Multiparametric CT-based assessment of pretracheal anatomical relationships for safe tracheotomy: A long-forgotten issue revisited

Dan Zhu; Ahmed Abdelrehem; Lizhong Wu; Ronghui Xia; Yaxin Zhu; Surui Sheng; Songtao Ai; Chunyue Ma

doi:10.1016/j.oraloncology.2022.105719

Multiparametric CT-based assessment of pretracheal anatomical relationships for safe tracheotomy: A long-forgotten issue revisited

Oral Oncol. 2022 Mar:126:105719. doi: 10.1016/j.oraloncology.2022.105719. Epub 2022 Feb 1.

Authors

Dan Zhu¹, Ahmed Abdelrehem², Lizhong Wu¹, Ronghui Xia³, Yaxin Zhu⁴, Surui Sheng⁵, Songtao Ai¹, Chunyue Ma⁶

Affiliations

¹ Department of Radiology, 9th People's Hospital, Shanghai Jiao Tong University School of Medicine, No. 639, Zhi Zao Ju Road, Shanghai 200011, China.
² Department of Oral & Maxillofacial - Head & Neck Oncology, 9th People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai Key Laboratory of Stomatology, No. 639, Zhi Zao Ju Road, Shanghai 200011, China; Department of Craniomaxillofacial and Plastic Surgery, Faculty of Dentistry, Alexandria University, Alexandria, Egypt.
³ Department of Oral & Maxillofacial - Head & Neck Oncology, 9th People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai Key Laboratory of Stomatology, No. 639, Zhi Zao Ju Road, Shanghai 200011, China; Department of Oral Pathology, 9th People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai Key Laboratory of Stomatology, No. 639, Zhi Zao Ju Road, Shanghai 200011, China.
⁴ Department of CT Clinical Research, CT Business Unit, Canon Medical Systems (China) CO. LTD., Beijing, China.
⁵ Department of Oral & Maxillofacial - Head & Neck Oncology, 9th People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai Key Laboratory of Stomatology, No. 639, Zhi Zao Ju Road, Shanghai 200011, China.
⁶ Department of Oral & Maxillofacial - Head & Neck Oncology, 9th People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai Key Laboratory of Stomatology, No. 639, Zhi Zao Ju Road, Shanghai 200011, China. Electronic address: maxifama@163.com.

PMID: 35121399
DOI: 10.1016/j.oraloncology.2022.105719

Abstract

Objectives: To assess the anatomical relationships and variations in the pretracheal space and to guide tracheotomy procedures in a safe manner with image-based evidence.

Materials and methods: A retrospective study was conducted on unirradiated patients requiring elective tracheotomies. Preoperative contrast-enhanced CT (CECT)/CT venography (CTV) was applied for an anatomical evaluation of the pretracheal region. Vascular morphologies were compared for three vessels: the anterior jugular vein (AJV), the innominate artery (IA) and the inferior thyroid vascular plexus (ITVP). The relationships between the thyroid isthmus and the 2nd-4th tracheal rings were also analyzed.

Results: A total of 120 patients were identified, most of whom (n = 110, 91.7%) had head and neck squamous cell carcinomas. Patients with recognizable AJVs (n = 118) were divided into 3 groups: single-branch (n = 11, 9.2%), double-branch (n = 105, 87.5%), and multibranch (n = 2, 1.7%). In addition, IAs were categorized as low-bifurcation (n = 51, 42.5%), high-bifurcation (n = 40, 33.3%), platform (n = 27, 22.5%) and variant types (n = 2, 1.7%). Within the platform types, high-lying IAs (n = 15, 8.3%) might have interfered with the standard tracheal incisions due to possible IA-tracheal overlay. This interference was also related to the height of intraoperative tracheal incisions (r_n = 0.364, P = 0.001). Within ITVPs, independent-trunk types were found in 71 cases (59.2%), while common-trunk types were found in 45 (37.5%). In addition, a low thyroid isthmus (suprasternal-isthmus distance <3 cm) was found in 83 cases (69.2%).

Conclusions: CT image-based evidence can prepare junior practitioners with important pretracheal anatomical information, thereby facilitating safer tracheotomy procedures. Our results shed light on vascular relationships for emergent tracheotomy.

Keywords: Abnormalities; Anterior jugular vein; Computed tomography; Elective surgical procedures; Head and neck neoplasms; Hemostasis; Innominate artery; Pretracheal anatomy; Tracheotomy.

MeSH terms

Humans
Retrospective Studies
Tomography, X-Ray Computed
Trachea / diagnostic imaging
Tracheostomy*
Tracheotomy* / adverse effects
Tracheotomy* / methods