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Thoracic Expertise

The trachea, known as the airway or windpipe, is a tube that starts under the larynx (voice box) and runs behind the breastbone. It then divides into two smaller tubes, (bronchi) which lead to the lungs. When breathing, a normal trachea widens and lengthens with each breath. Inflammation can cause scarring and narrowing of the trachea, while birth defects or injury can cause the trachea to become soft and floppy. Tumors can also cause blockage of the trachea or the main bronchi. All of these conditions can severely affect your breathing.

The main types of tracheal disorders include :

Tracheal stenosis is a narrowing of the trachea, or “windpipe,” that prevents air from fully reaching the lungs. The effects of this narrowing can range in severity from mild to more severe. In the most severe

Tracheal tumors include:

✔ Benign: pleomorphic adenoma, squamous cell papilloma, chondroma, granular cell tumor, glomus tumor, neurofibroma

✔ Malignant: adenoid cystic carcinoma, squamous cell carcinoma, malignant epithelial tumor, carcinoid tumor, mucoepidermoid carcinoma, small cell and non-small cells lung cancer.

Diagnosing Tracheal Conditions:

After taking your medical history and performing a careful physical examination, The Lung Center team may perform the following procedures to confirm a diagnosis of tracheal stenosis or tracheomalacia:

1. 6-minute walk test measures the distance an individual can walk over a period of 6 minutes on a hard, flat surface to determine functional exercise capacity.
2. Advanced cardiopulmonary exercise testing uses catheters during exercise (treadmill or stationary cycling) to measure heart and lung function.
3. Bronchoscopy uses a bronchoscope to examine the inside of the trachea, bronchi (air passages that lead to the lungs). It allows for precise diagnosis of the problem and measurement of the area affected to determine the best possible therapy options.
4. CT scan uses a combination of X-rays and computer technology to produce horizontal, or axial, images of any part of the body, including the bones, muscles, fat and organs.
5. Chest X-ray uses invisible electromagnetic energy beams to produce images of internal tissues, bones and organs on film or digital media.
6. Dynamic 3D chest CT scan takes a closer look at the area while the patient inhales and exhales to outline the structures for surgical planning.
7. Laryngoscopy allows your doctor to examine the back of your throat, larynx and vocal cords using a scope (laryngoscope).
8. Magnetic resonance imaging (MRI) uses strong magnetic fields, radio waves and field gradients to image the anatomy and physiological processes of the body. This procedure provides a non-invasive method of assessing the trachea.
9. Pulmonary Function Test measures how well the lungs work.
10. Pulmonary ventilation/perfusion scan involves two nuclear scan tests: injection of radioactive albumin into your veins and breathing radioactive gas through a mask to allow a machine to measure circulation (perfusion) and breathing (ventilation).

Treatment for Tracheal Disorders:

✔ Tracheal Stenosis

✔ Tracheomalacia

✔ Trachial Tumors

✔ Tracheal Stenosis

There are several surgical options to treat tracheal stenosis. Your surgeon will recommend the best option for you, based on the cause, location and severity of the narrowing. Possible treatments and procedures are:

Argon plasma coagulation (APC)

Bronchoscopic Tracheal dilation uses a balloon, tracheal dilator or electrocautery to widen the trachea.

Laser bronchoscopy uses lasers to remove scar tissue and proves excellent short-term relief for symptoms.

Tracheobronchial airway stent or T-tube.

Tracheal resection and reconstruction, where the scarred and constricted section of the trachea is removed and the upper and lower sections are rejoined. This treatment has excellent long-term results and is the first indicated procedure for certain tumors and stenosis.

Tracheobronchoplasty, a procedure performed at few hospitals across the United States, that involves suturing mesh to the outside of a patient’s trachea through a series of knots, which opens the collapsed tissue in the tracheal wall to create an opening to process air. The goal is that the area will scar over, thereby strengthening the structure and making it permanent. 

Tracheomalacia

Often, tracheomalacia can improve without treatment. However, you should be monitored closely if you suffer from frequent respiratory infections. Treatments may include:

Continuous positive airway pressure (CPAP) uses mild pressure to keep the airway open.

Tracheal resection and reconstruction, a surgical method that removes the constricted section of the trachea and rejoins the upper and lower sections.

Tracheal Tumors

In addition to using some of the surgical procedures listed above, your physician may treat your tumor using some of the following therapies:

Brachytherapy involves locally delivered radiation therapy to the airway.

Photodynamic therapy (PDT) uses the light of a specific wavelength to kill cells and damage tumor vasculature, with the goal of inducing an inflammatory reaction that helps to eliminate the tumor.

• 2.1 Chest Wall

Diseases of the chest wall and diaphragm may be congenital or acquired. Many are the result of trauma or malignancy.

The Thoracic Surgery services at Al Zahra Hospital Dubai offers comprehensive evaluation and advanced surgical treatment for a range of conditions affecting the chest wall (ribcage), breastbone (sternum) and diaphragm, including congenital issues and those caused by injury or illness.

✔ Chest Wall Cancer

✔ Pectus Malformation

✔ Rib Fractures

• 2.2 Chest Wall Cancer

Comprising less than five percent of all thoracic malignancies, cancers of the chest wall are rare and difficult to treat. Chest wall tumors can develop in the bones, soft tissues and cartilage of the chest cavity, which contains the heart, lungs and other organs. These tumors typically involve invasion or have metastasized from adjacent thoracic tumors and are malignant in more than half of cases.

The most common chest wall cancer is sarcoma of the chest wall, including:

✔ Chondrosarcoma

✔ Osteosarcoma

✔ Ewing’s sarcoma

✔ Fibrosarcoma and malignant fibrous histiocytoma (MFH), leiomyosarcoma

✔ Plasmacytoma

Treatment For Chest Wall Cancers

The purpose of surgery is to remove all visible diseases. We also strive to preserve the function of the chest and arms so patients can continue to enjoy activities important to them, including golf and other sporting activities. Surgical options for chest wall cancer include:

Chest wall resection and reconstruction is the primary surgical option for chest wall tumors. This surgery involves the removal of one or more ribs to extract the tumor, followed by reconstruction to recreate a normal appearance after invasive surgery. This can involve prosthetic materials and/or rotation of muscle flaps.

Video-assisted thoracic surgery (VATS), a minimally invasive procedure that involves the insertion of a thoracoscope (small camera) and surgical instruments into small incisions in the chest to remove the tumor.

• 2.3 Pectus Malformation

The pectus, or chest wall, is made up of bone and muscle covered by skin. It protects vital organs such as the heart, lungs and great vessels from injury, as well as aids the breathing process. Malformations can occur in the ribs and sternum of the chest wall, in which the sternum is abnormally sunken (pectus excavatum) or abnormally prominent (pectus carinatum). Pectus excavatum tends to be an inherited condition affecting males. Pectus carinatum may occur as a singular abnormality or in association with other genetic syndromes. Pectus malformations can have significant medical and psychological impact.

Treatment for Pectus Malformation

For many patients with pectus excavatum, there are no symptoms other than the sunken appearance of the chest and no treatment is required other than regular checkups with your doctor. For some patients, especially those who are born with this condition, the symptoms slowly develop as they get older and do not cause any problems until adulthood. When the function of the heart or lungs is compromised, or the patient’s breathing or posture is affected, surgery is recommended. Minimally invasive surgical treatments for pectus malformation are:

Highly modified Ravtich technique removes cartilage and elevates the breastbone with two stainless steel struts inserted through a small vertical incision in the mid-chest.

Nuss procedure, a type of VATS (video-assisted thoracic surgery) generally used for adolescent patients. A curved steel bar (known as the Lorenz Pectus Bar) is inserted through two small incisions under the sternum. It pushes out the depression and is then fixed to the ribs on either side.

Pectus Carinatum

Pectus carinatum often does not need treatment. When the condition is severe and causing medical issues or emotional distress, the following treatments are available:

Minimally invasive surgery may be performed to improve the appearance of the chest. Techniques include:

Osteotomy: Small bone cuts in the breastbone smooth out the contour and resolve rotation of the bone.

• 2.4 Rib Fractures

Rib fractures are commonly caused by trauma to the chest wall. Extremely painful, rib fractures can represent an isolated injury or be part of a larger multi-system injury. A rib may be fractured in one place, two places (flail), or be shattered.

Rib fractures are most caused by blunt injuries to the chest caused by a car accident, fall or assault. Penetrating injuries such as gunshot wounds are a less frequent cause. When severe, rib fractures can lead to flail chest (open chest wound) and cause breathing issues, pulmonary contusion, bleeding, and pneumothorax. When untreated, rib fractures will lead to serious short-term consequences such as severe pain when breathing, pneumonia and, rarely, death. Long-term consequences include chest wall deformity, chronic pain, and decreased lung function.

Although most broken ribs heal without surgery, a severely crushed chest with many broken ribs will likely benefit from this new operative technique.