An innovative approach to tracheotomy in patients with major obstruction of the upper airway

BackgroundPatients with severe dyspnea consecutive to locally advanced obstructive head and neck squamous cell carcinoma (HNSCC) or subglottic stenosis requiring definitive or temporary tracheotomy are frequently difficult to ventilate and intubate.Materials and MethodsWe describe a new procedure to perform tracheotomy easily and safely in patients with major obstruction of the upper airway. A catheter, specifically designed for cricothyroidotomy, was inserted into the trachea under local anesthesia. Then, general anesthesia was induced and the catheter was used as a guide for dilatation tracheotomy. From November 2009 to March 2013, the procedure was successfully used in 13 consecutive patients. Twelve out of 13 patients presented severe inspiratory dyspnea and stridor.ResultsDuring and after the procedure, no complications were reported.ConclusionsThe reported technique is quickly performed and is a safe way to ensure short and long time ventilation of patients with major obstruction of the upper airway.