3. Tracheobronchial Tree
A. Anatomy, Physiology and Embryology
Objectives: This section teaches the student; the anatomy, blood supply, physiology, and embryology of the trachea and bronchi and so that the student develops ability to apply findings of radiography, pulmonary function tests, and endoscopy to the patient care.
1. Student learns the anatomy and blood supply of the trachea and bronchi.
2. Student learns the endoscopic anatomy of the nasopharynx, hypopharynx, larynx, trachea, and major bronchi.
3. Student understands and become capable in interpreting pulmonary function studies of the trachea and bronchi (Lungs will be dealt separately).
4. Understands the radiologic assessment of the trachea and bronchi.
Contents:
1. Trachea
a. Blood supply
b. Histologic and gross anatomy
c. Lymphatic anatomy and drainage
d. Contiguous structures
e. Radiographic anatomy and tests
f. Endoscopic anatomy and tests
2. Bronchi
a. Blood supply
b. Histologic and gross anatomy
c. Segmental anatomy
d. Lymphatic relationships
e. Radiographic anatomy and tests
f. Endoscopic anatomy and tests
3. Physiologic evaluation
a. Pulmonary function tests
b. Flow volume loops
4. Radiologic evaluation
a. Plain radiographs
b. Tomography
c. CT scan
d. Fluoroscopy
e. MRI
f. Barium swallow
Skills gained: During the training program the resident will acquire knowledge and proficiency in;
1. Interpreting plain radiographic analyses, CT scan, MRI, and pulmonary function studies involving the trachea and bronchi. (Lungs will be dealt separately)
2. In performing routine (Elective) endoscopy procedures of the upper airway, trachea and major bronchi under supervision.
1. Student learns the anatomy and blood supply of the trachea and bronchi.
2. Student learns the endoscopic anatomy of the nasopharynx, hypopharynx, larynx, trachea, and major bronchi.
3. Student understands and become capable in interpreting pulmonary function studies of the trachea and bronchi (Lungs will be dealt separately).
4. Understands the radiologic assessment of the trachea and bronchi.
Contents:
1. Trachea
a. Blood supply
b. Histologic and gross anatomy
c. Lymphatic anatomy and drainage
d. Contiguous structures
e. Radiographic anatomy and tests
f. Endoscopic anatomy and tests
2. Bronchi
a. Blood supply
b. Histologic and gross anatomy
c. Segmental anatomy
d. Lymphatic relationships
e. Radiographic anatomy and tests
f. Endoscopic anatomy and tests
3. Physiologic evaluation
a. Pulmonary function tests
b. Flow volume loops
4. Radiologic evaluation
a. Plain radiographs
b. Tomography
c. CT scan
d. Fluoroscopy
e. MRI
f. Barium swallow
Skills gained: During the training program the resident will acquire knowledge and proficiency in;
1. Interpreting plain radiographic analyses, CT scan, MRI, and pulmonary function studies involving the trachea and bronchi. (Lungs will be dealt separately)
2. In performing routine (Elective) endoscopy procedures of the upper airway, trachea and major bronchi under supervision.
B. Congenital and Acquired Abnormalities
Objectives: This section teaches the student; congenital and acquired diseases of the trachea and adjacent structures, in order to make him understand the physiology of tracheal abnormalities, and create ability so that the student performs operative and non-operative management under supervision. During this section of didactic teaching, teacher will ensure that the student;
1. Understands congenital abnormalities and idiopathic diseases of the trachea.
2. Understands the etiology, presentation and management of acquired tracheal and bronchial strictures and their prevention.
3. Understands the etiology, presentation and management of tracheoesophageal fistulas and tracheoinnominate artery fistulas.
4. Exposed in detail operative approaches to the trachea and techniques of mobilization.
5. Learns intricacies of the methods of airway management, anesthesia and ventilation for tracheal operations.
6. Learns the principles of tracheal surgery and release maneuvers.
7. Understands the complications of tracheal surgery and their management.
8. Understands the etiology, presentation, and principles of airway trauma management.
9. Understands the radiologic evaluation of tracheal abnormalities.
Contents:
1. Radiologic assessment of the trachea and bronchi
a. Plain x-rays
b. CT scans
c. MRI
d. Barium swallow
2. Stricture of the trachea
a. Post-intubation
b. Post-tracheostomy
c. Post-traumatic
3. Strictures of the bronchi
a. Transplant
b. Stricture after sleeve resection
c. Histoplasmosis
4. Anesthesia for tracheal operations
a. Methods of airway control
b. Extubation concerns
5. Operative approaches to the trachea
a. Reconstruction of the upper trachea
b. Reconstruction of the lower trachea
c. Mediastinal tracheostomy
6. Tracheostomy and its complications
a. Tracheal stenosis
b. Tracheo-esophageal fistula
c. Tracheo-innominate artery fistula
d. Persistent tracheal stoma
7. Airway trauma
a. Airway control
b. Evaluation of associated injuries
c. Principles of repair (primary and secondary)
d. Protecting tracheostomies
8. Tracheomalacia, Bronchomalacia
a. Diagnosis
b. Strategies for management (operative and non-operative)
Skills gained: During the training program the resident will acquire knowledge and proficiency in;
1. Be able to evaluate independently diagnostic tests of the trachea and bronchi.
2. Be able to perform independently routine elective laryngoscopy and bronchoscopy of the trachea and bronchi, including dilation of stenoses.
3. Be able to perform tracheostomy under supervision
4. Be able to evaluate patients for tracheal resection and plan the operation under supervision.
5. Be able to assist tracheal resection and reconstruction for tracheal stenosis with full knowledge and ease.
6. Be able to perform placement of tracheal T-tubes independently.
7. Be able to assist operations for tracheo-esophageal fistula, tracheo-innominate fistula, subglottic stenosis, and traumatic airway injury with knowledge and ease.
8. Is knowledgeable regarding the indications and technique for placement of tracheobronchial stents.
1. Understands congenital abnormalities and idiopathic diseases of the trachea.
2. Understands the etiology, presentation and management of acquired tracheal and bronchial strictures and their prevention.
3. Understands the etiology, presentation and management of tracheoesophageal fistulas and tracheoinnominate artery fistulas.
4. Exposed in detail operative approaches to the trachea and techniques of mobilization.
5. Learns intricacies of the methods of airway management, anesthesia and ventilation for tracheal operations.
6. Learns the principles of tracheal surgery and release maneuvers.
7. Understands the complications of tracheal surgery and their management.
8. Understands the etiology, presentation, and principles of airway trauma management.
9. Understands the radiologic evaluation of tracheal abnormalities.
Contents:
1. Radiologic assessment of the trachea and bronchi
a. Plain x-rays
b. CT scans
c. MRI
d. Barium swallow
2. Stricture of the trachea
a. Post-intubation
b. Post-tracheostomy
c. Post-traumatic
3. Strictures of the bronchi
a. Transplant
b. Stricture after sleeve resection
c. Histoplasmosis
4. Anesthesia for tracheal operations
a. Methods of airway control
b. Extubation concerns
5. Operative approaches to the trachea
a. Reconstruction of the upper trachea
b. Reconstruction of the lower trachea
c. Mediastinal tracheostomy
6. Tracheostomy and its complications
a. Tracheal stenosis
b. Tracheo-esophageal fistula
c. Tracheo-innominate artery fistula
d. Persistent tracheal stoma
7. Airway trauma
a. Airway control
b. Evaluation of associated injuries
c. Principles of repair (primary and secondary)
d. Protecting tracheostomies
8. Tracheomalacia, Bronchomalacia
a. Diagnosis
b. Strategies for management (operative and non-operative)
Skills gained: During the training program the resident will acquire knowledge and proficiency in;
1. Be able to evaluate independently diagnostic tests of the trachea and bronchi.
2. Be able to perform independently routine elective laryngoscopy and bronchoscopy of the trachea and bronchi, including dilation of stenoses.
3. Be able to perform tracheostomy under supervision
4. Be able to evaluate patients for tracheal resection and plan the operation under supervision.
5. Be able to assist tracheal resection and reconstruction for tracheal stenosis with full knowledge and ease.
6. Be able to perform placement of tracheal T-tubes independently.
7. Be able to assist operations for tracheo-esophageal fistula, tracheo-innominate fistula, subglottic stenosis, and traumatic airway injury with knowledge and ease.
8. Is knowledgeable regarding the indications and technique for placement of tracheobronchial stents.
C. Neoplasms
Objectives: This section teaches the student; working knowledge of neoplasms affecting the trachea and adjacent structures, and creates and ability to plan according to the latest guidelines, patient's operative and non-operative managements.
1. Knows the types, histology, and clinical presentation of tracheal neoplasms;
2. Understands the radiologic evaluation and operative management of tracheal neoplasms;
3. Understands the methods of airway management;
4. Knows the indications for and the use of radiotherapy and chemotherapy.
Contents:
1. Neoplasms of the trachea
a. Benign
b. Malignant
c. Metastatic
2. Operative techniques
a. Resection of tracheal tumors
b. Methods of tracheal reconstruction
c. Operative approaches
3. Prosthetic materials
a. Silastic prosthetics
b. Stents
c. Types of tracheostomy tubes and tracheal T-tubes
4. Airway management
a. Bronchoscopic “core out”
b. Laser
c. Photodynamic therapy
Skills gained: During the training program the resident will acquire knowledge and proficiency in;
1. Be able to perform rigid and flexible bronchoscopy for diagnosis and “core-out” under supervision.
2. Assists and performs (10/2) resection of tracheal tumours.
3. Independently be able to manage patients and their airways after tracheal resection.
4. Understands the use of laser techniques in the management of endoluminal tumours.
5. Be able to decide and use stents, tracheal T-tubes and tracheostomy tubes in the management of tracheal neoplasms.
6. Be able to plan and discuss use of adjunctive therapy for the management of tracheal tumours with patients and colleagues
1. Knows the types, histology, and clinical presentation of tracheal neoplasms;
2. Understands the radiologic evaluation and operative management of tracheal neoplasms;
3. Understands the methods of airway management;
4. Knows the indications for and the use of radiotherapy and chemotherapy.
Contents:
1. Neoplasms of the trachea
a. Benign
b. Malignant
c. Metastatic
2. Operative techniques
a. Resection of tracheal tumors
b. Methods of tracheal reconstruction
c. Operative approaches
3. Prosthetic materials
a. Silastic prosthetics
b. Stents
c. Types of tracheostomy tubes and tracheal T-tubes
4. Airway management
a. Bronchoscopic “core out”
b. Laser
c. Photodynamic therapy
Skills gained: During the training program the resident will acquire knowledge and proficiency in;
1. Be able to perform rigid and flexible bronchoscopy for diagnosis and “core-out” under supervision.
2. Assists and performs (10/2) resection of tracheal tumours.
3. Independently be able to manage patients and their airways after tracheal resection.
4. Understands the use of laser techniques in the management of endoluminal tumours.
5. Be able to decide and use stents, tracheal T-tubes and tracheostomy tubes in the management of tracheal neoplasms.
6. Be able to plan and discuss use of adjunctive therapy for the management of tracheal tumours with patients and colleagues
