Question 10

Describe the anatomy of the neck and trachea relevant to the insertion of a tracheostomy

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College Answer

For a good answer candidates were expected to mention surface anatomy of the anterior of 
the neck from the superior to inferior aspects (e.g. hyoid bone, thyroid cartilage, 
cricothyroid ligament, cricoid cartilage and thyroid gland with sternohyoid muscle just lateral to the 
midline structures, the pathway of the trachea from anterior at level of larynx to more 
posterior as it enters the chest behind the sternal notch, nature of the tracheal rings (C 
shaped cartilages (first cartilage is bigger than the others in the cervical trachea) joined 
vertically by fibro-elastic tissue and connected posteriorly by the trachealis muscle, layers of 
dissection for tracheostomy (e.g. skin, subcutaneous tissue, fat, pre-tracheal fascia 
(superficial and deep), trachea and the relationship of thyroid to the trachea and 
surrounding vessels. There were some good answers amongst the successful candidates, 
whereas those who failed to pass this question did so because of a lack of detailed 
knowledge and relational anatomy. Candidates were not asked, and thus did not receive 
marks for, describing how to perform a tracheostomy.