The trachea, commonly called the windpipe, is the main passageway through which air passes from the nose and throat to the lungs. It has a tubular structure, about 10-12 cm long and 2.0-2.5 cm in diameter. The trachea begins just below the larynx (voice box) and runs down the center of the chest behind the sternum (breastbone) and in front of the esophagus (food pipe). It divides the chest into two smaller tubes called bronchi, one for each lung.
Structure of trachea
The trachea is surrounded by 18 to 22 U-shaped cartilages that provide support to keep the trachea open. The posterior (toward the back) wall of the trachea is composed of connective tissue and smooth muscle that allows it to contract or relax. As a part of normal respiration, subtle contractions of the trachea occur involuntarily (without conscious control).
A mucous membrane lines the interior of the trachea. Goblet cells present in this membrane release mucus. The trachea is also lined with tiny hair-like structures called cilia. The cilia together with the mucus trap expel the microorganisms and tiny airborne particles that enter the airway.
Conditions of trachea
Various diseases and infections that can affect the trachea are:
- Tracheomalacia: Caused by the progressive deterioration of tracheal cartilage. This condition leads to weakness or floppiness of the trachea. Tracheomalacia can also affect newborns because of the congenital weakness of tracheal cartilage.
- Tracheal stenosis: Narrowing of the trachea (stenosis) occurs when the trachea is damaged and scarring develops. Causes of tracheal stenosis include:
- Goiter
- Diphtheria
- Wegener's granulomatosis
- Polyps
- Lung cancer
- Thyroid cancer
- Lymphoma of the chest
- Sarcoidosis
- Amyloidosis
- Severe respiratory infections
- Tracheal tumors: Tracheal cancer is extremely rare. Benign tumors can also develop in the trachea and make it narrow. Surgical removal of the tumor, radiation therapy and chemotherapy are used as treatment.
- Tracheoesophageal fistula: An abnormal passageway forms between the trachea and the esophagus that allows swallowed food to enter the trachea and then into the lungs. Typically, it is the result of a congenital (inborn) defect.
- Foreign body and choking: If a foreign object gets lodged in the trachea, choking can happen. Suffocation, fainting, and death may occur without enough oxygen to the brain and other parts of the body. Bronchoscopy is usually needed to locate and remove the foreign object.
- Tracheitis: Tracheitis is the inflammation of the trachea, which is most often associated with a bacterial infection. Tracheitis is treated with antibiotics.
QUESTION
What percentage of the human body is water? See AnswerSigns and symptoms of tracheal diseases
If a health problem affects the trachea, a person may experience:
- Breathing difficulty
- Wheezing
- Stridor (squeaking or whistling sound when a person breathes)
- Hoarseness
- Cyanosis (bluish skin tone)
- Coughing
- Coughing up blood
- Trouble swallowing food
Examination of trachea
The trachea can be examined through:
- Bronchoscopy: An endoscope (narrow, flexible tube) is passed through the nose or mouth into the trachea.
- Computed tomography (CT scan)
- Magnetic resonance imaging (MRI scan)
- Chest X-ray
Treatment and rehabilitation of tracheal diseases or damage
After the underlying cause of tracheal damage is treated, efforts are made to support its function in the following ways:
- Tracheostomy: A breathing tube is inserted into the trachea through a surgical cut (an incision) in the throat. It is used when intubation through the nose or mouth is not possible or when long-term ventilator support is needed.
- Tracheal dilation and stent placement: During bronchoscopy, a flexible, tube-like instrument is inserted into the trachea and a tiny balloon is inflated to dilate the narrowing (stenosis) in the airway. A silicone or metal stent is then inserted to hold the trachea open.
- Ablation therapy: Stenosis can often be treated by destroying retracted scar tissue that causes the narrowing of the airway. Ablative techniques include laser therapy, electrocautery, cryotherapy (using cold), brachytherapy (using radiation), and argon plasma (using argon gas).
- Tracheal surgery: Surgery may be the best option for removing certain tumors. Surgery may also correct a tracheoesophageal fistula and acquired tracheomalacia.
- Tracheal resection and reconstruction (TRR): TRR is an open surgical procedure. This procedure is commonly used to remove tracheal tumors and treat stenosis or fistulas. Resection of the trachea involves the removal of a section of the trachea and the cut ends are then stitched together. Tracheal reconstruction involves the placement of a small piece of cartilage (taken from another part of the body) to rebuild the trachea and keep it well-supported.
- Chest physical therapy (CPT): CPT may be recommended for patients with tracheomalacia or anyone who experiences chronic airway obstruction or restriction. CPT involves deep breathing, controlled coughing, chest percussion, and oscillation.
Medically Reviewed on 11/7/2022
References
Medline Plus. Tracheal Disorders. https://medlineplus.gov/trachealdisorders.html
Science Direct. Trachea. https://www.sciencedirect.com/topics/medicine-and-dentistry/trachea
Science Direct. Trachea. https://www.sciencedirect.com/topics/medicine-and-dentistry/trachea
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