Korean J Phys Anthropol.  2018 Jun;31(2):57-63. 10.11637/kjpa.2018.31.2.57.

Minimally Invasive Horizontal Intercartilaginous Incision during Tracheostomy – A Cadaveric Study

• Jin SM
• Kim HC
• Yang HC
• Nam KI

• KMID: 2415442
• DOI: http://doi.org/10.11637/kjpa.2018.31.2.57

Abstract

The paper describes a minimally invasive tracheostomy technique that uses an intercartilaginous incision without resection of the tracheal cartilage and discusses its feasibility. A total of 20 adult cadavers (13 males and 7 females) were included in this study. The distance from the arch of the cricoid cartilage to the thyroid isthmus, maximal displacement of the thyroid isthmus, number of tracheal rings underneath the thyroid isthmus, and maximally opened distance resulting from an intercartilaginous incision were measured. The mean distance from the arch of the cricoid cartilage to the thyroid isthmus was 21.4±5.0 mm. The thyroid isthmus mainly overlaid the 3rd and 4th tracheal rings. The mean maximal displacement of the thyroid isthmus was 9.0±2.8 mm. Minimally invasive tracheostomy via an intercartilaginous incision is a feasible technique. A skin incision 2 cm below the cricoid cartilage enables exposure of the thyroid isthmus and anular ligament between the 2nd and 3rd tracheal rings. The intercartilaginous incision allows sufficient space for the tracheostomy tube. An intercartilaginous incision without resection of a tracheal ring can be a good alternative tracheostomy technique, especially for patients who require transient tracheostomy.

Keyword

Tracheotomy; Tracheal cartilage; Thyroid isthmus; Cricoid cartilage; Cadaver dissection

MeSH Terms

Adult
Cadaver*
Cartilage
Cricoid Cartilage
Humans
Ligaments
Male
Skin
Thyroid Gland
Tracheostomy*
Tracheotomy

Figure

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  Fig. 1. Schematic illustration of variables used in this study. Figure shows distance between cricoid cartilage to the lower margin of thyroid isthmus (A), the level of thyroid isthmus lower margin compared with tracheal ring number (B, dotted line), movability of thyroid istchmus (C), maximal widened distance between the lower margin of upper tracheal cartilage and the upper margin of lower tracheal cartilage (D).

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  Fig. 2. Schematic illustration of Minimally invasive horizontal intercartilaginous incision technique. The skin incision is made 2 cm below the center of the cricoid cartilage to exposure the inferior border of thyroid isthmus (A). The inferior border of thyroid isthmus is identified and retracted upward to expose the 2nd and the 3rd tracheal ring or the 3rd and the 4th tracheal ring (B). The annular ligament between the 2nd and the 3rd tracheal ring or the the 3rd and the 4th tracheal ring is identified, and an intercartilaginous incision was made.

Reference

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