OtoRhinoLaryngology Portal

The Leading Online Gallery of Otolaryngology and Head & Neck Surgery Specialty

OtoRhinoLaryngology Portal Video Collections @

YouTube & MEDtube

Tracheobronchial Anatomy

 Overall view of rima glottidis and below.

The subglottis"flushed" with cricotracheal segment.

Star- subglottis with cricothyroid membrane, cross- cricoid cartilage,

dashed line- 1st tracheal ring

Mid-trachea and below.

 

The "concertina" of tracheal rings. Horseshoe-shaped cartilage

with posterior musculomembranous segment (stars). 

The trachealis muscles being supplied by autonomic innervation. 

 

Video of trachealis muscles intermittent contraction.

The tracheal bifurcation into right and left main bronchii. 

The right main bronchus is wider and more vertical than the left.

 

Watch video on endoscopic anatomy of adult larynx, trachea, and bronchus

@ YouTube

Tracheal Wall Anatomy

 

                         Anterior view                            Antero-lateral view

 

Stars- horseshoe-shaped cartlaginous rings of trachea,

double-ended arrow- membranous posterior segment.

Tracheal Stenosis: Acquired

This image shows an 80-90% upper tracheal stenosis. 

The cricoid cartilage anatomy is normal. 

The patient had emergency tracheostomy performed earlier

for acute airway obstruction.

 

Fibro-membranous upper tracheal stenosis.

Arrow- cricoid cartilage.

 An upper tracheal tracheal stenosis complicating prolonged endotracheal intubation causing narrowing estimated 80% of normal tracheal lumen dimension (interrupted circle). Tracheostomy tube is seen below the stenotic segment (yellow arrow). Note incidental finding of right vocal cord cyst (green arrow).

Tracheal Stenosis:Infected and Evolving Stenotic Segment

Tracheal Stenosis with Complete Airway Obstruction

 

Figure shows a complete tracheal stenosis.  A good view of cricothyroid membrane seen through which cricothyroid puncture or incision made as a temporary measure in the management of an acute

and potentially fatal upper airway obstruction.

[yellow dotted line- cricothyroid cartilage, green dotted line- lower border of thyroid cartilage, CT-cricothyroid membrane, T-inferior half of anterior segment of thyroid cartilage, TVF- true vocal fold]

 

Watch video on complete upper tracheal obstruction @ YouTube

 

 

Voiceless due to complete upper tracheal obstruction.

Cricotracheal Web with Suprastomal Granulations

TVF - true vocal fold, A - arytenoid, X - web, (+) - suprastomal granulations. 

 Close-up view of the lesions.

Cricotracheal Stenosis with Compete Luminal Obstruction

This would be an ideal situation for a cricotracheal resection 

with end-to-end anastomosis.  Imaging is necessary to estimate

the vertical length involved by the stenosis.  It can be combined with

posterior cricoid split and cartilage graft placement whenever indicated.

 

Watch video on infected subglottic ulcers with cricotracheal stenosis @ YouTube

Endotracheal Suprastomal Granulations Post-Tracheostomy  

Granulation tissue seen along the anterior wall of trachea

above the tracheostomy tube prior to its excision.

Mediastinal Trachea Stenosis

Bronchial Stenosis

Figure shows proximal right main bronchi stenosis

due to circumferential cicatrial scar.

Tracheal Adenoma

Right tracheal adenoma with sessile pedicle which was ablated by using Nd:YAG laser.  Image taken during rigid bronchoscopy assessment.  (L - left, R - right)

Bronchial Narrowing Due To Subcarinal Mass

Haemoptysis: Blood Clot & Crusts

Dry blood clot at tracheal bifurcation as seen by using flexible endoscope passed via end-tracheostomy in a patient who had total laryngectomy for recurrent laryngeal cancer.  Metastases need to be ruled out.  

(P - posterior, R -right, L - left, C - carina)

The panoramic view of tracheal bifurcation taken months before the pathology developed. 

Tracheitis

Tracheitis with fibrin exudate formations involving mucosa of tracheal lumen (arrows) in a patient presenting with refractory coughs with excessive sputum.  (T - true vocal fold, F - false vocal fold).

Bronchial & Carinal Mucopus in Pneumonia

Thick and copious mucopus filling main bronchii and carina region.

Mucopus expectorant covering mucosal linings of lower trachea and bronchii worse on left side.  (L - left, R - right)

Segmental Anatomy

Flexible Bronchoscopy: Foreign Body Removal

Forein body removal from left superior lobar bronchus by using

flexible bronchoscope with instrumentation channel.

 

[Photos courtesy by Dr Mohd Zulkiflee Abu Bakar

from University of Malaya Medical Centre]

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