Abstract
AimWe aimed to investigate the potential of 3D virtual planning of tracheostomy tube placement and 3D cannula design to prevent tracheostomy complications due to inadequate cannula position.Materials and methods3D models of commercially available cannula were positioned in 3D models of the airway. In study (1), a cohort that underwent tracheostomy between 2013 and 2015 was selected (n = 26). The cannula was virtually placed in the airway in the pre-operative CT scan and its position was compared to the cannula position on post-operative CT scans. In study (2), a cohort with neuromuscular disease (n = 14) was analyzed. Virtual cannula placing was performed in CT scans and tested if problems could be anticipated. Finally (3), for a patient with Duchenne muscular dystrophy and complications of conventional tracheostomy cannula, a patient-specific cannula was 3D designed, fabricated, and placed.Results(1) The 3D planned and post-operative tracheostomy position differed significantly. (2) Three groups of patients were identified: (A) normal anatomy; (B) abnormal anatomy, commercially available cannula fits; and (C) abnormal anatomy, custom-made cannula, may be necessary. (3) The position of the custom-designed cannula was optimal and the trachea healed.ConclusionsVirtual planning of the tracheostomy did not correlate with actual cannula position. Identifying patients with abnormal airway anatomy in whom commercially available cannula cannot be optimally positioned is advantageous. Patient-specific cannula design based on 3D virtualization of the airway was beneficial in a patient with abnormal airway anatomy.
Highlights
IntroductionIn most of the cases commercially available, prefabricated tracheostomy cannulas are used to keep the tracheostomy open
Tracheostomy is a routine procedure for securing the airway
Two months after placement of the cannula, the granulation tissue healed and the cannula positioning was centered in the airway without any signs of decubitus off the trachea (Fig. 2). In this three-step study, using 3D technology, (1) we have a setup created for the 3D analysis of tracheostomy cannula and their placement, (2) we have identified cannulaspecific airway anatomy in patients with neuromuscular diseases, and (3) successfully designed, produced, and placed a 3D-planned cannula in a patients after several previous failures of custom-made cannula
Summary
In most of the cases commercially available, prefabricated tracheostomy cannulas are used to keep the tracheostomy open. These cannulas have fixed variations in size, radius, curvature, and diameter. In case of aberrant anatomy of the neck or thorax, the choice of the proper tracheostomy site with the corresponding cannula type can be challenging. In patients with abnormal anatomy of the neck and thorax, such as, e.g., patients with Duchenne muscular dystrophy, the commercially available cannulas often do not fit due to the extreme scoliosis [1]. Suboptimal cannula placement may result in inflammation of the trachea, eventually leading to granulation tissue formation, airway obstruction, or even in fatal complications [2]. Several case reports and our own experience have shown patients who had a fistula of the trachea and
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