Table of ContentsView AllTable of ContentsTrachea AnatomyTrachea FunctionAssociated ConditionsTreatmentSummary
Table of ContentsView All
View All
Table of Contents
Trachea Anatomy
Trachea Function
Associated Conditions
Treatment
Summary
Thetrachea(also called the windpipe) is the large tube that brings air from the nasal passages, throat, andlarynx(the upper respiratory tract) to the two large airways that branch off into each lung (bronchi). An important function of the trachea is warming and moisturizing the air, as well as catching debris and microbes before they can enter the lungs.
The trachea can become infected, inflamed, or damaged. In rare cases, these problems can lead to tracheal stenosis, a condition where the trachea narrows and a person struggles to breathe. Tracheal cancer is another rare condition that can affect the organ.
This article will cover the anatomy and function of the trachea, as well as what conditions can affect it.
The trachea is part of the lower respiratory tract, along with the lungs, bronchi,bronchioles, andalveoli. The strong, flexible tube is also called the windpipe because its main job is to move air in and out of the lungs.
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Structure
In an adult, the trachea is about 4 to 5 inches long and 1 inch around (diameter). The trachea starts just under the voice box (larynx) and runs down the center of the chest behind the breast bone (sternum) in front of theesophagus.
The trachea ends at a ridge of cartilage that separates and forms the junction into the bronchi (carina).
Membranes
Mucosal membranes are made up of epithelial cells, mucus-secreting goblet cells, and hair-like projections called cilia that line the inside of the trachea and help move foreign particles up and out of the airway.
The function of the trachea is to be the main passageway for air to pass from the upper respiratory tract to the lungs. As air flows into the trachea during inhalation, it is warmed and moisturized before entering the lungs.
The U-shaped sections of cartilage that line the trachea are flexible and can close and open a little as thetrachealismuscle at the back of the rings contracts and relaxes. These small contractions of the trachea occur involuntarily as part of normal breathing (respiration).
If any object, liquid, or irritant (like smoke) gets into the trachea, the muscles can contract violently, causing coughing to bring up the substance and get it out of the windpipe.
These contractions can also be done on purpose, such as withcontrolled coughingto clear the airways of people with conditions likechronic obstructive pulmonary disease(COPD) orcystic fibrosis.
How to Tell What a Cough Means
What Conditions Affect the Trachea?
The trachea is vulnerable to any substances that are breathed in that can damage tissue and affect breathing. Certain infections and diseases can also affect the trachea.
Symptoms of Trachea Problems
Many people with tracheal conditions do not have any symptoms. That said, some of the common signs and symptoms that can point to a problem with the trachea include:
Having trouble breathing or swallowing is always a reason to see your provider. If these symptoms are severe, go to urgent care or the emergency room.
Common Causes of Throat Pain
Choking
Coughing is the body’s way of removing foreign substances from the throat, trachea, or lungs. If an object cannot be expelled from the trachea, a person can choke.
Severe choking can prevent oxygen from getting into the lungs, which may lead tosyncope(fainting), asphyxiation (suffocation), or death.
Emergency care like the Heimlich maneuver or atracheostomymight be needed to clear out the trachea so a person can breathe. Non-life-threatening blockages can be treated withbronchoscopy, a procedure that uses a flexible scope that goes down the throat to find and remove foreign objects.
Treatment and Prevention of Choking
Tracheitis
Tracheitisis inflammation of the trachea. It occurs almost always only in children. It is usually linked to abacterial infectionthat has spread from the upper respiratory tract.
Tracheitis can be dangerous for babies and young children because any inflammation of their small windpipes can lead to a blockage and, in some cases, the inability to breathe.
Croup (laryngotracheobronchitis) is an inflammatory, infectious illness that can lead to airway blockages in children.
Bacterial tracheitis is usually treated with antibiotics. Severe cases may need intravenous antibiotics as well as intubation andmechanical ventilation to help with breathing.
What Is an Upper Respiratory Infection?
Tracheoesophageal Fistula
Atracheoesophageal fistulais an abnormal passageway between the trachea and the esophagus that lets swallowed food get inside the trachea and the lungs.
A fistula can lead to choking, gagging, trouble breathing, and bluish skin due to the lack of oxygen (cyanosis). A complication isaspiration pneumonia.
A transesophageal fistula is rare but can happen from trauma, cancer, or a congenital defect that causes the incomplete formation of the esophagus (esophageal atresia).
Roughly one of every 4,000 children in the United States is born with a tracheoesophageal fistula. In most cases, it can be treated with surgery.
Is it Tracheitis or Croup?
Tracheal Stenosis
If the trachea is damaged, scars can form and make the airway narrow (tracheal stenosis).
Tracheal stenosis can cause stridor and shortness of breath (dyspnea), especially with physical activity (exertion).
Causes of tracheal stenosis include:
Between 1% and 2% of people who have intubation and mechanical ventilation will get tracheal stenosis. People who need prolonged ventilation are at the highest risk for it.
Stenosis can be treated with stents and tracheal dilation. In severe cases, surgery is needed to fix it.
Tracheomalacia
Tracheomalaciais an uncommon condition where the trachea collapses on itself during breathing and coughing.
It often happens after prolonged intubation and can be a complication of COPD (since there is progressive wearing down of the tracheal cartilage from chronic inflammation and coughing).
Tracheomalacia can also affect babies if they are born with weakness of tracheal cartilage (congenital). Symptoms include stridor, rattling breath sounds, and cyanosis.
Anatomy of the Lungs
Tracheal Cancer
Tumors that are not cancer (benign)—likechondromasandpapillomas—can also form in the trachea. Though they are benign, the tumors can block the airway and affect breathing, as well as trigger stenosis.
The surgical removal of a tracheal tumor is the preferred method of treatment (with or without radiation therapy). Some people with tracheal cancer can be treated with radiation alone. Chemotherapy with radiation often is used if a tumor cannot be taken out.
Signs of Throat Cancer
Treatment and Rehabilitation
Injuries, infections, and diseases of the trachea can cause damage to the airway, and it can’t always be fixed or healed. Tracheal stenosis is one example. In this case, the scars that form are usually permanent. Once the cause of a tracheal injury is treated, efforts can be made to repair the trachea or at least support its function.
Chest Physical Therapy
Chest percussion, vibration/oscillation, deep breathing, and controlled coughing are examples of techniques that can be used. A humidifier and continuous positive airway pressure (CPAP) device might also be recommended.
CPT is sometimes recommended for adults with tracheomalacia or chronic airway obstruction or restriction. Regular exercise, 20 to 30 minutes five times weekly, can also help.
How Wheezing Is Treated
Tracheal Dilation and Stent Placement
In some cases of tracheal stenosis, a flexible, tube-like instrument called abougienagecan be put into the trachea during a bronchoscopy and expanded with a balloon to open up (dilate) the airway. A rigid silicone or metal sleeve (stent) is then put in to hold the trachea open.
Tracheal dilation and stent placement are typically only used when surgery is not possible. Most procedures can be done on an outpatient basis and only require a short-acting anesthetic like propofol.
Ablation Therapy
Ablative techniques include laser therapy (using a narrow beam of light),electrocautery(using electricity),cryotherapy(using cold),brachytherapy(using radiation), and argon plasma (using argon gas).
Ablation therapies usually can be done on an outpatient basis with a mild, short-acting sedative and tend to be successful. However, possible side effects include pain, cough, and infection.
Treatments for Chronic Sore Throat
Fistula Repair
Tracheoesophageal fistulas almost always need to be fixed with surgery to close the hole between the trachea and the esophagus. Although tracheal stenting is sometimes used to plug the gap, a stent can slip and would need repositioning or replacement.
Surgery is a more permanent solution.Once the hole is repaired with sutures, a full-thickness skin graft or muscle graft can be added to prevent the fistula from opening up again.
The rate of complications after fistula repair surgery is high—between 32% and 56%. Pneumonia, airway obstruction, wound infection, and reopening of the fistula are the most common complications.
Emergency Airway Management
Tracheal Resection
Tracheal resection and reconstruction (TRR) is an open surgical procedure used to remove tracheal tumors and treat severe post-intubation stenosis or fistulas.
This procedure involves the removal of a section of the airway, the cut ends of which are then stitched together with sutures. Reconstruction involves the placement of a small piece of cartilage (taken from another part of the body) to rebuild the trachea and keep it well-supported.
TRR is considered major surgery and typically requires two to three weeks of recovery. Complications include post-operative stenosis or fistula as well asvocal cord dysfunction.
Tracheal Reconstruction
Techniques such as the Maddern procedure and the REACHER technique are sometimes used to treat stenosis in the upper part of the trachea near the larynx.
These procedures involve removing diseased tissue and putting in a full-thickness skin graft from the thigh.
You may need to find a specialist ENT-otolaryngologist who can use these techniques to treat the condition if they are recommended for your condition.
Why Is Intubation Done?
Tracheostomy
Tracheostomyandtracheotomyare surgical procedures where a breathing tube is put into the trachea through an incision in the throat.
These procedures are also used when intubation through the nose or mouth is not possible or when long-term ventilator support is needed.
What to Expect With a Tracheostomy
The main function of the trachea is to bring air to your lungs. There are many conditions that can affect the trachea. These disorders don’t always cause symptoms, but people may have breathing trouble or difficulty swallowing if there is something wrong with their trachea. Diagnosing tracheal disorders usually requires seeing a provider who specializes in them and can recommend the best treatment.
20 SourcesVerywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.Furlow P, Mathisen D.Surgical anatomy of the trachea.Annals Cardiothoracic Surgery.2018;7(2):255-60. doi:10.21037/acs.2018.03.01Widdicombe JH.Early studies of airway submucosal glands.Am J Physiol Lung Cell Mol Physiol. 2019;316(6):L990-L998. doi:10.1152/ajplung.00068.2019Trivedi A, Hasina Outtz Reed.The lymphatic vasculature in lung function and respiratory disease.Frontiers in Medicine. 2023;10. doi:https://doi.org/10.3389/fmed.2023.1118583Loyola University Chicago.Cough reflex.University of Michigan.Tracheal disease.Nationwide Children’s.Choking and suffocation.Kuo CY, Parikh SJ.Bacterial tracheitis.Pediatric Rev. 2014 Nov:35(11):497-9. doi:10.1542/pir.35-11-497American Pediatric Surgical Association.Esophageal atresia and tracheo-esophageal fistula (EA and TEF).Motus I, Nadezhda G.Tracheal stenosis: Prevention and treatment.Eur Respir J.2013;42 (Suppl_7):P4955.Liu J, Zhang CP, Li Y, Dong S.Post-intubation tracheal stenosis after management of complicated aortic dissection: a case series.J Cardiothorac Surg. 2015;10:148. doi:10.1186/s13019-015-0357-zMount Sinai.Tracheal stenosis.Kerolus G, Ikladios O.Tracheomalacia and recurrent exacerbations of chronic obstructive pulmonary disease: a case report and review of the literature.J Community Hosp Intern Med Perspect. 2016;6(6):33540. doi:10.3402/jchimp.v6.33540Kurada S, Karthikeyan RB, Vakamudi M, Thangavelu P.Management of tracheomalacia in an infant with Tetralogy of Fallot.Indian J Anaesth. 2015;59(4):240-3. doi:10.4103/0019-5049.155002Napieralska A, Miszczyk L, Blamek S.Tracheal cancer - treatment results, prognostic factors and incidence of other neoplasms.Radiol Oncol. 2016;50(4):409-17. doi:10.1515/raon-2016-0046López-Padilla D, García-Luján R, Puente Maestu L, De Miguel Poch E.Tracheobronchomalacia treatment: How far have we come?.J Thorac Dis.2016;8(12):3490-3. doi:10.21037/jtd.2016.12.91Bacon JL, Patterson CM, Madden BP.Indications and interventional options for non-resectable tracheal stenosis.J Thorac Dis. 2014;6(3):258-70. doi:10.3978/j.issn.2072-1439.2013.11.08Bibas BJ, Cardoso PFG, Minamoto H, Pêgo-Fernandes PM.Surgery for intrathoracic tracheoesophageal and bronchoesophageal fistula.Ann Transl Med. 2018;6(11):210. doi:10.21037/atm.2018.05.25Auchincloss HG, Wright CD.Complications after tracheal resection and reconstruction: prevention and treatment.J Thorac Dis. 2016;8(Suppl 2):S160-S167. doi:10.3978/j.issn.2072-1439.2016.01.86Daniero JJ, Ekbom DC, Gelbard A, Akst LM, Hillel AT.Inaugural symposium on advanced surgical techniques in adult airway reconstruction: Proceedings of the North American Airway Collaborative (NoAAC).JAMA Otolaryngol Head Neck Surg. 2017;143(6):609-13. doi:10.1001/jamaoto.2016.4126Cheung NH, Napolitano LM.Tracheostomy: Epidemiology, indications, timing, technique, and outcomes.Respir Care.2014;59(6):895-915. doi:10.4187/respcare.02971
20 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.Furlow P, Mathisen D.Surgical anatomy of the trachea.Annals Cardiothoracic Surgery.2018;7(2):255-60. doi:10.21037/acs.2018.03.01Widdicombe JH.Early studies of airway submucosal glands.Am J Physiol Lung Cell Mol Physiol. 2019;316(6):L990-L998. doi:10.1152/ajplung.00068.2019Trivedi A, Hasina Outtz Reed.The lymphatic vasculature in lung function and respiratory disease.Frontiers in Medicine. 2023;10. doi:https://doi.org/10.3389/fmed.2023.1118583Loyola University Chicago.Cough reflex.University of Michigan.Tracheal disease.Nationwide Children’s.Choking and suffocation.Kuo CY, Parikh SJ.Bacterial tracheitis.Pediatric Rev. 2014 Nov:35(11):497-9. doi:10.1542/pir.35-11-497American Pediatric Surgical Association.Esophageal atresia and tracheo-esophageal fistula (EA and TEF).Motus I, Nadezhda G.Tracheal stenosis: Prevention and treatment.Eur Respir J.2013;42 (Suppl_7):P4955.Liu J, Zhang CP, Li Y, Dong S.Post-intubation tracheal stenosis after management of complicated aortic dissection: a case series.J Cardiothorac Surg. 2015;10:148. doi:10.1186/s13019-015-0357-zMount Sinai.Tracheal stenosis.Kerolus G, Ikladios O.Tracheomalacia and recurrent exacerbations of chronic obstructive pulmonary disease: a case report and review of the literature.J Community Hosp Intern Med Perspect. 2016;6(6):33540. doi:10.3402/jchimp.v6.33540Kurada S, Karthikeyan RB, Vakamudi M, Thangavelu P.Management of tracheomalacia in an infant with Tetralogy of Fallot.Indian J Anaesth. 2015;59(4):240-3. doi:10.4103/0019-5049.155002Napieralska A, Miszczyk L, Blamek S.Tracheal cancer - treatment results, prognostic factors and incidence of other neoplasms.Radiol Oncol. 2016;50(4):409-17. doi:10.1515/raon-2016-0046López-Padilla D, García-Luján R, Puente Maestu L, De Miguel Poch E.Tracheobronchomalacia treatment: How far have we come?.J Thorac Dis.2016;8(12):3490-3. doi:10.21037/jtd.2016.12.91Bacon JL, Patterson CM, Madden BP.Indications and interventional options for non-resectable tracheal stenosis.J Thorac Dis. 2014;6(3):258-70. doi:10.3978/j.issn.2072-1439.2013.11.08Bibas BJ, Cardoso PFG, Minamoto H, Pêgo-Fernandes PM.Surgery for intrathoracic tracheoesophageal and bronchoesophageal fistula.Ann Transl Med. 2018;6(11):210. doi:10.21037/atm.2018.05.25Auchincloss HG, Wright CD.Complications after tracheal resection and reconstruction: prevention and treatment.J Thorac Dis. 2016;8(Suppl 2):S160-S167. doi:10.3978/j.issn.2072-1439.2016.01.86Daniero JJ, Ekbom DC, Gelbard A, Akst LM, Hillel AT.Inaugural symposium on advanced surgical techniques in adult airway reconstruction: Proceedings of the North American Airway Collaborative (NoAAC).JAMA Otolaryngol Head Neck Surg. 2017;143(6):609-13. doi:10.1001/jamaoto.2016.4126Cheung NH, Napolitano LM.Tracheostomy: Epidemiology, indications, timing, technique, and outcomes.Respir Care.2014;59(6):895-915. doi:10.4187/respcare.02971
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
Furlow P, Mathisen D.Surgical anatomy of the trachea.Annals Cardiothoracic Surgery.2018;7(2):255-60. doi:10.21037/acs.2018.03.01Widdicombe JH.Early studies of airway submucosal glands.Am J Physiol Lung Cell Mol Physiol. 2019;316(6):L990-L998. doi:10.1152/ajplung.00068.2019Trivedi A, Hasina Outtz Reed.The lymphatic vasculature in lung function and respiratory disease.Frontiers in Medicine. 2023;10. doi:https://doi.org/10.3389/fmed.2023.1118583Loyola University Chicago.Cough reflex.University of Michigan.Tracheal disease.Nationwide Children’s.Choking and suffocation.Kuo CY, Parikh SJ.Bacterial tracheitis.Pediatric Rev. 2014 Nov:35(11):497-9. doi:10.1542/pir.35-11-497American Pediatric Surgical Association.Esophageal atresia and tracheo-esophageal fistula (EA and TEF).Motus I, Nadezhda G.Tracheal stenosis: Prevention and treatment.Eur Respir J.2013;42 (Suppl_7):P4955.Liu J, Zhang CP, Li Y, Dong S.Post-intubation tracheal stenosis after management of complicated aortic dissection: a case series.J Cardiothorac Surg. 2015;10:148. doi:10.1186/s13019-015-0357-zMount Sinai.Tracheal stenosis.Kerolus G, Ikladios O.Tracheomalacia and recurrent exacerbations of chronic obstructive pulmonary disease: a case report and review of the literature.J Community Hosp Intern Med Perspect. 2016;6(6):33540. doi:10.3402/jchimp.v6.33540Kurada S, Karthikeyan RB, Vakamudi M, Thangavelu P.Management of tracheomalacia in an infant with Tetralogy of Fallot.Indian J Anaesth. 2015;59(4):240-3. doi:10.4103/0019-5049.155002Napieralska A, Miszczyk L, Blamek S.Tracheal cancer - treatment results, prognostic factors and incidence of other neoplasms.Radiol Oncol. 2016;50(4):409-17. doi:10.1515/raon-2016-0046López-Padilla D, García-Luján R, Puente Maestu L, De Miguel Poch E.Tracheobronchomalacia treatment: How far have we come?.J Thorac Dis.2016;8(12):3490-3. doi:10.21037/jtd.2016.12.91Bacon JL, Patterson CM, Madden BP.Indications and interventional options for non-resectable tracheal stenosis.J Thorac Dis. 2014;6(3):258-70. doi:10.3978/j.issn.2072-1439.2013.11.08Bibas BJ, Cardoso PFG, Minamoto H, Pêgo-Fernandes PM.Surgery for intrathoracic tracheoesophageal and bronchoesophageal fistula.Ann Transl Med. 2018;6(11):210. doi:10.21037/atm.2018.05.25Auchincloss HG, Wright CD.Complications after tracheal resection and reconstruction: prevention and treatment.J Thorac Dis. 2016;8(Suppl 2):S160-S167. doi:10.3978/j.issn.2072-1439.2016.01.86Daniero JJ, Ekbom DC, Gelbard A, Akst LM, Hillel AT.Inaugural symposium on advanced surgical techniques in adult airway reconstruction: Proceedings of the North American Airway Collaborative (NoAAC).JAMA Otolaryngol Head Neck Surg. 2017;143(6):609-13. doi:10.1001/jamaoto.2016.4126Cheung NH, Napolitano LM.Tracheostomy: Epidemiology, indications, timing, technique, and outcomes.Respir Care.2014;59(6):895-915. doi:10.4187/respcare.02971
Furlow P, Mathisen D.Surgical anatomy of the trachea.Annals Cardiothoracic Surgery.2018;7(2):255-60. doi:10.21037/acs.2018.03.01
Widdicombe JH.Early studies of airway submucosal glands.Am J Physiol Lung Cell Mol Physiol. 2019;316(6):L990-L998. doi:10.1152/ajplung.00068.2019
Trivedi A, Hasina Outtz Reed.The lymphatic vasculature in lung function and respiratory disease.Frontiers in Medicine. 2023;10. doi:https://doi.org/10.3389/fmed.2023.1118583
Loyola University Chicago.Cough reflex.
University of Michigan.Tracheal disease.
Nationwide Children’s.Choking and suffocation.
Kuo CY, Parikh SJ.Bacterial tracheitis.Pediatric Rev. 2014 Nov:35(11):497-9. doi:10.1542/pir.35-11-497
American Pediatric Surgical Association.Esophageal atresia and tracheo-esophageal fistula (EA and TEF).
Motus I, Nadezhda G.Tracheal stenosis: Prevention and treatment.Eur Respir J.2013;42 (Suppl_7):P4955.
Liu J, Zhang CP, Li Y, Dong S.Post-intubation tracheal stenosis after management of complicated aortic dissection: a case series.J Cardiothorac Surg. 2015;10:148. doi:10.1186/s13019-015-0357-z
Mount Sinai.Tracheal stenosis.
Kerolus G, Ikladios O.Tracheomalacia and recurrent exacerbations of chronic obstructive pulmonary disease: a case report and review of the literature.J Community Hosp Intern Med Perspect. 2016;6(6):33540. doi:10.3402/jchimp.v6.33540
Kurada S, Karthikeyan RB, Vakamudi M, Thangavelu P.Management of tracheomalacia in an infant with Tetralogy of Fallot.Indian J Anaesth. 2015;59(4):240-3. doi:10.4103/0019-5049.155002
Napieralska A, Miszczyk L, Blamek S.Tracheal cancer - treatment results, prognostic factors and incidence of other neoplasms.Radiol Oncol. 2016;50(4):409-17. doi:10.1515/raon-2016-0046
López-Padilla D, García-Luján R, Puente Maestu L, De Miguel Poch E.Tracheobronchomalacia treatment: How far have we come?.J Thorac Dis.2016;8(12):3490-3. doi:10.21037/jtd.2016.12.91
Bacon JL, Patterson CM, Madden BP.Indications and interventional options for non-resectable tracheal stenosis.J Thorac Dis. 2014;6(3):258-70. doi:10.3978/j.issn.2072-1439.2013.11.08
Bibas BJ, Cardoso PFG, Minamoto H, Pêgo-Fernandes PM.Surgery for intrathoracic tracheoesophageal and bronchoesophageal fistula.Ann Transl Med. 2018;6(11):210. doi:10.21037/atm.2018.05.25
Auchincloss HG, Wright CD.Complications after tracheal resection and reconstruction: prevention and treatment.J Thorac Dis. 2016;8(Suppl 2):S160-S167. doi:10.3978/j.issn.2072-1439.2016.01.86
Daniero JJ, Ekbom DC, Gelbard A, Akst LM, Hillel AT.Inaugural symposium on advanced surgical techniques in adult airway reconstruction: Proceedings of the North American Airway Collaborative (NoAAC).JAMA Otolaryngol Head Neck Surg. 2017;143(6):609-13. doi:10.1001/jamaoto.2016.4126
Cheung NH, Napolitano LM.Tracheostomy: Epidemiology, indications, timing, technique, and outcomes.Respir Care.2014;59(6):895-915. doi:10.4187/respcare.02971
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