Tracheal Closure: Causes of Airway Narrowing and Obstruction

The trachea's C-shaped cartilaginous rings normally maintain patency. Functional or structural narrowing arises in specific pathologies:

1. Laryngospasm

Reflex adduction of true vocal folds (vagus nerve mediated) causing complete glottic closure. Triggers: laryngopharyngeal reflux, intubation/extubation, secretions, anesthesia emergence, panic. Treatment: Larson's maneuver (firm pressure at laryngospasm notch), deepening anesthesia, succinylcholine as last resort.

2. Tracheal Stenosis

• Acquired: Post-intubation ischemia→fibrosis, tracheostomy, trauma, TB, granulomatosis with polyangiitis (GPA), sarcoidosis.
• Congenital: Complete tracheal rings, vascular rings.
• Presentation: Inspiratory/expiratory stridor, exertional dyspnea, recurrent pneumonias.
• Treatment: Endoscopic dilation, laser resection, stenting, segmental resection/anastomosis (slide tracheoplasty for long-segment).

3. Tracheomalacia

• Dynamic airway collapse (>50% cross-sectional area loss on expiration) from cartilage softening.
• Primary (congenital): Immature cartilage; often improves by age 2–3.
• Secondary (acquired): Chronic compression (vascular ring, goiter, tumor), chronic inflammation (tracheostomy, intubation), COPD, aging.
• Treatment: CPAP, stenting, aortopexy, tracheopexy, resection.

4. External Compression

Thyroid goiter, mediastinal mass, aortic aneurysm, aberrant innominate artery.

Any acute airway obstruction is a medical emergency. Secure airway (intubation, tracheostomy, cricothyrotomy) → definitive treatment.