Abstract
Objectives: This article describes how to make a customized tracheostomy tube immediately in the operating room setting. This is particularly critical when a commercial customized tracheostomy tube cannot be readily obtained. Study Design: Case presentation. Methods/Results: A 73-year-old female was seen in our clinic for management of a recurrent invasive paraganglioma of the thyroid. She underwent a total laryngopharyngectomy, cervical esophagectomy, and anterolateral thigh free flap reconstruction followed by post-operative radiation. In follow-up, the patient presented with dyspnea related to two areas of stenosis, one at the level of her stoma and one at the distal trachea. The patient was therefore taken to the operating room urgently for dilation and placement of a tracheostomy tube. Available tracheostomy tubes were tried and ill fitting as each tube narrowed the patient’s stoma or abutted her distal granulation tissue. To custom create a tracheostomy tube, we used a standard rib shearer to shorten a #6 uncuffed tracheostomy tube by 2 cm. The edges were further smoothed and beveled using sand paper and a diamond burr drill. The finished product was a wide diameter tube with a custom length suited to our patient. Conclusions: Although a simple solution, the use of a rib shearer provides a quick and feasible solution to creating custom length tracheostomy tubes in situations where custom length tubes are needed yet unavailable.
Highlights
Tracheotomies are amongst the most common neck procedures performed and essential for long-term airway management
She underwent a total laryngopharyngectomy, cervical esophagectomy, and anterolateral thigh free flap reconstruction followed by post-operative radiation
The patient was taken to the operating room urgently for dilation and placement of a tracheostomy tube
Summary
Tracheotomies are amongst the most common neck procedures performed and essential for long-term airway management. Often straight forward, the procedure can be made technically difficult in short statured, short necked, or obese patients [1]. In such patients, unfavorable anatomy can include exaggerated curvature of the spine, elongated depth from skin to trachea, lateral curvature of the trachea, or a short cricoid to sternal distance [2,3]. Unfavorable anatomy can include exaggerated curvature of the spine, elongated depth from skin to trachea, lateral curvature of the trachea, or a short cricoid to sternal distance [2,3] These anatomical differences often make standard tracheostomy tubes unsuitable. We present a simple yet effective technique to modify standard cuffless tracheostomy tubes immediately in the operating room setting
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