Outline the anatomical relations of the cervical trachea relevant to performing a percutaneous tracheostomy.
• Trachea is attached superiorly to the cricoid cartilage, by the cricotracheal membrane
• Trachea is covered anteriorly by skin, superficial fascia, strap muscles
(sternohyoid, sternothyroid), and deep (pretracheal) fascia.
• 2nd to 4th rings of the trachea are covered by isthmus of the thyroid anteriorly.
• Branches of the superior thyroid artery run along the superior aspect of the thyroid isthmus, anterior to the trachea.
• Lateral lobes of the thyroid lie between the trachea and the carotid sheath and its contents.
• Oesophagus lies posterior to the trachea.
• Carotid sheath containing carotid artery, jugular vein, and vagus nerve lie posterolateral to the trachea.
• Recurrent laryngeal nerves lie posterolaterally in the grove between the trachea and the oesophagus.
• Anterior jugular veins are often connected by a vein that runs superficially across the lower neck.
• Inferior thyroid veins lie anterior to the lower part of the cervical trachea, posterior to the strap muscles.
A picture is worth a thousand words. Instant Anatomy does it best. However, if words are called for... Trauma.org has an excellent tutorial on this technique. ANZICS also has a position statement for percutaneous tracheostomy.
- Anterior to the second and third rings of the trachea, is merely skin, subcutaneous tissue, sternothyroid and sternohyoid muscles, and pretracheal fascia.
- Sometimes, there is an anterior communicating jugular vein which also travels through this space.
- Posteriorly lies the oesophagus.
- Posterolaterally, on either side of the oeseophagus lie the recurrent laryngeal nerves
- Laterally, on both sides there are the vagus nerves, carotid arteries and the jugular veins, covered by the carotid sheath
- Superiorly is the cricoid cartilage and the cricothyroid membrane
- Inferiorly lies the isthmus of thyroid and the inferior thyroid veins
Muhammad, Joseph Kamal, Edward Major, and David William Patton. "Evaluating the neck for percutaneous dilatational tracheostomy." Journal of Cranio-Maxillofacial Surgery 28.6 (2000): 336-342.
Epstein, Scott K. "Anatomy and physiology of tracheostomy." Respiratory care 50.4 (2005): 476-482.