Morphometric characterisation of human tracheas: focus on cartilaginous ring variation

Advances in studies on tracheal stent design addressing the related complications

Tracheal stents can be used to quickly reconstruct the airway and relieve symptoms of dyspnea in patients with tracheal stenosis. However, existing tracheal stents lead to complications such as granulation tissue formation, difficulty in removal, persistent growth of malignant tumors, stent migration, and mucus plugging. In this article, we reviewed the main methods used to reduce complications associated with tracheal stent design. Drug-eluting stents can inhibit granulation tissue formation and prevent infection and local chemotherapy. The biodegradable stent can support the trachea for some time, maintain tracheal patency, and degrade gradually, which avoids removing or replacing the stent. Radioactive stents loaded with I125 have good potential for inhibiting the persistent growth of malignant tumors. Three-dimensional printing technology enables the manufacturing of patient-specific stents, which increases the degree of matching between the complex tracheal anatomy and the stent, thus providing a new solution for stent migration caused by structural mismatch. Minimizing the barrier of the stent to mucociliary clearance, providing an anti-fouling coating, and culturing respiratory epithelial cells on the surface of the stent are the main methods used to reduce mucus plugging. We also proposed future research directions for tracheal stents to guide the design and manufacture of ideal tracheal stents.

Significance of the evaluation of tracheal length using a three-dimensional imaging workstation

BACKGROUND

Limited information is available on the total tracheal length and its other characteristics for tracheal surgery. This study aimed to investigate the reference value of tracheal length and assess its relationship with physiological variables.

METHODS

We measured the tracheal length of 215 patients (107 men and 108 women) who underwent contrast-enhanced computed tomography before thoracic surgery using a three-dimensional imaging workstation. Pearson correlation analysis and multiple linear regression analysis were performed to investigate the relationship between the total tracheal length (cervical and thoracic) and common physiological parameters.

RESULTS

The mean total tracheal length was 11.5±1 cm (range, 8.8-14.4 cm); 8% of the patients had a total tracheal length <10 cm. The cervical trachea was significantly shorter in men than in women (2.9±1.3 vs. 3.8±1.3 cm, P<0.001), whereas the thoracic trachea was significantly longer in men than in women (8.9±1.1 vs. 7.4±1.1 cm, P<0.001). Correlation analysis showed that the total tracheal length was positively associated with height in both sexes, while the height was positively associated with only cervical tracheal length. In the multiple linear regression analysis, the total tracheal length was influenced most by height, while cervical and thoracic tracheal lengths were influenced most by sex. Older age was also an independent contributor to a shorter cervical trachea and longer thoracic trachea in both sexes.

CONCLUSIONS

The total tracheal length ranged from short to long in individuals, and characteristics of tracheal length varied with height, age, sex, and part of the trachea. We should thus be aware of the tracheal length of each patient for appropriate tracheal management.

Effect of wavy trachea walls on the oscillation onset pressure of silicone vocal folds

The influence of non-smooth trachea walls on phonation onset and offset pressures and the fundamental frequency of oscillation were experimentally investigated for three different synthetic vocal fold models. Three models of the trachea were compared: a cylindrical tube (smooth walls) and wavy-walled tubes with ripple depths of 1 and 2 mm. Threshold pressures for the onset and offset of phonation were measured at the lower and upper ends of each trachea tube. All measurements were performed both with and without a supraglottal resonator. While the fundamental frequency was not affected by non-smooth trachea walls, the phonation onset and offset pressures measured right below the glottis decreased with an increasing ripple depth of the trachea walls (up to 20% for 2 mm ripples). This effect was independent from the type of glottis model and the presence of a supraglottal resonator. The pressures at the lower end of the trachea and the average volume velocities showed a tendency to decrease with an increasing ripple depth of the trachea walls but to a much smaller extent. These results indicate that the subglottal geometry and the flow conditions in the trachea can substantially affect the oscillation of synthetic vocal folds.

Genotype-Phenotype Correlation of Tracheal Cartilaginous Sleeves and Fgfr2 Mutations in Mice

OBJECTIVES

To characterize tracheal cartilage morphology in mouse models of fibroblast growth factor receptor (Fgfr2)-related craniosynostosis syndromes. To establish relationships between specific Fgfr2 mutations and tracheal cartilaginous sleeve (TCS) phenotypes in these mouse models.

METHODS

Postnatal day 0 knock-in mouse lines with disease-specific genetic variations in the Fgfr2 gene (Fgfr2^C342Y/C342Y , Fgfr2^C342Y/+ , Fgfr2^+/Y394C , Fgfr2^+/S252W , and Fgfr2^+/P253R ) as well as line-specific controls were utilized. Tracheal cartilage morphology as measured by gross analyses, microcomputed tomography (μCT), and histopathology were compared using Chi-squared and single-factor analysis of variance statistical tests.

RESULTS

A greater proportion of rings per trachea were abnormal in Fgfr2^C342Y/+ tracheas (63%) than Fgfr2^+/S252W (17%), Fgfr2^+/P253R (17%), Fgfr2^+/Y394C (12%), and controls (10%) (P < .001 for each vs. Fgfr2^C342Y/+ ). TCS segments were found only in Fgfr2^C342Y/C342Y (100%) and Fgfr2^C342Y/+ (72%) tracheas. Cricoid and first-tracheal ring fusion was noted in all Fgfr2^C342Y/C342Y and 94% of Fgfr2^C342Y/+ samples. The Fgfr2^C342Y/C342Y and Fgfr2^C342Y/+ groups were found to have greater areas and volumes of cartilage than other lines on gross analysis and μCT. Histologic analyses confirmed TCS among the Fgfr2^C342Y/C342Y and Fgfr2^C342Y/+ groups, without appreciable differences in cartilage morphology, cell size, or density; no histologic differences were observed among other Fgfr2 lines compared to controls.

CONCLUSION

This study found TCS phenotypes only in the Fgfr2^C342Y mouse lines. These lines also had increased tracheal cartilage compared to other mutant lines and controls. These data support further study of the Fgfr2 mouse lines and the investigation of other Fgfr2 variants to better understand their role in tracheal development and TCS formation.

LEVEL OF EVIDENCE

NA Laryngoscope, 131:E1349-E1356, 2021.

Developmental plasticity associated with early structural integration and evolutionary patterns: Examples of developmental bias and developmental facilitation in the skeletal system

The relation of developmental plasticity to evolutionary diversification is a key component of evolutionary theory involving developmental bias, but the basis of the relationship varies among traits and among taxa. Here I review some scenarios of how structural integration during early organogenesis could influence this relationship. When condensations are highly integrated and dependent on each other during early organogenesis, both plasticity and evolution are restricted, for example size proportions in molar tooth rows and phalanges within a digit. When similar condensations develop and remain separate (in tracheal cartilages and feather buds), they show high levels of variation and diversity in number but not in shape and size, at least at early stages. When non-similar structures form separately and then integrate while still undergoing patterning, high levels of plasticity (in number, size, shape; in rib uncinate processes) or new dimensions of ecologically-significant variation (cusp offset, in mammal teeth) are seen. Although each of these structural integration scenarios is unique, the modulation of evolvability is detectable and informative. Parsing the influence of structural integration at these developmental levels, rather than later-stage structural correlations or only through genetic covariation, may be necessary to advance understanding of evolvability of the phenotype.