• Journal of Chest Surgery
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• v.28 no.8
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• pp.766-771
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• 1995

The trachea is defined as the airway from the inferior border of the cricoid cartilage to the top of the carinal spur. This paper would confirm the normal tracheal length of Korean adults through the actual measurement using the fiberoptic bronchoscopy. The subjects of this study were 25 patients, 13 males and 12 females between the age of 20 to 69 without abnormality on the neck, trachea, mediastinum and lung pharenchyme on the preoperative chest X-ray, who received the operations from the period of July to September, 1994. For those patients who had heart diseases, the cardiothoracic ratio was below 50%. The measurement was performed on the patients with endotracheal intubation under the general anesthesia in supine and neutral position. The tracheal length was calculated by the difference between the length from the tip of the endotracheal tube [E-tube to carina and to the needle which was inserted into the E-tube at the lower border of the palpated cricoid cartilage, by inserting the broncoscopy through the E-tube. The result was as follow : 1 The measured tracheal length for men was 11.8 0.2 cm[mean standard deviation and women was 10.5 0.3 cm, and that was longer than this [p<0.01 . The average was 11.2 1.0 cm and the standard error was 0.20 cm. 2 According to the correlation between the tracheal length to weight, height[Ht , age, and body surface area[BSA respectively, the Ht [p=0.003 , age [p=0.055 , and the BSA[p=0.017 were significant, while weight was not [p=0.314 . 3 From the regression analysis of the tracheal length[T.L. to the Ht, Age, and the BSA which were significant, the following equation was derived.i Ht : T.L.= -1.29 + 0.076 x Ht [P=0.003 ii Age: T.L.= 10.04 + 0.028 x Age [P=0.055 iii BSA : T.L.= 5.60 + 3.48 x BSA [P=0.017 iv In multi-regression : T.L. = -4.15 + 0.034 x Age + 0.085 x Ht [P=0.0002]

• Journal of Chest Surgery
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• v.28 no.2
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• pp.156-161
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• 1995

Although there are many kinds of method in treatment of tracheal stenosis, tracheal resection and primary anastomosis can be performed for management of various kinds of tracheal stenosis because it is considered the most anatomical ideal therapeutic modality. During a 10-year period we performed 18 tracheal resection on 18 patients with no operative mortality and some morbidity. 13 patients had tracheal stenosis caused by endotracheal intubation [eight patients or tracheostomy [five patients ; and five patients caused by a variety of neoplastic lesions [four primary and one secondary . The length of tracheal stenosis were various from 1.5cm to 5.5cm and site of tracheal stenosis were cervical[17patients and thoracic [one patient . Operative techniques were tracheal resection and primary anastomosis[18 patients and additional procedures were cricoid cartilage reconstruction with costal cartilage [one patient , primary repair of esophagus[one patient and suprahyoid laryngeal release technique[eight patients without any complications. We have eight complications; tracheal restenosis were developed in five patients[growth of grannulation tissue at anastomotic site in three patients, delayed restenosis in two patients , anastomotic disruption in one patient, hoarseness and pneumonia in each of two patients. We managed tracheal complications with T-tube insertion in two patients, permanent tracheostomy in three patients and insertion of Gianturco tracheal stent in one patient, but tracheal stent did not reveal good result because it caused persistent production of sputum. We concluded that it is necessary to access full length of normal trachea including suprahyoid laryngeal release technique to avoid anastomotic tension in tracheal surgery and develope new ideal techniques to manage postoperative tracheal complications, because we suppose tracheal complications are developed due to anastomotic tension.

• Journal of Chest Surgery
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• v.21 no.2
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• pp.395-402
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• 1988

Increasing success in the management of patients with severe respiratory failure by mechanical respirators has produced iatrogenic tracheal stenosis. And the surgical management of these lesions have provided a major field for tracheal reconstructive surgery. Recently we have experienced three cases of postintubation tracheal stenosis between December, 1985 and October, 1987 and successfully performed circumferential resection and end to end anastomosis of the trachea. The lesion of the first case which was located in the subcricoid level was resected about 2cm length with cervical incision. And the lesion of the second case located at the cuff site was also resected about 2.5cm length with cervical and median sternotomy incision. Also the lesion of the third case located at the stoma site was resected about 1.8cm length with cervical incision. The postoperative courses were uneventful but there was extubation difficulty in the third case because of stupor mentality and problem of secretion excretion. So we have observed the postoperative course after T-tube insertion.

• Journal of Chest Surgery
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• v.22 no.5
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• pp.834-838
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• 1989

Tracheal stenosis is being encountered more frequently as ventilatory support and cuffed tubes are increasingly used for treatment of respiratory failure. We experienced 13 cases of tracheal stenosis treated surgically at department of Thoracic and Cardiovascular Surgery, school of medicine, Kyung Hee university during the 4 years. The causes of tracheal stenosis were prolonged endotracheal intubation 5 cases, tracheostomy 3 cases, tracheal tumor 2 cases, thyroid tumor 1 case and congenital double aortic arch 1 case. The methods used to manage the tracheal stenosis were tracheal resection % end to end anastomosis 8 cases, 2 cases of subglottic stenosis were underwent primary laryngotracheal anastomosis, Lt. aortic arch division 1 case, and stent insertion 2 cases. In two cases, who had 6 cm in length of tracheal stenosis, we were underwent tracheal resection k end to end anastomosis with supralaryngeal release procedure. Postoperative courses were uneventful except one case with tracheal tumor.

• Korean Journal of Bronchoesophagology
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• v.7 no.2
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• pp.128-139
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• 2001

The purpose of this study was to review the literatures of experimental tracheal reconstruction. Although there have been significant advancements in the surgical treatment of the long circumferential tracheal injuries, there still has been a difficult problem with high morbidity and mortality. The method for tracheal reconstruction after circumferential resection is preferred end-to-end anastomosis for defects up to 6 cm in length, but larger tracheal defects require the use of tracheal allograft, various artificial prosthesis or autogenous organs. The tracheal allotransplantation has been widely used as there was significantly improved the method of surgical technique, preservation and immunosuppression. But it has been limited by a number of factors such as few donor, limited use of immunosuppressant, delayed revascularization and re-epitheliazation. Experimental studies on the tracheal prosthesis have a long history and they tried to use silicone, polytetrafluoroethylene, polypropylene mesh, Dacron, Marlex mesh, external or internal stents. Other experimental studies were reported the use of autogenous tissues that were cartilage. jejunum, aorta, skin, muscle, periostium or esophagus. But a great variety of these protheses have been resulted unsatisfactory in a significant Proportion of cases. Alternatively, the tissue-engineering technique has showed a new approach to reconstruct trachea and much progress in tissue-engineering bas been made recently. In conclusion, although the tracheal allotransplantation and the use of prosthesis and allograft have been reported a lot of limitation to overcome, we could sooner expect good result of ideal tracheal prosthesis.

• Korean Journal of Bronchoesophagology
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• v.4 no.1
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• pp.27-34
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• 1998

Despite improvement in respiratory care, including use of low pressure and high volume cuffed tubes, tracheal stenosis remains a serious complication after a long-term tracheal intubation and tracheostomy. In such patients, tracheal resection and primary anastomosis is still considered ideal therapeutic modality. Between 1989 and 1997, we performed tracheal resections with end-to-end anastomosis on 14 patients with no operative mortality and some morbidity. Tracheal stenosis was caused by tracheostomy in nine patients, by endotracheal intubation in three patients and by thyroid carcinoma in two patients. The length of stenosis was various from 2cm to 4.5cm. All patient underwent segmental tracheal resection and primary anastomosis(14 patients) and additional procedures were cricoid cartilage reconstruction(2 patients), suprahyoid laryngeal release(3patients), carinal release technique(2 patients) and arytenoidectomy(2 patients). We have nine complications: granulona at anastomosis site in four patients, vocal cord palsy in two patients and restenosis, pneumonia, skin necrosis in each of those patients. The granuloma was removed by bronchoscopic forceps(4 patients). Vocal cord palsy was treated by arytenoidectorny(2 patients), restenosis by T-tube insertion, pneumonia by antibiotics and skin necrosis was treated by skin graft. We reviews our expenence of clinical features of tracheal stenosis and surgical treatment by tracheal one-to-end anastomosis with additional procedures to avoid postoperative complications for sucessful results.

• Journal of Chest Surgery
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• v.13 no.4
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• pp.496-496
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• 1980

A 37 year old male patient was suffered from severe labored breathing caused by post tracheostomy stenosis, which was localized at the mediastinal trachea [cuffed tracheal stenosis] and ranged 1.5 cm in length and approximately 3 ram. in diameter on tracheogram. After dilation of tracheal stenosis with dilator, endotracheal intubation was tried for induction of anesthesia and control of respiration during operation. A tube was placed just beyond the tracheal stenosis without respiratory difficulty. Under the endotracheal anesthesia, circumferential resection of the mediastinal trachea containing the stenosis, approximately 2 cm in length [4 tracheal rings}, was carried out and primary direct end to end anastomosis was performed with interrupted submucosal sutures [3-0 Dexon] and mobilization of trachea Postoperative tracheostomy was not performed. The patient was completely relieved from dyspnea immediately after operation. Post-operative convalescence was entirely uneventful and at present, about 3 months after operation, he is now conducting a usual life. From the literature and our experience, the etiology and treatment of post-tracheostomy stenosis were discussed.

• Journal of Chest Surgery
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• v.13 no.4
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• pp.503-506
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• 1980

A 37 year old male patient was suffered from severe labored breathing caused by post tracheostomy stenosis, which was localized at the mediastinal trachea [cuffed tracheal stenosis] and ranged 1.5 cm in length and approximately 3 ram. in diameter on tracheogram. After dilation of tracheal stenosis with dilator, endotracheal intubation was tried for induction of anesthesia and control of respiration during operation. A tube was placed just beyond the tracheal stenosis without respiratory difficulty. Under the endotracheal anesthesia, circumferential resection of the mediastinal trachea containing the stenosis, approximately 2 cm in length [4 tracheal rings}, was carried out and primary direct end to end anastomosis was performed with interrupted submucosal sutures [3-0 Dexon] and mobilization of trachea Postoperative tracheostomy was not performed. The patient was completely relieved from dyspnea immediately after operation. Post-operative convalescence was entirely uneventful and at present, about 3 months after operation, he is now conducting a usual life. From the literature and our experience, the etiology and treatment of post-tracheostomy stenosis were discussed.

• Applied Microscopy
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• v.26 no.2
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• pp.137-155
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• 1996

The development of the ganglia of the trachea was studied by electron microscopy in human fetuses ranging from 40 mm to 260 mm crown rump length. At 40 mm fetus, the tracheal ganglia was observed in the submucosa of the trachea. The primitive ganglia consisted of neuroblasts, undifferentiated cells, and unmyelinated nerve fibers. At 50 mm fetus, the neuroblast and their processes in the tracheal ganglia ware ensheathed by the bodies or processes of satellite cells. The cytoplasm of the neuroblast contained rough endoplasmic reticulum, mitochondria, Golgi complex, and ribosomes. At 70 mm fetus, cholinergic and adrenergic axon terminals were observed. Cholinergic axon terminals with agranular vesicles were abundant in the tracheal ganglia with increasing age. During next prenatal stage from 100 mm fetus, the ganglion cells and its processes were completely covered by a thin processes of the satellite cells. Unmyelinated nerve fibers were also completely ensheathed by processes of Schwann cell. Synaptic contacts between the cholinergic axon and dendrite of ganglion cells and a few dendrodendritic synapses were first observed at 100 mm fetus. The granule-containing cells were first identified in the tracheal ganglia at 200 mm fetus. These findings indicate that tracheal ganglia of human fetus resembles other parasympathetic and sympathetic ganglia, but not the enteric ganglia.

• Journal of Chest Surgery
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• v.21 no.2
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• pp.389-394
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• 1988

The patient was 22-year old male who had been suffered from labored breathing. Computerized tomography, tracheoscopy, tracheogram disclosed tracheal obstruction by external mass compression on Tl level, which ranged 4.Oem in the length and approximately 4mm in diameter on tracheogram. Under the local anesthesia, tracheostomy was done to prevent intraoperative airway obstruction. And general anesthesia, low collar incision 8z extended median sternotomy was made and nearly total thyroidectomy was performed. After the circumferential resection of the obstructed segment approximately 4cm in length[7 tracheal rings], direct end-to-end anastomosis of trachea was performed. Postoperatively, the patient`s neck was maintained in flexion state to reduce tension of anastomotic site. Postoperatively. medical therapy[Comthyroid k Calcium lactate] and radiotherapy were done. At present, 2-months after operation, he lives well.