Journal List > Korean J Phys Anthropol > v.31(2) > 1098130

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Jin, Kim, Yang, and Nam: Minimally Invasive Horizontal Intercartilaginous Incision during Tracheostomy – A Cadaveric Study
Original Article

Korean J Phys Anthropol 2018;31(2):57-63.

Published online: 20 February 2018

DOI: https://doi.org/10.11637/kjpa.2018.31.2.57

Minimally Invasive Horizontal Intercartilaginous Incision during Tracheostomy – A Cadaveric Study

Seong Min Jin1, Hong Chan Kim1, Hyung Chae Yang1, Kwang Il Nam2,

1Department of Otolaryngology-Head and Neck Surgery, Chonnam National University Hospital

2Department of Anatomy, Medical School, Chonnam National University

Correspondence to: Kwang Il Nam (Department of Anatomy, Medical School, Chonnam National University) Hyung Chae Yang (Department of Otolaryngology-Head and Neck Surgery, Chonnam National University Hospital) E-mail: atlas@jnu.ac.kr, blessed@jnu.ac.kr

Received 15 March 2018       Revised 12 June 2018       Accepted 15 June 2018

Copyright © 2018 Korean Association of Physical Anthropologists

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

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.

Keywords: Tracheotomy, Tracheal cartilage, Thyroid isthmus, Cricoid cartilage, Cadaver dissection

References

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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).
kjpa-31-57f1.tif
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.
kjpa-31-57f2.tif
Table 1.
Demographic and anatomic characteristics of cadavers who underwent dissection for tracheotomy.
  Gender Age A (mm) B C (mm) D (mm)
#1 M 64 12.81 3–4 th ring 10.03 9.01
#2 F 31 21.00 3–4 th ring th 8.95 10.39
#3 M 69 18.88 3–4 th ring th 11.62 9.02
#4 F 90 20.12 3–4 th ring th 9.42 9.85
#5 F 66 19.08 3–4 th ring th 11.56 11.68
#6 M 81 37.33 4–5 th ring th 5.37 11.92
#7 M 63 21.74 3–4 th ring 7.42 9.89
#8 M 89 25.27 3–4 th ring th 6.93 6.56
#9 M 57 26.56 3–4 th ring th 9.16 13.44
#10 F 88 18.45 3–4 th ring th 9.01 13.54
#11 F 92 20.72 3–4 th ring th 6.18 9.36
#12 M 60 26.62 3–4 th ring th 7.51 9.62
#13 M 92 21.12 3–4 th ring th 9.66 8.98
#14 F 88 20.64 4–5 th ring th 5.67 11.99
#15 M 79 24.72 4–5 th ring th 18.16 12.75
#16 M 52 20.26 3–4 th ring th 5.12 9.41
#17 F 91 20.07 3–4 th ring th 10.12 10.91
#18 M 82 16.13 2–3 th ring th 7.56 6.73
#19 M 81 16.07 2–3 th ring th 8.51 10.05
#20 F 90 20.83 3–4 th ring 5.86 11.45

A. distance between cricoid cartilage to the lower margin of thyroid isthmus B. the level of thyroid isthmus lower margin compared with the number of tracheal ring C. movability of thyroid isthmus D. maximal widened distance between the lower margin of upper tracheal cartilage and the upper margin of lower tracheal cartilage

Table 2.
The measurements of the anatomic factors according to gender.∗
  Male Female p-value‡
Number 12 8  
Age 72.4±13.2 79.5±21.3 .101
Factor A 22.3±6.5 20.1±0.9 .343
Factor B (3/4/5) 2/8/2 0/7/1 0.603
Factor C 8.9±3.5 8.3±2.2 1.000
Factor D 9.8±2.1 11.1±1.3 .098

∗ Plus-minus values are means standard deviation. Factor A denotes distance between cricoid cartilage to the lower margin of thyroid isthmus. Factor B, the level of thyroid isthmus lower margin compared with tracheal ring number: Factor C, movability of thyroid isthmus: Factor D, maximal widened distance between the lower margin of upper tracheal cartilage and the upper margin of lower tracheal cartilage.

‡ Mann-Whitney U tests were used to analyze Age, Factor A, Factor C, and Factor D. The chi-square and Fisher's exact tests were used to analyze Factor B.

Table 3.
The measurements of the anatomic factors according to age groups.∗
  Age<65 Age≥65 p-value‡
Number 6 14  
Age 54.5 + 12.3 84.1 + 8.3 0.000
Factor A 21.5 + 5.1 21.3 + 5.3 0.353
Factor B (3/4/5) 0/6/0 2/9/3 0.260
Factor C 8.0 + 1.7 8.9 + 3.4 0.062
Factor D 10.3 + 1.6 10.3 + 2.1 0.841

∗ Plus-minus values are means standard deviation. Factor A denotes distance between cricoid cartilage to the lower margin of thyroid isthmus. Factor B, the level of thyroid isthmus lower margin compared with tracheal ring number: Factor C, movability of thyroid isthmus: Factor D, maximal widened distance between the lower margin of upper tracheal cartilage and the upper margin of lower tracheal cartilage.

‡ Mann-Whitney U tests were used to analyze Age, Factor A, Factor C, and Factor D. The chi-square and Fisher's exact tests were used to analyze Factor B.

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