Anatomy

The trachea is a conduit for ventilation. It would seem to be an ideal structure for reconstruction, however there are several unique anatomic features that make it extremely difficult to surgically reconstruct in certain instances. It is a rigid structure and is relatively short and close anatomically to major cardiovascular structures. The adult trachea averages 12 cm in length from the level of the cricoid to the carina. There are approximately twenty cartilagenous rings, about two rings per centimeter. The trachea, when viewed laterally, actually does not proceed in a direct superior-inferior course, but rather courses inferiorly and posteriorly and angles from a nearly subcutaneous position anteriorly going back to rest against the esophagus quite a distance posteriorly. The thyroid isthmus passes over the trachea in the region of the second ring.

The upper portion of the trachea is s upplied by the inferior thyroid artery. The lower portion of the trachea is supplied by bronchial arteries. The arteries approach the trachea laterally and devascularization of the trachea is most pronounced when the dissection is performed laterally rather than anteriorly or posteriorly. Lying in the groove between the trachea and the esophagus are the recurrent nerves, coursing around the ligamentum arteriosum on the left and around the subclavian artery on the right. A nonrecurrent nerve occasionally is present on the right side. The nerves enter the larynx between the cricoid and thyroid cartilage. The trachea consists of an anterior cartilagenous portion and a posterior membranous portion. The trachea is lined with respiratory mucosa which is columnar and ciliated. In chronic smokers, squamous metaplasia frequently occurs.

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