Clinical review of patients undergoing cricotracheostomy

Abstract

Tracheostomy for patients with low lying larynx, obesity, or brevicollis is sometimes difficult to perform because of limitations of the surgical view and troublesome postoperative management. Cricotracheostomy is useful for such patients in spite of the partial removal of the cricoid cartilarge. We reviewed 14 cases of cricotracheostomy that were performed at our department and examined the effectiveness of the procedure.

Overall, 10 of 14 patients presented with low lying larynx, obesity, and brevicollis; however, there were no major complications, such as reinsertion difficulty and subcutaneous migration of the cannula. Moreover, 5 of 14 patients underwent long-term intubation for pneumonia associated with coronavirus 2019 (COVID-19). To shorten the time from fenestration to cannula placement, we developed an inverted U-shaped fenestration procedure. In 2 of 14 patients, surgery was performed under local anesthesia owing to upper airway obstruction caused by a tumor. Notably, cricotracheostomy was considered a safe procedure as the cricothyroid membrane and operative field are adjacent; moreover, if asphyxiation were to occur during surgery, the procedure could be changed to cricothyroidotomy. In 4 of 14 patients, the stoma was closed. Follow-up examination at 6 months after closure revealed no complications, such as airway stenosis.

Cricotracheostomy is a safe procedure for patients with low lying larynx, obesity, and brevicollis. Furthermore, this procedure can be used for long-term intubation in patients with COVID-19 pneumonia, under local anesthesia, and in cases where laryngeal stoma closure is possible. However, because of the possibility of long-term complications, patient selection should be performed carefully.