TRACHEA

By
Vd. Vaibhavi Hardikar
• Trachea or windpipe is the patent tube for passage of air to and from the lungs.

• esophagus lying behind the trachea opens only while drinking or eating.

• Thoracic duct brings the lymph from major part of the body to the root of the neck.

• The trachea is a non-collapsible membrano-cartilaginous tube forming the beginning of

lower respiratory passage

 EXTENT

• Trachea extends from the lower border of cricoid cartilage at the

lower border of the C6 vertebra to the lower border of T4 vertebra

in supine position, where it terminates by dividing into right and
left principal bronchi.
 DIMENSIONS

• The trachea is a 4–6 inch (10–11 cm) long tube.

• The upper half of trachea is located in the neck (cervical part) whereas the lower half lies in the
superior mediastinum of the thoracic cavity (thoracic part).

• The external diameter of trachea is 2 cm in males and 1.5 cm in females.

• The lumen is smaller in living human than that in cadavers.

• It is about 3 mm in newborns and remains so up to the third year of life, thereafter the lumen
increases by 1 mm each year up to 12 years, after which it remains fairly constant.

• This knowledge is very important for the anesthetists to select the appropriate size of tracheal tube
to be inserted into the trachea in children during general anesthesia .
 STRUCTURE

• The trachea is composed of about 16–20 C-shaped rings of hyaline cartilage lying one
above the other.

• The cartilages are deficient posteriorly where the gap is filled by connective tissue and
involuntary muscle called trachealis.

• The absence of cartilages on the posterior aspect allows expansion of nesophagus during

deglutition.

• In cross section the trachea appears D-shaped or horseshoe-shaped

 CERVICAL PART OF TRACHEA

• The cervical part of the trachea is about 7 cm in length and extends from the lower border
of cricoid cartilage to the upper border of manubrium sterni.

• It extends downwards and slightly backwards in front of the esophagus following curvature
of the cervical spine and enters the thoracic cavity in the median plane with slight deviation
on the right side.
 Relations of the Cervical Parts of Trachea
• Anteriorly, from superficial to deep it is related to: • Posteriorly it is related to:
• (a) skin, • (a) esophagus, and
• (b) superficial fascia containing anterior jugular veins and • (b) recurrent laryngeal nerve in the
jugular venous arch (crossing in the suprasternal space of tracheoesophageal
Burns),
• (c) investing layer of deep cervical fascia, • groove (on each side).
• (d) sternothyroid and sternohyoid muscles, • On each side it is related to:

• (e) isthmus of thyroid gland in front of the 2nd, 3rd, and 4th • (a) lobe of thyroid
gland extending
tracheal rings, up to the 5th or 6th
• (f) inferior thyroid veins and arteria thyroideaima (occasional), • tracheal ring, and
• (g) left brachiocephalic vein in children may rise in the neck,
• (b) common carotid artery in the
• (h) thymus gland (in children), and carotid sheath
• (i) brachiocephalic artery (sometimes) in children.
 BLOOD SUPPLY AND LYMPHATIC DRAINAGE

• The arterial supply of the cervical part of trachea is derived mainly from
branches of the inferior thyroid arteries.

• The veins from trachea drain into the left brachiocephalic vein.

• The lymph from trachea drains into pre- and paratracheal nodes.
 NERVE SUPPLY

• This is by sympathetic and parasympathetic fibres.

• The parasympathetic fibres are derived from vagus through the recurrent laryngeal nerve.

• They are secretomotor and sensory to the mucus membrane and motor to the trachealis

muscle.

• The sympathetic fibres are derived from the middle cervical sympathetic ganglion. They
are vasomotor in nature.
HISTOLOGY
• The skeletal basis of the trachea is made up of 16 to 20 tracheal cartilages. Each of
these is a C-shaped mass of hyaline cartilage.

• The open end of the ‘C’ is directed posteriorly.

• Occasionally, adjoining cartilages may partly fuse with each other or may have Y-
shaped ends.

• The intervals between the cartilages are filled by fibrous tissue that becomes
continuous with the perichondrium covering the cartilages.

• The gaps between the cartilage ends, present on the posterior aspect.

• The connective tissue in the wall of the trachea contains many elastic fibres.
• The lumen of the trachea is lined by mucous membrane that consists of a lining
epithelium and an underlying layer of connective tissue.

• The lining epithelium is pseudostratified ciliated columnar.

• It contains numerous goblet cells, and basal cells that lie next to the basement
membrane.

• Numerous lymphocytes are seen in deeper parts of the epithelium.

CLINICAL ANATOMY
• In radiographs, the trachea is seen as a vertical translucent shadow due to the
contained air in front of the cervicothoracic spine.

• Clinically the trachea is palpated in the suprasternal notch.

• Normally it is median in position.

• Shift of the trachea to any side indicates a mediastinal shift.

• During swallowing when the larynx is elevated, the trachea elongates by stretching
because the tracheal bifurcation is not permitted to move by the aortic arch. Any
downward pull due to sudden and forced inspiration, or aortic aneurysm will
produce the physical sign known as 'tracheal tug'.
• Tracheostomy: It is a surgical procedure which allows air to enter directly into trachea. It is done in
cases of blockage of air pathway in nose or larynx.
• As the tracheal rings are incomplete posteriorly the esophagus can dilate during swallowing.
• This also allows the diameter of the trachea to be controlled by the trachealis muscle.
• This muscle narrows the caliber of the tube, compressing the contained air if the vocal cords are
closed.
• This increases the explosive force of the blast of compressed air, as occurs in coughing and
sneezing.
• Mucus secretions help in trapping inhaled foreign particles, and the soiled mucus is then expelled by
coughing.
• The cilia of the mucous membrane beat upwards, pushing the mucus towards the pharynx.
• The trachea may get compressed by pathological enlargements of the thyroid, the thymus, lymph
nodes and the aortic arch.
• This causes dyspnoea, irritative cough, and often a husky voice.