Use of cricothyroidostomy in oral and maxillofacial surgery

Tracheostomy in the ICU

The placement of a tracheostomy has become a routine procedure for intensive care unit patients who are mechanical ventilator dependent for a period of time, usually exceeding 1 or 2 weeks. It is vital for the intensivist to be familiar with all aspects of tracheostomies care including the timing of converting a patient to a tracheostomy, types of procedure, risks and benefits, and issues of daily care including oral feedings, speech, and decannulation. In this article we provide a comprehensive review for the intensivist regarding tracheostomies in the intensive care setting. We specifically review indications, timing, surgical options including percutaneous dilation tracheostomy, complications, decannulation, oral feeding, speaking devises, stomal stents, and routine tracheostomy care.

Maxillofacial and neck trauma: a damage control approach

Severe maxillofacial and neck trauma exposes patients to life threatening complications such as airway compromise and hemorrhagic shock. These conditions require rapid actions (diagnosis and management) and a strong interplay between surgeons and anesthesiologists. Effective airway management often makes the difference between life and death in severe maxillofacial and neck trauma and takes initial precedence over all other clinical considerations. Damage control strategies focus on physiological and biochemical stabilization prior to the comprehensive anatomical and functional repair of all injuries. Damage control surgery (DCS) can be defined as the rapid initial control of hemorrhage and contamination, temporary wound closure, resuscitation to normal physiology in the intensive care unit (ICU) and subsequent reexploration and definitive repair following restoration of normal physiology. Damage control resuscitation (DCR) consists mainly of hypotensive (permissive hypotension) and hemostatic (minimal use of crystalloid fluids and utilization of blood and blood products) resuscitation. Both strategies should be administered simultaneously in all of these patients.

Elective use of surgical cricothyroidotomy for maxillofacial fracture fixation with contraindication of nasotracheal intubation: a case report

We report three cases of airway management with elective surgical cricothyroidotomy (SCT) for anesthetic management during surgical repair of maxillofacial injury involving basal skull fracture or nasal-bone fracture. In all patients, general anesthesia was induced, a supraglottic airway (SGA) device inserted, and SCT performed. Tracheal intubation was performed through SCT site, and the SGA device was removed. After surgery of maxillofacial fixation, the SGA device was re-inserted and the tracheal tube was removed. No major complications, such as subglottic stenosis or voice change, occurred. SCT holds potential as an alternative to tracheostomy because of ease of performance, fewer complications, and better cosmetic outcomes.

Changing indications for tracheostomy in maxillofacial trauma

PURPOSE

Tracheostomy is one of the most common surgical procedures, but not always without complications. The purpose of this article was to reevaluate the indications of maintaining the airway with the use of tracheostomy.

MATERIALS AND METHODS

A total of 399 patients with maxillofacial trauma, who were treated in the Maxillofacial Surgery Department from 1985 to 1992, were evaluated for the type of fracture and air-way problems.

RESULTS

Out of the 399 patients evaluated, 13 needed a tracheostomy. Of these, 6 had had a cricothyroidotomy on arrival, 3 required tracheostomy because of impending airway obstruction, 3 because of respiratory distress, and 1 due to difficulty in intubation.

CONCLUSIONS

The results of this study indicated that surgically securing the airway by tracheostomy should be revised compared to other available methods. In the era of rigid fixation of fractures and the possibility of leaving the patient with an open mouth, it is unnecessary to carry out tracheostomy for securing the airway as frequently as in the past.

Cricothyroidotomy, a useful alternative to tracheostomy in maxillofacial surgery

Tracheostomy and prolonged intubation are traditionally used in maintaining the airway, particularly after extensive maxillofacial surgery. The literature reports significant morbidity and mortality from both these procedures. Cricothyroidotomy is proposed as a useful alternative in certain circumstances. Recent documentation suggests that traditional fears of subglottic stenosis after cricothyroidotomy are ill-founded. Cricothyroidotomy may also benefit the patient by quicker rehabilitation and in early mobilisation, compared with prolonged intubation. The surgical procedure is quick and easily performed, making it suitable for emergency airway control. Cricothyroidotomy is not appropriate in children or in patients with inflammation to the trachea, since these may predispose to subglottic stenosis.