Alternatives to surgical tracheostomy: A critical review

Abstract

Surgical tracheostomy (ST) is the oldest life-saving procedure in records, usually done by otolaryngologists and occasionally by general surgeons, thoracic surgeons, and neurosurgeons. It has been an important surgical skill for any given otolaryngology training program. On the contrary, retromolar, submental, submandibular endotracheal intubations, and their modifications are carried out by oral surgeons, maxillofacial surgeons, skull base surgeons, and plastic surgeons and are considered alternative to ST. Despite none are done in an emergency situation, it is suggested to be less invasive, simple, safe, with less surgical time, nearly unknown complications, has unsightly scar and cheaper in comparison to ST. It is thought that these techniques provide free surgical access in cases where oral and nasal intubations are often not suitable and require intermittent intraoperative dental occlusion to check alignment of fractured fragments. In the current report, PubMed has been reviewed for the reasons, indications, complications, techniques, and modifications of the above mentioned ST alternatives. The article critically discusses the surgical part of these innovative procedures and concludes that ST, in spite of its risks, remains the procedure of choice for surgical airway access when long-term intubation is not anticipated, especially in emergencies and difficult airways. A regular workshop of this highly in demand surgical skill is suggested.