gms | German Medical Science

The cartilaginous skeleton of the trachea shows vast variations in its structure. These structural alterations encompass both the form and number of cartilaginous rings as well as the junctions between them. This anatomical feature seems to be frequently underestimated, despite its clinical significance in some surgical procedures.

A total of 110 publications were analyzed, including ENT, Anatomy, Surgery textbooks, atlases and articles. Both illustrations and text were checked if they represent/describe the tracheal cartilages as strictly parallel or having any deviation, e.g. non-parallel cartilages, bifurcated cartilages etc.

The publications studied were published in the time period from 1897 to 2016. Only 29% of the ENT textbooks contain tracheal illustrations with intercartilagineous variations. Illustrators of the Anatomy manuals and atlases both show alternating tracheal cartilage structure in 78% of the books. Merely 36% of Surgical textbooks and 20% of the articles show deviation from the parallel presentation of the tracheal rings. Deviations from the general schematic representation are located in the intrathoracic part of the trachea, with the cervical part being drawn as composed of parallel orientated cartilages only (65% of the sample vs. 27% parallel tracheal cartilages in the neck and thorax, respectively). Only in 4 sources (3.6%) the text specifies, that the tracheal rings are not uniform in shape and have common intercartilagineous contacts.

The illustrations of the trachea in the medical textbooks are deceivingly stylized, not corresponding to the real anatomical structure. This also applies to the text presented in medical literature. In certain surgical situations such a wrong and schematic concept may mislead the surgeon.

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