The 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.
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.
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 that arise in the trachea and bronchi are much more uncommon that tumors of adjacent structures that involve the trachea.
Cancer of the structures around the airway can affect the passage of air through the trachea. These include:
Diseases of the trachea are evaluated using a combination of non-invasive and invasive tests.
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:
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).