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The middle and posterior mediastinal compartments are separated by the line connecting a point on each thoracic vertebra about a centimeter behind its anterior margin (Fig. 16 Conditions that can be found in each of the compartments of the mediastinum are logically based on the anatomic structures found within the compartments. For example, tracheal, esophageal, and thyroid lesions would lie in the middle mediastinum. Neurogenic tumors and spinal problems would be in the posterior mediastinum. Cardiac and thymic lesions would occupy the anterior mediastinum.
21 Nonfusion of the anterior and/or the posterior arch exists as a normal variant in adults and should not be mistaken as fractures (Fig. 2-1). The second cervical vertebra, the axis (C2), is the largest and heaviest cervical segment. The odontoid process (dens) serves as the conceptual body of C1, around which the atlas rotates and bends laterally. In contrast to the other cervical vertebrae, C2 does not have a discrete pedicle. Figure 2-1 Nonfused anterior and posterior arches of C1, normal variant.
6 Important to rigid laryngoscopy and endotracheal intubation is the distance between the occiput and the posterior tubercle of C1, the atlanto-occipital distance (Fig. 2-6A and 6B), which is quite variable from individual to individual. Head extension is limited by the abutment of the occiput to the posterior tubercle of C1. 6,31 Occipitalization of C1 with the occiput not only limits head extension but also adds stress to the atlantoaxial joint. 31 Of note is the distinction made between the maneuver of general hyperextension of the head and neck and flexing the neck, then extending the head and neck, at the atlanto-occipital joint to improve the alignment of the airway structures and thus ease of intubation.