Surgical diseases of the trachea

The trachea is the windpipe that moves air from the mouth to the lungs. It’s connected above in the neck to the larynx (“Adam’s apple”), and below, in the chest, it divides into the left and right bronchi, which connect to each lung. The surgeons in the Department of Thoracic Surgery and Lung Transplantation at Baylor University Medical Center, part of Baylor Scott & White health in Dallas diagnose and treat a variety of diseases affecting the trachea.

​Types of diseases

Benign conditions

  • Tracheal stenosis—A narrowing of the trachea, most commonly following the placement of a breathing tube (intubation) or previous surgery. Babies can also be born with this condition, but most adult cases develop due to the growth of scar tissue during prolonged placement of a breathing tube or following tracheostomy, a surgically created opening in the neck for breathing. The trachea can also be externally compressed by other structures, most commonly tumors of the thyroid gland and esophagus.
  • Tracheal inflammation—Several autoimmune disorders and infections may cause the trachea to become swollen and inflamed, essentially blocking airflow similar to tracheal stenosis. These include Wegener’s granulomatosis, sarcoidosis and amyloidosis. It can also occur as a side effect of radiation therapy to the head, neck or chest for other conditions.

Diagnosing disease in the trachea

Evaluating diseases in the trachea or bronchi can be done using a combination of non-invasive and invasive tests.

Tracheal disease treatment options

Diseases and conditions in the trachea are complex and require a multidisciplinary approach. Surgeons on the medical staff of the Department of Thoracic Surgery at Baylor University Medical Center in Dallas coordinate care between the thoracic surgeons, interventional pulmonologists, head and neck surgeons, radiologists, anesthesiologists and pathologists to determine the optimal strategy for each patient.

Tracheal disease treatments range from the administration of medication (such as chemotherapy) or radiation, endoscopic interventions, or open surgery. Thoracic surgeons constantly train using new products and techniques to offer the most advanced care in tracheal medicine and often provide therapy to patients deemed untreatable at other centers.

Minimally Invasive Options

Interventions using an endoscope can be performed as definitive treatment of many conditions or to lessen symptoms. They can typically be performed through a tiny fiberoptic camera (flexible bronchoscope), but occasionally require a larger metal scope (rigid bronchoscope); either way, no incisions are made and side effects are minimal. These interventions include:

  • Tumor removal—Some tumors can be partially or completely removed through a scope with no open surgery necessary. This can be done mechanically or with the aid of argon beam or laser therapy.
  • Dilation—Tracheal stenosis or pressure by an external structure can be relieved by dilating the blocked area with a balloon, which can result in temporary or permanent resolution.
  • Stents—Placement of metal or silicone stents within the area can keep the constricted area open. This can be performed as a temporary or permanent measure and allows for symptom relief while other treatments are administered, such as chemotherapy or radiation.

Surgery

Open tracheal surgery is complex and requires a specialized surgical center and a highly trained team. The surgeons in Dallas within the Department of Thoracic Surgery at Baylor University Medical Center all are skilled in advanced airway surgery, which is only performed a select centers in the country.

Surgery on the trachea involves removal (resection) of the diseased segment followed by reattachment of the ends of the airway (reconstruction). This is the preferred method of treating cancerous diseases, as well as benign diseases that have not responded to less-invasive techniques. Sometimes there is a need for a temporary or permanent tracheostomy, a surgically created opening in the neck for breathing.

Surgical resection and reconstruction is most often done through an incision in the neck, but occasionally requires extension of the incision into the chest through a sternotomy, or dividing the upper part of the breast bone. Diseases of the lower airway, or bronchi, can be approached through the side of the chest, dividing the muscle between the ribs (thoracotomy), and it sometimes can be performed in a minimally invasive fashion (video-assisted thoracic surgery, VATS).