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A. Circumferential stenosis of the subglottis and superior trachea. Dashed lines represent the external extent of resection. A lateral transection through the cricoid lamina allows removal of the anterior cricoid arch while preserving the posterior cricoid lamina, thereby protecting the recurrent laryngeal nerves. A posterior membranous tracheal wall flap is formed distally. B. The superior line of resection is through the cricothyroid membrane, curving inferiorly through the lateral cricoid laminae. The first preserved tracheal ring is shaped into an inverted U for anastomosis directly to the thyroid cartilage. If a longer posterior flap is required for reconstruction, the level of tracheal resection may be dropped by an additional ring. C. The internal line of resection (dotted line) removes the stenosis involving the posterior cricoid lamina. With neoplasms that involve the cricoid, the posterior lamina may be resected, but the Source: Chapter 55. Subglottic Resection of the Airway, Adult Chest Surgery posterior perichondrium and a superior horizontal strut of cartilage should be preserved to maintain arytenoid stability and posterior muscular attachments. Citation: Sugarbaker Bueno R, is Krasna MJ,with Mentzer SJ, Zellos L. flap Adult Chest Available at: http://mhmedical.com/ D. The denuded posterior lamina DJ, of the cricoid covered the membranous from theSurgery; posterior2009 trachea. The first tracheal ring is shapedAccessed: to fit the May 09, 2017 inferior thyroid cartilage resection line. E. 4-0 Vicryl is used internally to close the mucosal defect over the posterior cricoid lamina. 3-0 Vicryl suture is used Copyright © 2017 Education. Allcartilages rights reserved to anastomose the tracheal ringMcGraw-Hill to the thyroid and cricoid and to anchor the base of the membranous flap to the posterior cricoid cartilage, taking care not to injure the recurrent laryngeal nerves. All knots are tied outside the lumen. F. The superior trachea is anastomosed to the thyroid cartilage with