Abstract
Surgical tracheotomy techniques are classified into tracheotomy and tracheal fenestration, according to the method of suturing the tracheal wall to the margin of the skin incision. In tracheotomy technique, the inferior based tracheal flap is sutured to the inferior margin of the skin incision using only several stitches, or the tracheostoma is not sutured to the margin of the skin incision. In tracheal fenestration technique, the tracheostoma is sutured to the margin of the skin incision to create a circumferential mucocutaneous junction. The former is performed to achieve relatively short-term airway management. The latter is performed to achieve long-term airway management, with risk of accidental decannulation, etc. We investigated 79 cases who had undergone surgical tracheotomy at the Department of Otorhinolaryngology, Tracheo-esophagology, International Medical Center of Japan from Feb. 2002 to Aug. 2007. In 24 cases, the patients underwent tracheotomy, and 55 patients underwent tracheal fenestration. There were 52 males and 27 females, and their mean age was 57 years (range : 1-89). The most common indication was bilateral vocal cord paralysis in the tracheotomy group, and long-term endotracheal intubation in the tracheal fenestration group. The mean operation time for tracheotomy was 35 minutes and for tracheal fenestration 42 minutes. Patients required airway management by tracheostoma during more than 1 month in 72.2%of the tracheotomy group, and in 100%of the tracheal fenestration group. We found low rates for both early and late complications when comparing tracheal fenestration to tracheotomy.
We conclude that if long-term airway management by tracheostoma will be necessary, we should choose the tracheal fenestration technique.
