Image Based Question – 66682

In a patient presenting with carcinoma of Larynx,the following tube as shown in the image ,is planned to be inserted.What would be the location for insertion of this tube?

A. Through IV ring of trachea with division of isthmus.

B. Through II and III rings of trachea with division of isthmus.

C. Below level of thyroid isthmus.

D. Above level of thyroid isthmus.

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Correct Answer » D Explanation

Ans:D. Above level of thyroid isthmus.

• Image shown is of a Tracheostomy tube.

• A tracheostomy is planned in the patient suffering from Carcinoma of Larynx.

TYPES OF TRACHEOSTOMY

Tracheostomy has also been divided into:

A. High tracheostomy:

• Done above level of thyroid isthmus.

• It violates the 1st ring of trachea.

• Tracheostomy at this site can cause perichondritis of the cricoid cartilage and subglottic stenosis and is always avoided.

• Only indication for high tracheostomy is carcinoma of larynx because in such cases, total larynx would ultimately be removed and a fresh tracheostome made in a clean area lower down.

B. Mid tracheostomy:

• It is the preferred one and done through II and III rings/IV rings division of isthmus.

• A mid tracheostomy is done through the II or III rings and would entail division of the thyroid isthmus (isthmus lies against II, III and IV tracheal rings) or its retraction by cricoid hook upwards or downwards to expose this part of trachea.

C. Low tracheostomy: Done below level of isthmus. Trachea is deep at this level and close to several large vessels.