CERVICAL CERVICAL OESOPHAGOTOMY OESOPHAGOTOMY IN ANIMALS IN ANIMALS

SITE OF OPERATION SITE OF OPERATION

1. At the level of 1. At the level of obstruction or obstruction or lesion lesion

2. At upper or lower 2. At upper or lower border of jugular border of jugular furrow furrow

TOPOGRAPHIC TOPOGRAPHIC ANATOMY ANATOMY

1. The oesophagus 1. The oesophagus is three to three is three to three and or half feet and or half feet long in medium long in medium sized animals and sized animals and is comparatively is comparatively small in dogs. It small in dogs. It connects pharynx connects pharynx and the stomach. and the stomach.

2. The whole length of 2. The whole length of oesophagus is divided oesophagus is divided into cervical, thoracic into cervical, thoracic and abdominal part in and abdominal part in horses and dogs the horses and dogs the abdominal part is abdominal part is absent in dogs. absent in dogs.

3. The average diameter 3. The average diameter approximately one to approximately one to two inches and is two inches and is masculomembrane masculomembrane tube. tube.

4. In cervical area it is 4. In cervical area it is almost in dorsal almost in dorsal position at origin and position at origin and passes gradually to passes gradually to left left

side of the trachea at side of the trachea at the level of about 4th the level of about 4th cervical vertebrae. cervical vertebrae. Thereafter it Thereafter it

occupies the left position occupies the left position of trachea upto 3rdof trachea upto 3rd

thoracic vertebrae. thoracic vertebrae.

In the thoracic In the thoracic

region it is median in region it is median in position and enters position and enters the abdominal the abdominal cavity through cavity through hiatus hiatus

oesophagus and oesophagus and terminates at the terminates at the cardia of the cardia of the stomach. stomach.

5. As the oesophagus 5. As the oesophagus crosses to left side of crosses to left side of the trachea it is the trachea it is accompanied by accompanied by longus coli and longus longus coli and longus capitis muscles capitis muscles dorsally, left carotid dorsally, left carotid artery, artery, vagosympathetic vagosympathetic

trunk, jugular vein and trunk, jugular vein and recurrent laryngeal recurrent laryngeal nerve laterally. nerve laterally.

Overlying the Overlying the

oesophagus are skin, oesophagus are skin, cervical fascia, cervical cervical fascia, cervical paniculus muscle and paniculus muscle and the the

omohyoideus muscle, omohyoideus muscle, which crosses the which crosses the jugular furrow obliquely jugular furrow obliquely from below from below

upward, forward and upward, forward and inward towards the inward towards the median line. median line.

6. Its wall is composed of 6. Its wall is composed of • fibrous sheath, fibrous sheath, • the tunica adventitia, the tunica adventitia, • the muscular coat, the muscular coat, • the submucous and mucous the submucous and mucous

coat. In cervical area the coat. In cervical area the oesophageal wall is thicker. oesophageal wall is thicker.

7. The oesophagus is supplied 7. The oesophagus is supplied by branches of by branches of

• carotid, carotid, • brachio-oesophageal brachio-oesophageal • and gastric arteries. and gastric arteries.

8. The nerve supply to oesophagus is 8. The nerve supply to oesophagus is by by

• vagus, vagus, • glosso-pharyngeal glosso-pharyngeal • and sympathetic nerves. and sympathetic nerves.

INDICATIONS INDICATIONS

1. Oesophageal 1. Oesophageal obstruction and obstruction and wounds of wounds of oesophagus. oesophagus.

2. Stricture of 2. Stricture of oesophagus or oesophagus or oesophageal oesophageal stenosis. stenosis.

3. Neoplastic 3. Neoplastic growths inside the growths inside the oesophagus oesophagus

4. Oesophageal 4. Oesophageal diverticulum. diverticulum.

CONTROL AND ANAESTHESIA CONTROL AND ANAESTHESIA

1. The position of animal is right 1. The position of animal is right lateral recumbency after proper lateral recumbency after proper sedation. sedation.

2. Anaesthesia is by general 2. Anaesthesia is by general anaesthesia in small animals or by anaesthesia in small animals or by local in filtration local in filtration

analgesia at the site of operation. analgesia at the site of operation.

SURGICAL TECHNIQUE SURGICAL TECHNIQUE 1. At the marked site, a long 1. At the marked site, a long

incision is made on skin incision is made on skin and subcutaneous tissue, and subcutaneous tissue,

sufficient enough to extract sufficient enough to extract the obstruction, if present. the obstruction, if present.

2. The omohyoideus muscle 2. The omohyoideus muscle is separated from upper is separated from upper and lower structure. The and lower structure. The areolar areolar

tissue is bluntly dissected tissue is bluntly dissected with the help of fingers. with the help of fingers.

3. The trachea is recognized 3. The trachea is recognized to locate the oesophagus to locate the oesophagus on its lateral surface. on its lateral surface.

4. The oesophagus is 4. The oesophagus is drawn out and fixed in drawn out and fixed in position by placing position by placing blunt instrument blunt instrument

under it. under it.

5. Make an incision on 5. Make an incision on dorsal wall of dorsal wall of oesophagus either oesophagus either anterior or posterior to anterior or posterior to

obstruction. The incision obstruction. The incision should be large should be large enough to extract the enough to extract the obstruction/foreign obstruction/foreign

body. body.

6. The repair of oesophageal incision can be 6. The repair of oesophageal incision can be done in two layers. The mucous done in two layers. The mucous

membrane can be sutured with mattress sutures membrane can be sutured with mattress sutures or continuous sutures. or continuous sutures.

The The muscularis layer is to be sutured with connell muscularis layer is to be sutured with connell pattern or continuous lock stitch pattern or continuous lock stitch pattern. Chromic catgut or silk suture is used for pattern. Chromic catgut or silk suture is used for suturing.suturing.

7. The oesophagus is replaced in its 7. The oesophagus is replaced in its original position. original position.

8. The skin wound is closed in routine 8. The skin wound is closed in routine manner or it is left as open wound. manner or it is left as open wound.

POST OPERATIVE CARE POST OPERATIVE CARE 1. Do not allow solid food for few days and 1. Do not allow solid food for few days and

intravenous fading is done twice intravenous fading is done twice daily. daily. 2. A course of antibiotics is to be completed 2. A course of antibiotics is to be completed

(4-5 days) (4-5 days) 3. Antiseptic dressing of the wound should 3. Antiseptic dressing of the wound should

be carried one till healing is complete be carried one till healing is complete or when sutures are removed after 8-12 or when sutures are removed after 8-12

days. days.

IMPORTANT CONSIDERATION/ REMARKS IMPORTANT CONSIDERATION/ REMARKS 1. Check hemorrhage during surgery 1. Check hemorrhage during surgery 2. If oesophagus is empty it is recognized by passing a 2. If oesophagus is empty it is recognized by passing a

stomach tube. stomach tube.

3. During dissection, 3. During dissection, prevent damage to prevent damage to recurrent laryngeal recurrent laryngeal nerve. nerve.

4. Suturing only 4. Suturing only oesophagus and oesophagus and leaving the skin leaving the skin wound open is the wound open is the procedure of procedure of

choice because choice because

a) It favours early closure of a) It favours early closure of oesophageal wound oesophageal wound

b) It prevents escape of alimentary b) It prevents escape of alimentary matter during swallowing. matter during swallowing.

c) It permits drainage of any material, c) It permits drainage of any material, if present. if present.

TRACHETOMY AND TRACHETOMY AND TRACHEOSTOMY IN ANIMALSTRACHEOSTOMY IN ANIMALS

Mostly indicated in buffalo Mostly indicated in buffalo and cattle. and cattle.

SITE OF OPERATION SITE OF OPERATION At the junction of upper and At the junction of upper and

middle third portion of the middle third portion of the neck on mid ventral neck on mid ventral

line. line. TOPOGRAPHIC ANATOMY TOPOGRAPHIC ANATOMY 1. Trachea is a musculo-1. Trachea is a musculo-

membrano-cartilagenous membrano-cartilagenous tube extending from thetube extending from the

larynx to larynx to

the hilus of the the hilus of the lungs. It lungs. It occupies a occupies a median position median position in the ventral in the ventral aspect of the aspect of the neck. neck.

2. It is composed of 2. It is composed of incomplete cartilaginous incomplete cartilaginous rings, which helps to rings, which helps to keep the trachea keep the trachea

permanently open. In permanently open. In ruminants these rings ruminants these rings are 45 to 60 in number. are 45 to 60 in number. These rings These rings

are enclosed and are enclosed and connected by connected by fibroelastic membrane fibroelastic membrane and constitute the and constitute the tracheal tracheal

annular ligament. annular ligament.

3. The cervical part 3. The cervical part of the trachea is of the trachea is related dorsally to related dorsally to the longus coli the longus coli muscle and muscle and

oesophagus and oesophagus and laterally to the laterally to the thyroid gland, the thyroid gland, the carotid artery, the carotid artery, the jugular vein, jugular vein,

the vagus, sympathetic and recurrent the vagus, sympathetic and recurrent laryngeal nerves, the tracheal lymph laryngeal nerves, the tracheal lymph duct duct

and cervical lymph gland. and cervical lymph gland.

4. The sternocephalicus muscle 4. The sternocephalicus muscle converges from below to above and converges from below to above and crosses the crosses the

trachea obliquely, passing from the trachea obliquely, passing from the ventral surface, forward its sides and ventral surface, forward its sides and

diverging to reach the angle of jaws. diverging to reach the angle of jaws. The left-over area of trachea is The left-over area of trachea is covered only covered only

with skin, subcutaneous tissue and areolar with skin, subcutaneous tissue and areolar tissue between the two halves of tissue between the two halves of

sternothyroideus muscles which lie on the sternothyroideus muscles which lie on the ventral surface. ventral surface.

• 5. 5. • The branches of common carotid artery The branches of common carotid artery

supply the trachea supply the trachea

• nerve supply is nerve supply is by vagus and sympathetic nerves. by vagus and sympathetic nerves.

INDICATIONS INDICATIONS 1. Obstruction in the upper respiratory 1. Obstruction in the upper respiratory

passage.(rattle snake bite, regional passage.(rattle snake bite, regional lymph node abscessation due to lymph node abscessation due to streptococcus, nasopharyngeal streptococcus, nasopharyngeal neoplasia, excessive distension of neoplasia, excessive distension of gutteral pouches etc. )gutteral pouches etc. )

2. Paralysis of intrinsic muscles of the 2. Paralysis of intrinsic muscles of the larynx larynx

3. Fracture of tracheal ring causing 3. Fracture of tracheal ring causing obstruction of trachea. obstruction of trachea.

CONTROL AND ANAESTHESIA CONTROL AND ANAESTHESIA

1. The animal is positioned in lateral 1. The animal is positioned in lateral recumbency with neck extended. recumbency with neck extended.

2. Head is kept in lower position to prevent 2. Head is kept in lower position to prevent aspiration of fluids. aspiration of fluids.

3. The anaesthesia is local linear infiltration 3. The anaesthesia is local linear infiltration analgesia at the site of incision. analgesia at the site of incision.

SURGICAL TECHNIQUE SURGICAL TECHNIQUE 1. A mid line 7-10 cm long incision is made 1. A mid line 7-10 cm long incision is made

through the skin and subcutaneous through the skin and subcutaneous tissues. tissues.

2. Separate two portions of 2. Separate two portions of sternothyroideus muscle and exposed the sternothyroideus muscle and exposed the trachea after trachea after

bluntly dissecting the areolar tissue. bluntly dissecting the areolar tissue.

3. Two tracheal rings are selected, 3. Two tracheal rings are selected, exposed at wound edges and fixed with exposed at wound edges and fixed with the help the help

of two sharp hooks through the inter-of two sharp hooks through the inter-annular ligament. annular ligament.

4. If temporary 4. If temporary tracheotomy is tracheotomy is desired, an incision desired, an incision is made on the inter-is made on the inter-annular annular

ligament. just enough ligament. just enough to permit the to permit the passage of tracheal passage of tracheal tube. tube.

5. If permanent 5. If permanent tracheotomy tracheotomy (tracheostomy) is (tracheostomy) is desired, the incision is desired, the incision is made in the made in the

tracheal ring using tracheal ring using either of following either of following techniques. techniques.

a) Incise the inter-a) Incise the inter-annular ligament and annular ligament and the tracheal ring in its the tracheal ring in its transverse plane transverse plane

going semi circularly going semi circularly leaving half portion of leaving half portion of the tracheal ring the tracheal ring intact. intact.

Repeat the Repeat the sameprocedure on sameprocedure on opposite tracheal ring. opposite tracheal ring. The incised portion of The incised portion of the cartilage along the cartilage along with with

inter-annular ligament is inter-annular ligament is removed. An oval removed. An oval opening in the trachea opening in the trachea will be created. will be created.

Instead of oval, square Instead of oval, square opening can also be opening can also be made. made.

OR OR b) Make a b) Make a

longitudinal incision longitudinal incision on two or three on two or three tracheal rings and tracheal rings and with the with the

help of traction help of traction sutures, applied sutures, applied through cartilaginous through cartilaginous rings on either side rings on either side of incision, of incision,

the tracheal lumen is the tracheal lumen is exposed. exposed.

6. Insert the tracheostomy 6. Insert the tracheostomy tube through these tube through these openings into the tracheal openings into the tracheal lumen and lumen and

then keep in position by then keep in position by suturing it to trachea suturing it to trachea

7. The remainder 7. The remainder tracheostomy tracheostomy incision is sutured, incision is sutured, applying applying continuous suture continuous suture

pattern using silk pattern using silk thread. thread.

8. The skin wound is 8. The skin wound is closed in routine closed in routine manner. manner.

POST OPERATIVE CARE POST OPERATIVE CARE 1. The tube is cleaned daily for first few days. 1. The tube is cleaned daily for first few days. 2. The opening of tracheostomy tube should be 2. The opening of tracheostomy tube should be

covered with gauze to prevent covered with gauze to prevent entrance of any foreign material. entrance of any foreign material. 3. The course of antibiotics for 5 days must be 3. The course of antibiotics for 5 days must be

completed. completed. 4. Daily/alternate day antiseptic dressing of wound 4. Daily/alternate day antiseptic dressing of wound

till complete healing when till complete healing when sutures are removed (normally 8-12 days after sutures are removed (normally 8-12 days after

operation). operation).