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The anatomical basis for post-tracheotomy innominate artery rupture
A E Oshinsky1, J S Rubin, C S Gwozdz
1Department of Otorhinolaryngology, Montefiore Medical Center, Bronx, NY.
The Laryngoscope
|October 1, 1988
Summary
Tracheostomy tube placement at the second and third tracheal rings does not guarantee innominate artery protection. Cadaver dissections revealed the artery is often adjacent to the tracheostomy tube, challenging traditional surgical teaching.
Area of Science:
- Anatomy
- Surgical Procedures
- Vascular Safety
Background:
- Classical surgical teaching posits tracheostomy at tracheal rings 2-3 protects the innominate artery.
- This anatomical relationship is crucial for preventing life-threatening hemorrhage during tracheotomy.
Purpose of the Study:
- To evaluate the anatomical relationship between the innominate artery and tracheostomy tube placement.
- To determine if tracheostomy at tracheal rings 2-3 adequately safeguards the innominate artery.
Main Methods:
- Ten fresh adult cadavers underwent tracheotomy via a vertical incision at the second and third tracheal rings.
- Measurements assessed the proximity of the tracheostomy tube (cuff and tip) to the innominate artery and surrounding structures.
Main Results:
- In all cadaver dissections, the innominate artery was found to be adjacent to the tracheostomy tube cuff or tip.
- This proximity was consistent regardless of the precise incision placement within the second and third rings.
Conclusions:
- Contrary to established belief, tracheostomy placement at the second and third tracheal rings does not inherently protect the innominate artery.
- Surgical strategies must account for the frequent adjacency of the innominate artery to the tracheostomy site to prevent rupture.