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trachea.jpgThe trachea is the windpipe which transports air from the mouth to the lungs. It is 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 at Baylor University Medical Center diagnose and treat a variety of diseases affecting the trachea.

Diseases of the Trachea

​Benign conditions include:

  • Tracheal stenosis: narrowing of the trachea, most commonly following intubation (breathing tube placement) or previous surgery
  • Tracheal inflammation: associated with systemic diseases such as Wegener’s granulomatosis

Malignant conditions include:

  • Tumors of the airway
  • Cancer of adjacent organs causing compression or invasion of the trachea

Tracheal Stenosis

Tracheal stenosis is narrowing of the trachea. Babies can be born with this condition, but most adult cases develop due to the growth of scar tissue during a period of prolonged intubation (breathing tube placement) 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 can cause inflammation of the trachea which functionally blocks air flow 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.

Tumors of the Airway

Tumors that arise in the trachea and bronchi are much more uncommon that tumors of adjacent structures that involve the trachea.

Benign tracheal and bronchial tumors include:

  • Carcinoid tumors: these tumors grow much more commonly in the bronchi than the trachea. They occur most often between the ages of 40-60 years, are not associated with smoking, and can produce hormones that cause other systemic symptoms in the heart and gastrointestinal tract.
  • Papillomas: these tumors are benign growths associated with human papillomavirus (HPV). They often grow in groups, referred to as papillomatosis, and can carry the risk of transforming into squamous cell carcinoma.
  • Chondroma: these tumors grow from the cartilage portion of the airway and are very rare.
  • Hemangioma: these are tumors of the blood vessels of the airway and can cause significant bleeding if rupture or during surgical manipulation.

Malignant tracheal and bronchial tumors include:

  • Squamous cell carcinoma: this most common type of tracheal tumor usually grows in the lower part of the trachea. Smoking is the main risk factor, and these tumors tend to grow quickly and cause bleeding and shortness of breath.
  • Adenoid cystic carcinoma: much less common, these tumors grow slowly and are not associated with smoking.

Cancer of Adjacent Organs

Cancer of the structures around the airway can affect the passage of air through the trachea. These include:

  • Thyroid gland: benign goiter as well as cancer of the thyroid gland can compress the trachea in the neck or chest region and cause shortness of breath.
  • Esophagus: the food pipe sits directly next to the trachea. Cancers of this organ can (1) grow into the airway; (2) develop abnormal communication with the airway (fistula) and (3) treatment of this condition with radiation therapy or stents can damage the airway.
  • Lung: the lung is directly communicating with the airway at the level of the bronchi, but tumors of the upper part of the lung as well as abnormal lymph nodes in the chest can compress the trachea and cause symptoms.

Diagnosing Diseases of the Trrachea

Diseases of the trachea are evaluated using a combination of non-invasive and invasive tests.

Non-invasive testing includes:

  • Pulmonary function testing determines how much air can be breathed in and out and helps classify types of airway and lung diseases. It can also be used to assess the muscles of the chest wall and mechanics of breathing.
  • Ultrasound uses sonography to see inside the body. It is particularly useful for assessing the thyroid gland when it is abnormally large and impinging on the trachea.
  • CT (computed tomography) scan uses x-ray images to create virtual images of the inside of the body. It is essential in the diagnosis of airway and lung diseases. Advanced 3D reconstructions are particularly useful in planning treatment for airway conditions.
  • PET (positron emission tomography) scan uses an injected dye to assess metabolic activity and detect the likelihood of cancer.

Invasive testing includes:

  • Endoscopy: fiberoptic tubes that are inserted through the mouth or nose and relay a high-definition image to the operator allowing direct visualization inside the body. Bronchoscopy includes endoscopic evaluation of the larynx, trachea, and bronchi. This can be augmented with endobronchial ultrasound (EBUS), which allows sonographic visualization of the tissue around the airway, most specifically the lymph nodes. EBUS is essential in diagnosing and staging tumors of the trachea, lungs, and esophagus.
  • Biopsy: tumors of the airway or surrounding structures can be biopsied at the time of endoscopy, or rarely at a separate appointment through the skin. Biopsy samples are evaluated under the microscope by our pathologists, and rare cases are further reviewed at an interdisciplinary tumor board.

Treating Diseases of the Trachea

Diseases of the trachea are complex and require a multidisciplinary approach. The Department of Thoracic Surgery at Baylor University Medical Center coordinates care between our thoracic surgeons, interventional pulmonologists, head and neck surgeons, radiologists, anesthesiologists, and pathologists to determine the optimal strategy for each individual patient.

Treatments range from the administration of medication (such as chemotherapy) or radiation, to endoscopic interventions, to open surgery. Our physicians are constantly trialing new products and techniques to stay on the cutting edge of tracheal medicine, and often will provide therapy to patients deemed untreatable at other centers.

Endoscopic interventions can be performed for definitive treatment of many conditions or for palliation of 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 resection: 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 compression by an external structure can be relieved by pneumatically 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.


Open tracheal surgery is complex, and requires a specialized center and a highly trained team. The surgeons in the Department of Thoracic at Baylor University Medical Center all underwent advanced training in 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 sometimes can be performed in a minimally invasive fashion (video-assisted thoracic surgery, VATS).


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