Dilatational Tracheotomy in Head and Neck Surgery

Abstract

The pre- and postoperative airway management during surgery of head and neck cancer is a clinically relevant and challenging task. Usually an epithelialised tracheostomy is used. The significance of percutaneous dilatational tracheostomy (PDT) in combination with tumour surgery of the head neck area has not yet been fully considered. Within a surgical therapy of head neck tumours, 58 patients were treated with a PDT by Ciaglia or Fantoni at the Department of Otorhinolaryngology, Head and Neck Surgery, Martin-Luther-University Halle during the period from December 2002 to October 2007. The patient data were retrospective analyzed in a pseudonymous way. In a follow-up examination the resulting conditions of the PDT were reviewed. The median of the length of time till decannulation was 12 days. There were no documented disorders or complications after PDT at 25 patients (43%). As serious complications pneumothorax in 2 patients (3,4%), 9 bleedings (15,5%) and 1 infection (1,7%) were recorded. After occurrence of tracheostomy metastases in 2 patients with tracheostomy by Fantoni, this method was no longer used. For the subsequent follow-up examination 33 patients were included. No tracheal stenosis or serious long term complications were determined. Under consideration of the indications and contraindications, the percutaneous dilatational tracheostomy by Ciaglia with associated bronchoscopy is a safe method with low complication rate for the airway management of patients with head neck cancer. Long term complications and disorders after PDT are not to be expected. Tracheotomy according to Fantoni cannot be recommended for this treatment.