methods: We have performed four slide tracheoplasties in the period between February 2019 and December 2020 in children who underwent medical treatment in the department of thoracic surgery in our center. Median age was 10 ± 5.5 months (2 months-1 year 6 months). Median weight was 6.9 ± 1.9 kg (4.5-9 kg). Slide tracheoplasty was performed using central venoarterial extracorporeal membrane oxygenation in 3 cases and using cardiopulmonary bypass in 1 case. Results: Patients were on artificial lung ventilation for 2-6 days in the postoperative period. Patients were discharged 14-18 days after the surgery. There were no lethal outcomes in our study. Discussion: Long segment congenital tracheal stenosis is an often and serious life-threatening anatomical malformation that bounded the length of trachea >50%. There is no unique treatment strategy for patients with such pathology. Sliding tracheoplasty can be recommended for all, but not for the shortest segments of stenosis, as it creates permissible voltage fluctuations during tracheal anastomosis. Excellent results in management of such severe patients can be achieved only through the collaboration of multidisciplinary team of specialists sharing organized and consistent patient-oriented approach.

Volumetric Morphology of Segmental Trachea Sections

Introduction & Objective The trachea is the airway between the larynx and primary bronchi, extending from the inferior aspect of the cricoid cartilage to its bifurcation at the carina. Its anterior and lateral walls are comprised of 16-22 C-shaped cartilaginous rings held together by annular ligaments, while its posterior wall consists primarily of trachealis muscle. Studies of trachea length, coronal and sagittal diameters, and dynamics are well represented in the literature with significant differences reported between genders. However, studies regarding volumetric morphology of the trachea are limited. Several structures (e.g., thyroid gland, brachiocephalic trunk, left brachiocephalic vein, etc.) are in contact with different regions of the trachea and could potentially affect lumen volumes. The objective of this study was to investigate tracheal volumetric morphology through segmental area analysis of cadaveric male and female tracheas and compare those results to a known case of distal trachea constriction. Materials & Methods Tracheas of seven male and seven female human cadavers were dissected, eviscerated, and photographed (iPad Pro, Apple Inc.). Trachea lengths were recorded to the nearest millimeter via gross measurement. Tracheas were covered at the proximal end and filled with water. Water volumes were subsequently measured in triplicate. Tracheas were then sectioned into ten equal segments and photographed (iPad Pro, Apple Inc.). Lumen areas of each segment were measured in triplicate (ImageJ, 1.52q), and mean segmental areas were multiplied by trachea length to determine segmentally derived trachea volumes. T-tests were used to compare segmentally derived volumes to actual volumes measured by water displacement. Male and female data were compared separately, and comparable data from a separate clinical case of distal tracheal constriction in a female cadaver was compared to the female data collected in this study. Results Male tracheas were longer (11.9 ± 0.7 cm vs. 10.3 ± 0.7 cm, p < 0.05) and of greater volume (28.7 ± 5.0 mL vs. 16.5 ± 0.8 mL, p < 0.05) compared to female tracheas. While sequential comparison of segmentally derived volumes in both genders suggest similar regions of natural trachea constriction (middle third) and dilation (distal third), both regions were statistically indifferent from actual trachea volume. The segmentally derived volumes from the distal half of the clinically constricted trachea were considerably less than the female volumetric data (distal half) quantified in this study (8.82 ± 1.36 mL vs. 14.86 ± 0.90 mL, p < 0.05). Conclusions & Significance While variations in lumen area of sequential trachea segments are apparent, they have little to no significant effect on total trachea volume unless substantially impacted by a clinical condition. Certain segments of the trachea may be more accurate for estimating its total volume. The noted mid-section constriction is believed to be caused by the brachiocephalic artery and left brachiocephalic vein crossing obliquely over the anterior aspect of trachea but merits more study. This study and future data expansion via additional tracheal measurements will help define “normal” tracheal volumetric morphology. This information may be valuable to physicians performing surgical procedures and diagnosing abnormalities of the trachea.

The lengths of trachea and main bronchus in Chinese\xa0Shanghai population

The knowledge of airway length is the theoretical basis in the diagnosis and management of airway disease. The objective of this study is to measure the length of trachea and left and right main bronchus in Chinese Shanghai population. A total of 153 consecutive adult patients with minor pulmonary disease in Xinhua hospital were enrolled for bronchoscopy examination. Measurements were conducted on head and neck neutral position and height, weight and age for each patient were recorded either. Student t test and multiple linear regression was used to compare means between males and females and to analyze correlation among height, weight, sexual dimorphism and the lengths of the trachea and bronchus. The lengths of the trachea and left main bronchus are significantly different between male and female patients (P < 0.01), but not for the lengths of right main bronchus between man and woman. Multiple linear regression analysis showed that height but not sexual dimorphism and weight correlated with the lengths of the trachea and right main bronchus. The lengths of the trachea and left main bronchus are significantly longer in males than in females. Moreover, height but not sexual dimorphism and weight influenced the length of airway.

Assessment of tracheal elasticity and tracheal anastomosis tension in cicatricial stenosis

To assess the tracheal elasticity and tracheal anastomosis tension for prevention of anastomosis-related complications and estimation of the maximum length of resection. At the first stage, 20 patients with cicatricial tracheal stenosis underwent tracheoscopy in usual position, under maximum flexion and extension of the head for the period from September 2017 to December 2019. We measured the total length of trachea and length of stenotic segment. Tracheal extensibility was assessed considering the difference in measurements. At the second stage, anastomosis tension was intraoperatively measured using a dynamometer in normal head position, as well as at maximum flexion in 22 patients who underwent tracheal resection. Unlike multiple other studies, we studied tissue tension intraoperatively. Mean length of trachea was 12.8 cm, extensibility - 1.3 cm. Tracheal elasticity was greater in patients with a longer trachea and in patients under 40 years old. Mean length of resection was 3.9 cm (30% of mean length of trachea), anastomosis tension - 2.7 H or 270 g. Head flexion was followed by tension decrease by 0.7 H (26.9%), i.e. 70 g. This approach is less effective in case of resection of more than 30% of trachea length in a particular patient. Further experience in measurement of tracheal extensibility and anastomosis tension will make it possible to establish clinical significance of these indicators for prevention of complications.

Management of Tracheal Diseases in Children.

Tracheal pathology in children are primarily congenital. They can be considered primary or de novo, when this is seen as an inherent defect within the cartilages of the tracheal segment. While segmental cartilage defects are very rare, there are often occasions when one or more cartilages can be considered missing from the length of trachea, contributing to airway abnormality. Secondary tracheal pathologies can often be seen in relation to disorders affecting nearby vascular elements or thoracic cage in general. In general, the pathological entity of tracheal disorders can be classified into either tracheomalacia or tracheal stenosis.

A Study on Morphometric Features of Trachea and Larynx

Certain data such as weight and dimensions of structures are important in dosimetry for treating cancer patients using radiotherapy.The objective of this study is to determine the morphometric features of trachea and larynx and discuss the possible correlation between the height and weight of these structures with other parameters such as height, weight and age of patients. 29 samples were measured using measuring tape and digital scale. The results of measurements showed significant correlation between the age of individuals and the weight and length of trachea and larynx. However, no significant correlation was found between the length and weight of trachea or larynx with either gender, height or weight of individuals.

A novel method of Uniblocker placement: extraluminal technique supported by trachea length measurement: A CONSORT-compliant article.

Background:The use of bronchial blockers has been increased for one-lung ventilation; however, the placement of bronchial blockers is time consuming. The objective of this study was to compare the novel extraluminal technique of Uniblocker placement supported by trachea length measurement on computerized tomography images with conventional intraluminal Uniblocker placement method.Methods:Seventy adult patients undergoing left side thoracic surgery were included in the study. All the patients were randomly assigned to one of two groups: conventional intraluminal intubation group (CV-IN group, n = 35) or extraluminal CT guided group (CT-EX group, n = 35). The primary endpoints were the optimal positions of Uniblocker and the injuries of bronchi and carina. The secondary outcomes included the time of Uniblocker placement, the adequacy of lung collapse, the incidences of Uniblocker displacement, sore throat, and hoarseness postoperative.Results:In the CV-IN group, 19 of 35 Uniblockers went to the left main-stem bronchus on the initial blind insertion and 15 of 35 Uniblockers were considered as in optimal depth, whereas in the CT-EX group, 32 of 35 Uniblockers went to the left main-stem bronchus on the initial blind insertion and 31 of 35 Uniblockers were considered as in optimal depth (P < .01). The incidence of bronchi and carina injuries was obviously lower in the CT-EX group (occurred in 1 of 35 cases) than that in the CV-IN group (occurred in 8 of 35 cases) (P < .05). The time of Uniblocker placement took 145.4 s in the CV-IN group and 85.4 s in the CT-EX group (P < .01). The malpositions of Uniblocker, the degree of pulmonary collapse and the adverse events postoperative such as sore throat and hoarseness were not significantly different between the two groups (P > .05).Conclusion:The novel extraluminal technique of Uniblocker placement supported by trachea length measurement on computerized tomography images was proved to be more rapid, more accurate and less complications than conventional intraluminal Uniblocker placement method.

P3.01-114 Dissociation of Heart and Great Vessels for Long Tracheal Tumors and Lung Cancer Invaded Trachea: The Chinese Experience

The length limit of tracheal resection is less than five centimeters. Up to know, there is no any report about resection of more than five centimeters for tracheal tumors. We created a new technique and successfully remove 124 tracheal tumors more than 5 cm in length and 52 lung cancer invaded trachea through dissociation heart and great vessels. Here, we report the results of 176 patients surgically treated in series. All patients were given general anesthesia and single cavity endotracheal intubation. After thoracotomy, the right pericardium was totally excised, the heart, inferior vena cava, superior vena cava, ascending aorta and innominate artery were dissociated. Then, thoracic trachea, left and right main bronchus were dissociated; the proximal and distal end of trachea, or left and right main bronchus, or left main bronchus and right middle trunk bronchus were cut off. Fallowing, the distal end of trachea was anastomosed to the proximal end of trachea, or anastomosed to the left and right main bronchus, or anastomosed to the left main bronchus and right middle trunk bronchus with 3-0 micro Joe lines. Finally, the pulmonary artery sleeve reconstruction was performed, and resection and reconstruction of SVC was performed. There were 124 patients with tracheal tumor over than 5cm in length and 52 patients with lung cancer invaded trachea. The length of trachea tumor was 5.5 cm to 10.9 cm. 5 tracheal tumor involved SVC and combined with SVCS. The trachea length invaded by the cancer was 4.5cm-7.0cm in the 52 patients with lung cancer. Of the 52 cases, 10 cancer invaded right main pulmonary artery, 22 cancer involved right main pulmonary artery and SVC. The operative procedures included: (1) resection and reconstruction of trachea, or combined with carina in 124 cases, and combined with resection and reconstruction of SVC in 5 cases in the tracheal tumor group; (2) Sleeve right upper lobectomy combined with resection and reconstruction of trachea and carina in 52 cases, combined with sleeve pulmonary artery in 10 cases, combined with sleeve pulmonary artery, and resection and reconstruction of SVC in 32 cases of lung cancer group. There were 5 operative death in this series. The 1-, 3-, 5- and 10-year survival were 71.2%, 54.3%, 33.1% and 22.5%. We pioneered a new technique and treated 124 tracheal tumor more than 5 cm in length and 52 lung cancer invaded trachea in the world.

Prevalence of major vessels anterior to the trachea at sites of potential front-of-neck emergency airway access in adults

BackgroundSeveral case reports have described anatomical variations that can cause difficulty with front-of-neck airway access, such as major vessels anterior to the trachea. The prevalence of these anomalies is unknown. MethodsWe screened 500 consecutive thoracic computed tomography (CT) scans in adult patients performed independently in any public hospital in Western Australia. The prevalence of major vessels anterior to the trachea in the anterior triangle of the neck was determined. ResultsIn the suprasternal notch, 264 CT scans (53%) demonstrated part of a major vessel anterior to the trachea, most commonly the brachiocephalic artery. At 10, 20, and 30 mm above the suprasternal notch, respectively, 126 (25%), 48 (9%), and 5 (1%) CT scans showed a major vessel anterior to the trachea. None showed a major vessel anterior to the cricothyroid membrane. In the suprasternal notch, a major vessel was anterior to the trachea in 10 of 120 CT scans (8%) that had a manubrio-cricoid distance <25 mm, and 108 of 116 CT scans (93%) that had a manubrio-cricoid distance >50 mm. In a logistic-regression model, increased length of trachea above the manubrium was a strong predictor of major vessels anterior to the trachea in the suprasternal notch, whilst sex, age, thoracic kyphosis, tracheal diameter, and the origin of the brachiocephalic artery were not strong predictors. ConclusionsIt is common for patients to have some portion of a major vessel anterior to the trachea at sites where an emergency tracheostomy might be performed.

A Cadaveric Study of Length of Trachea in Nepalese Population of Various Age Groups

INTRODUCTION :The trachea is centrally located membranocartilaginous unpaired hollow organ extending downwards as a continuation of the larynx. The study of the semorphometric variations is of profound clinical importance as it may help the clinicians to understand the etiology of several pulmonary diseases and the surgeons to deal with resection and reconstruction of the tracheobronchial tree. This knowledge is also helpful for smooth conduction of some maneuvers like endotracheal intubation and bronchoscopic procedures.MATERIALS &amp; METHODS: A study of length of human trachea was undertaken in the Department of Anatomy, College of Medical Science Teaching Hospital, Bharatpur, Nepal from april 2012 to December 2013. Twenty nine specimens were collected out of which, sixteen were male and thirteen were female. The specimens were grouped into five age groups for both sexes. The length of trachea, was measured and, standard error (SE), standard deviation(SD) and test of significance were calculated using independent sample 't' test and multiple comparison test. RESULTS:The length of trachea, there was a rapid increase in length from 0-15 years group to 16-25 years group in both the sexes. Thereafter it exhibited very insignificant variations from 26-40 and 41-55 years group in both sexes. From 41-55 years age group to &gt;55 years age group there was a slight increase in tracheal length in both sexes. CONCLUSION: The length of trachea varies with age and the results observed are comparatively less than written in standard books from foreign authors ,hence racial difference plays a key role in the length of trachea. Furthermore, we suggest more research is required in this field from our regional area.Journal of Universal College of Medical Sciences (2017) Vol.05 No.01 Issue 15 17, page: 17-21

A rare case of male Turner syndrome for penetrating keratoplasty

&lt;p class="abstract"&gt;&lt;span lang="EN-IN"&gt;Turner syndrome (TS) is a complex genetic disorder. These abnormalities especially those relating to the airway and cardiovascular system, pose a challenge to the anaesthesiologist. The main anatomo-physiological changes pertaining to the anaesthesiologist include a short neck, maxillary and mandibular hypoplasia which might be responsible for difficult airway. The shorter length of trachea as well as higher location of its bifurcation predispose to bronchial intubation and accidental endotracheal extubation when tracheal cannula is under traction. The presence of cardiopathies, endocrine and gastro intestinal disorders, liver and kidney changes as well as osteoarticular involvement besides ophthalmologic and hearing impairments are very frequent and should be detected during pre-anaesthetic evaluation. The incidence of TS is variously reported as 1:3000 to 1:10000 live (female) births. Very few cases of male turner have been reported in literature&lt;/span&gt;&lt;span lang="EN-IN"&gt;. &lt;/span&gt;&lt;/p&gt;&lt;p class="abstract"&gt; &lt;/p&gt;

Development of tracheal reconstruction methods from scaffold engineering to injectable matrix

Backgrand: For patients with long segment of tracheal stenosis, resection and replacement is necessary. Tracheal reconstruction associated with complications such as stenosis, insufficiency of blood supply and surgical complication. Methods: In this study, we prepared collagen-chitosan scaffold and sheep's decellularized trachea plus culture medium with nanocup contain growth factors for chondrocyte and fibroblast-epithelial cell culture in rotary bioreactor. After attachment of cells, engineered trachea put into the omentum. Peritoneal stem cell interact with the epithelial and chondrocytes with attendance of growth factors released from nanocup. The bioengineered trachea with omental pedicle transposed from behind the sternum and transplanted in the position of resected trachea. In third experiment, we introduce the in situ tracheal repair technique with injectable matrix for reconstruction of long-segmental stenosis of trachea in a 29-year-old woman. Results: Severe tortuosity in the first experiment and mild stenosis was seen in the second experiment. In third experiment, normal shape in tracheal diameter was seen at injection sites. The interior portion of the trachea at virtual computed tomography (CT) scan and bronchoscopy were similarity to normal after four month fallowing up of injection. Conclusions: Severe tortuosity, mild stenosis in whole length of trachea in this study and disadvantage of trachea transplantation include open surgery, fatal consequences of anastomosis leakage, and rupture besides large mediastinal vessels; hence, we decided to introduce the novel in situ tracheal repair technique. Injectable bioresorbable scaffolds may be used as a temporary scaffolding for transplanted cells and thereby allow the cells to secrete extracellular matrix of their own to enable, in the long term, a complete and natural tissue replacement.