A clinical study of 13 cases with cricoid cartilage fenestration

Abstract

Tracheostomy, the most common way of creating a surgical airway, is sometimes difficult to perform and manage in high-risk cases, such as in patients with severe obesity, short neck, and long-term cannula management Several concerns regarding intraoperative and postoperative complications have been raised in such cases. In 2007, Kano et al. reported a new technique called cricoid cartilage fenestration (CCFn), and it has been confirmed to be a useful option for high-risk cases of tracheostomy. In our department, CCFn was performed in 13 patients between December 2020 and December 2021. Regarding these cases, post-resuscitation encephalopathy was observed in 7/13 (54%), cerebral hemorrhaging (including brainstem hemorrhaging) in 2/13 (15%), spinal cord infarction in 2/13 (15%), and other issues in 2/13 (15%). Obesity with a body mass index greater than 30 was observed in 4/13 (31%), and 5/13 (38%) were on anticoagulants. No patients had any complications or difficulties of insertion or had the tube fall out. Ventilator withdrawal was possible in 8/13 (62%). One of the two patients with spinal cord infarction was conscious and able to speak; however, they had upper limb motor dysfunction and difficulty speaking due to manual closure of the stoma. While CCFn is a safe technique in a difficult airway setting, it should be performed with caution in patients with upper limb motor dysfunction.