Tracheal Placement Research Articles

Confirmation of placement of endotracheal tube - A comparative observational pilot study of three ultrasound methods.

Background and Aims:Confirmation of endotracheal tube (ETT) position is necessary to ensure proper ventilation. The present study was conducted with the aim to compare the efficacy of three ultrasonographic (USG) techniques in terms of time taken for confirmation of ETT position. The time taken by each USG technique was also compared with that for auscultation and capnography. The ability of the three USG techniques to identify tracheal placement of ETT was evaluated in all patients.Material and Methods:Ninety adult American Society of Anesthesiologists (ASA) I/II patients requiring general anaesthesia with tracheal intubation were randomised into three groups (n = 30 each) depending upon the initial USG transducer position used to confirm tracheal placement of ETT: group T (tracheal), group P (pleural) and group D (diaphragm). The time taken for confirmation of tracheal placement of ETT by USG, auscultation and capnography was recorded for each of the groups. Subsequently, USG confirmation of ETT placement was performed with the other two USG techniques in all patients.Results:The time taken for USG in group T was significantly less (3.8 ± 0.9 s) compared to group P (12.1 ± 1.6 s) and group D (13.8 ± 1.7 s); P < 0.001. USG was significantly faster than both auscultation and capnography in group T (P < 0.001), whereas in group P and group D, USG took longer time compared to auscultation (P = 0.014 and P < 0.001, respectively) but lesser time than capnography (P < 0.001 in both groups).Conclusion:USG is a rapid technique for identification of ETT placement. All the three USG techniques are reliable in identifying the tracheal placement of ETT.

Suture fixation of tracheal stents for the treatment of upper trachea stenosis: a retrospective study

BackgroundStent migration is a common complication in treating trachea stenosis. There is no report concerning suture fixation of tracheal stent. The aim of this study was to investigate whether suture fixation of tracheal stent could avoid stent migration in patients with upper trachea stenosis. The complications were further investigated.MethodsThe patients with upper trachea stenosis who underwent tracheal stent placement for benign/malignant conditions in our hospital between May 2016 and April 2018 were retrospectively reviewed. Clinical data were collected for each patient, including age, gender, co-morbid diseases, site of tracheal obstruction, degree of tracheal obstruction, success of stent placement, impact on patient’s symptoms, complications, etc.ResultsEleven patients (8 males and 3 females; range of age: 17–85, and average age of 63) were enrolled into this study. Six silicone stents and five membrane-covered metal stents were used. The surgery was successfully performed in all the cases. The postoperative recovery was uneventful. All symptoms of the patients were relieved. No complications occurred. The average follow-up for patients was 5 months (range of 1–13 months). During the follow-up, no stent migration was observed according to CT and bronchoscope.ConclusionThe results suggested that suture fixation of stents could avoid stent migration in treating upper trachea stenosis with metal stent or silicone stent. This method seemed to be effective without operation complications.

敗血症性多臓器障害治療中に気管軟化症が明らかになり気管ステント留置を行った1例(A case of tracheal stenting in a tracheomalacia patient associated with septic organ failure)

要旨気管軟化症は気管壁の脆弱性に伴う気管の呼気性狭窄であり，保存的治療に抵抗性であることが多い。今回，遷延する敗血症性多臓器障害の治療中に発覚した気管軟化症に対し，気管ステントを留置した症例を経験したので報告する。症例は，気管支喘息の既往がある76歳の女性。呼吸苦と意識障害を主訴に救急搬送された。肺炎およびCO2ナルコーシスを認め，ICUで人工呼吸管理を開始したが，薬剤治療抵抗性の呼気性喘鳴を伴う換気不良が続いた。第36病日に気管支鏡にて気管軟化症と診断し，意識障害や凝固異常を合併していたが，人工呼吸器依存状態が遷延していたため，全身麻酔下にY字シリコンステント挿入を決断した。ステント留置後は気道狭窄音が消失したが，敗血症性多臓器不全のため第78病日に死亡した。気管軟化症は気管支喘息と誤診されやすく，来院時CTでも気管横径は短縮していたため，本症例は来院前より気管軟化症を呈していた可能性が高い。気管ステントは手術に比して低侵襲であるため，敗血症性多臓器障害を来した患者にも留置できた。本症例は，喘息の既往歴やCTによる気管径短縮の所見から早期に気管軟化症を疑うべきであった。呼気時気道狭窄の原因として常に気管軟化症を鑑別にあげ，早期診断することが重要である。

Awake tracheal placement of the Tritube® under flexible bronchoscopic guidance

SummaryA 71‐year‐old male with hoarse voice was referred to our institution for panendoscopy. Previous radiotherapy for piriform fossa carcinoma resulted in a 'radiotherapy neck' and reduced neck extension. He also had a background of severe chronic obstructive pulmonary disease (COPD). In view of his anticipated difficult airway combined with airway pathology and COPD, we opted for awake tracheal placement of a novel tracheal tube, the Tritube®, and ventilation using the Evone® ventilator (Ventinova Medical B.V., Eindhoven, Netherlands). After successful awake placement of the flexible bronchoscope, the Tritube® was passed alongside, guided by a silk suture which was inserted through the lumen of the tube and then tied over the bronchoscope. Once correct placement was confirmed, the patient was successfully ventilated throughout the procedure with the Evone® ventilator. The narrow lumen of the Tritube® allowed adequate surgical access with the advantage of a definitive airway, whilst continuous ventilation was delivered. To our knowledge, this is the first reported case of an awake tracheal placement of the Tritube® with ventilation via the Evone®ventilator.

Tube tip and cuff position using different strategies for placement of currently available paediatric tracheal tubes

BackgroundTracheal tube tip and cuff positions of different cuffed paediatric tracheal tube brands in the trachea can vary with design. MethodsData from three clinical studies with measured tracheal lengths were pooled in a database including 422 children aged from birth to 16 yr. Dimensional data of seven cuffed paediatric tracheal tube brands (ID 3.0–7.0 mm) were recorded. Positions of tracheal tube tip and upper cuff border were calculated for each of the 422 tracheas using depth mark based tracheal tube placement, placement of the tracheal tube tip at a calculated safety distance above the carina, and mid-tracheal tube placement. Percentage of accidental bronchial intubations and tracheal tube cuff positions in the subglottic or supraglottic region were calculated. ResultsDepth mark based tracheal tube placement resulted in accidental bronchial intubation of up to 18% of cases and tracheal tube cuffs being placed in the subglottic region in up to 91%. Tracheal tube tip placement at a calculated safety distance resulted in up to 54% of tube cuffs placed too high. Mid-tracheal tube placement led to 100% subglottic or supraglottic tracheal tube cuff positions. ConclusionsAll studied cuffed paediatric tracheal tubes have major design flaws potentially leading to airway complications. Tracheal tube manufacturers are urgently asked to improve the design of cuffed paediatric tracheal tubes. Alternative strategies for tracheal tube placement can allow safe tracheal tube placement of uncuffed but not of cuffed tracheal tubes.

Validation of tracheal intubation of wire-reinforced endotracheal tube with ultrasonography

Objective. The use of ultrasonography (US) is a new method for verifying the location of the endotracheal tube.Design. Our study was designed as a paired-data and investigator-blind clinical study for evaluating the effectiveness of US for verification of wire-reinforced endotra-cheal tube (WR-ETT) placement compared with capnography.Setting.&nbsp;This study was conducted on 56 patients scheduled for elective surgery un-der general anesthesia.Patients.&nbsp;Fifty patients completed the study as 6 were excluded for various reasons. Intervention. Two different investigators performed the ultrasonography and intu-bation independently from one another. While investigator 1 attempted to verify the location of the WR-ETT with a portable ul-trasonography with sagittal trans-tracheal view, investigator 2 intubated the patient and verified the location of the ETT using capnography.Measurements. Time for verifying the loca-tion of the ETT using both US and capnog-raphy was recorded.Main Results.&nbsp;When the ultrasonography method was compared with capnography for verification of the WR-ETT placement, the results showed 95.75% sensitivity and 100% specificity. The average verification times for endotracheal intubation were 12.78 ± 7.46 s. and 24.44 ± 1.45 s. with US and capnography, respectively (p=0.003). Conclusion. Our results suggest that ultra-sound identification of a WR-ETT within the trachea is a rapid and accurate method for confirmation of tracheal placement. Larger studies are needed before wide-spread use of this technique.

Collaborating with interventional pulmonology in managing a massive tracheoesophageal fistula that extends from cricoid to carina: a case report

Tracheoesophageal fistulas (TEF) present a perioperative management challenge. A 62 year-old man with esophageal carcinoma presented with a large tracheoesophageal fistula extending most of the trachea. Previously, the patient had two overlapping esophageal and one tracheal stent placed, but he developed progressive tracheal disruption due to esophageal stent perforation near the level of the cricoid. This case describes the anesthetic management of tracheal stent placement for an expanding TEF. Management included a spontaneous breathing inhalation induction followed by ventilation through a supraglottic device—laryngeal mask airway (LMA). Finally, during rigid bronchoscopy, a combination of bag ventilation and jet ventilation was utilized.

Predictive Value of Tracheal Rapid Ultrasound Exam Performed in the Emergency Department for Verification of Tracheal Intubation.

BACKGROUND:Verification of the correct placement of the endotracheal tube (ETT) has been one of the most challenging issues of airway management in the field of emergency medicine. Early detection of oesophagal intubation through a reliable method is important for emergency physicians.AIM:The aim of this study was to assess the diagnostic accuracy of tracheal rapid ultrasound exam (TRUE) to assess endotracheal tube misplacement during emergency intubation.METHODS:This was an observational prospective study performed in the emergency department of the major tertiary referral hospital in the city. We included a consecutive selection of 100 patients. TRUE was performed for all these patients, and subsequently, quantitative waveform capnography was done. The later test is considered as the gold standard.RESULTS:From our total 100 eligible patients, 93 (93%) participants had positive TRUE results (tracheal intubation) and 7 (7%) patients have negative TRUE results (esophageal intubation). Quantitative waveform capnography report of all 93 (100%) patients who had positive TRUE was positive (appropriate tracheal placement). Sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of TRUE for detecting appropriate tracheal placement of ETT were 98.9% (95% CI, 93.3% to 99.8%), 100% (95% CI, 51.6% to 100%), 100% (95% CI, 95.1% to 100%) and 85.7% (95% CI, 42% to 99.2%) respectively.CONCLUSIONS:Performing TRUE is convenient and feasible in many emergency departments and pre-hospital settings. We would recommend emergency units explore the possibility of using TRUE as a method in the assessment of proper ETT placement.

Intubation of the Right Atrium During an Attempted Modified Surgical Airway in a Pig.

In modern medicine, the surgical cricothyrotomy is an airway procedure of last resort. In austere environments, however, its simplicity may make it a more feasible option than carrying a full complement of laryngoscopes. To create a Transportation Security Agency-compliant compact first-response bag, we attempted to establish a surgical cricothyrotomy in a pig, using trauma shears, basic medical scissors, a pocket bougie, and an endotracheal tube. Bougies can provide tactile feedback via the "tracheal ring sign" and "stop sign" to indicate positive tracheal placement during orotracheal intubation. We report on a previously unknown serious potential complication that questions the use of scissors to establish a surgical airway and the reliability of tactile bougie signs when translated into certain surgical airways.

The “Hitch Stitch”: An Effective Method of Preventing Migration in High Tracheal Stenosis

Background: The incidence of caudal stent migration in high tracheal stenting is 13-21% and is common with silicone stents. This can lead to major problems, including emergency repeat procedures. Several antimigration methods are described, but have limitations in terms of their success rate, availability, cost or ease of the procedure. Objectives: We describe an innovative method of stent migration prevention using a simple percutaneous anchoring “hitch stitch”, validated in a large series. Methods: After tracheal stent placement, an Ethilon suture was passed into the stent lumen through an 18-G needle. To take this suture back to the exterior to complete the stitch, a retrieval loop was passed through another 14-G percutaneous cannula inserted into the stent lumen. Bronchoscopically, using a forceps the first suture was pulled inside the loop, the loop was retracted, the suture was exteriorized, and the knot was completed and embedded subcutaneously. While removing the stent, an endoscopic scissor was used to cut the stitch to free the stent. Results: A total of 42 “hitch stitches” were done in 29 patients over 5 years, predominantly for silicone stents. Indications for stenting included postintubation tracheal stenosis (83.3%), malignancy (11.9%) and tracheoesophageal fistula (4.8%, metal stents). The procedure was successful in 41/42 (97.6%) patients. Stitch removal was uncomplicated. Conclusion: This is the largest series of an external stent anchoring procedure as a migration prevention strategy in high tracheal stenting, applicable to both silicone and metal stents. Stent migration prevention using this “hitch stitch” is simple, safe and successful, without any complications during stent removal.

Predictive Value of Tracheal Rapid Ultrasound Exam Performed in the Emergency Department for Verification of Tracheal Intubation

Verification of the correct placement of the endotracheal tube (ETT) has been one of the most challenging issues of airway management in the field of emergency medicine. Early detection of esophageal intubation through a reliable method is important for emergency physicians. The aim of this study was to assess the diagnostic accuracy of tracheal rapid ultrasound exam (TRUE) to assess endotracheal tube misplacement during emergency intubation. This was an observational prospective study performed in the emergency department of the major tertiary referral hospital of the city. We included a consecutive selection of 100 patients. TRUE was performed for all these patients, and subsequently, quantitative waveform capnography was done. The later test is considered as the gold standard. From our total 100 eligible patients, 93(93%) participants had positive TRUE results (tracheal intubation) and 7 (7%) patients have negative TRUE results (esophageal intubation). Quantitative waveform capnography report of all 93 (100%) patients who had positive TRUE were positive (appropriate tracheal placement). Sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of TRUE for detecting appropriate tracheal placement of ETT were 98.9% (95% CI, 93.3% to 99.8%), 100% (95% CI, 51.6% to 100%), 100% (95% CI, 95.1% to 100%) and 85.7% (95% CI, 42% to 99.2%) respectively. Performing TRUE is convenient and feasible in many emergency departments and pre-hospital settings. We would recommend emergency units explore the possibility of utilizing TRUE as a method in the assessment of proper ETT placement.

外ステント術, 心内修復術を同時に施行した気管軟化症, 心室中隔欠損症の1例

外ステント術, 心内修復術を同時に施行した気管軟化症, 心室中隔欠損症の1例

Bedside Ultrasound for Tracheal Tube Verification in Pediatric Emergency Department and ICU Patients: A Systematic Review.

Improper placement of the tracheal tube during intubation can lead to dangerous complications, and bedside ultrasound has been proposed as a method of quickly and accurately identifying tube placement. Recent studies in adults have found it to be accurate, but its applicability in pediatric patients is unclear. This systematic review aims to describe the current available data on the accuracy and feasibility of bedside ultrasound for tracheal tube placement in children. OVID MEDLINE and EMBASE. Available articles on bedside neck or lung/diaphragm ultrasound for confirmation of tracheal tube placement in children through December 2015. Two reviewers screened studies for eligibility and abstracted data independently. The quality of selected articles was evaluated using Quality Assessment of Diagnostic Accuracy Studies statement. A total of nine articles were identified: one study using neck ultrasound, two using lung/diaphragmatic ultrasound, one with both, and five studies looking at direct visualization of the tracheal tube tip met our inclusion criteria. There were 81 intubations evaluated using neck ultrasound, 214 intubations evaluated using diaphragmatic or pleural sliding, and 165 intubations evaluated for feasibility of bedside ultrasound in visualizing tracheal tube tip placement. The sensitivities of transtracheal ultrasound for intubation were overall high ranging from 0.92 to 1.00 with excellent specificities at 1.00. For lung ultrasound, the sensitivities for tracheal placement versus esophageal placement were high at 1.00, but only one study reported esophageal intubations and had a specificity of 1.00. When assessing the appropriate tracheal tube depth for tracheal intubations using lung ultrasound, the sensitivities ranged from 0.91 to 1.00 with specificities ranging from 0.5 to 1.0. Regarding feasibility of direct visualization of tracheal tube tip, visualization ranged from 83% to 100%. Bedside ultrasound has been described to be feasible in determining tracheal tube placement in several small single center studies and could be a useful adjunct tool in confirming tracheal tube placement in critically ill pediatric patients, but further studies are needed to assess its accuracy in a randomized multicenter setting.

A national survey of tracheal tube introducers and associated complications

Tracheal tube introducers (bougies) are frequently used by anaesthetists in the UK for the management of difficult tracheal intubation. The re-usable gum elastic bougie (GEB) is regarded as the gold standard. However, there are concerns about the risks of cross-infection, detachment of the tip or fracture of the outer varnish layer with re-usable GEBs. Despite evidence showing that the GEB has a higher success rate for tracheal placement 1 and that single-use tracheal tube introducers have potential to produce airway trauma, oesophageal perforation and pneumothorax 2, 3, there has been a move towards single-use airway devices. Concerns have been raised about the lack of evidence for clinical efficacy or safety 4. With approval from the Difficult Airway Society (DAS) Survey Committee, an email with a link to an online survey was sent to all UK DAS members in March 2013, asking about the type of introducers used and whether any complications had been associated with their use. Results of the 485 DAS members who replied (36% response rate) are summarised in Table 1. Our data shows that the GEB is associated with the lowest complication rate and its use is preferred by the majority of DAS members. However, at approximately £30 (€38, $43), it is more than twice as expensive as single-use devices 5, and fewer hospitals are seemingly prepared to permit the routine use of the GEB compared to 10 years ago 6. We propose that newer single-use tracheal tube introducers require urgent further evaluation 7 before they are considered suitable replacements for the re-usable gum elastic bougie.

Damage to endotracheal cuff inflation tube by harmonic scalpel in tonsillectomy leading to compromised airway

Use of harmonic scalpel has increased in the recent past for different surgical procedures. We report a case of damage to an endotracheal tube inflation line in a 47 year old female patient who underwent elective tonsillectomy due to harmonic scalpel. Pre-anaesthetic evaluation of the patient revealed no abnormalities. The patient’s trachea was intubated via nasal route with a cuffed north facing Ring, Adair and Elwyn tube of 7.0 mm internal diameter. The cuff was inflated after confirmation of tracheal placement of tube and pharyngeal packing was done. After 30 minutes of surgery, the bellows of the ventilator were collapsing. Suspecting a leak an attempt was made to inflate the cuff, which revealed high resistance in inflation tube. Surgeon was immediately asked to stop the surgery. Check laryngoscopy revealed damage to cuff inflation tube which was sealed by harmonic scalpel in semi-inflated condition. Anticipating that the tracheal extubation in that inflated position would result in vocal cord trauma, a 23 gauge spinal needle attached to 5ml syringe was introduced under direct laryngoscopic guidance. The cuff was punctured and air aspirated so as to deflate the cuff. The tube was taken out and was replaced. The surgery continued for next one hour, was uneventful and trachea extubated at completion.

Quick Response Tracheotomy: A Novel Surgical Procedure.

Quick response tracheostomy (QRT) is a novel open surgical technique to emergently establish an airway. The method is simple; the skills necessary to perform this procedure are rapidly acquired; and it is expedient, minimally traumatic, and remarkably devoid of complications often encountered with percutaneous dilatational tracheotomies, including those complications seen with cricothyroidotomies. Unlike all other tracheotomies in which considerable blunt dissection is required, QRT avoids tissue crushing because sharp dissection alone is used to acquire surgical access to the trachea. The QRT does not entail inserting a guidewire into the trachea, a standard feature for percutaneous tracheal access; it avoids any risk of unintended laceration of the posterior tracheal wall and proximal subjacent esophagus. The technique averts tracheal ring fracture and tracheoesophageal fistula complications. The QRT has a uniquely low incidence of inducing hemorrhage, and it requires no steps that cause temporary tracheal occlusion and will therefore not facilitate hypoxia. The QRT contributes minimally to conditions favorable for generating subglottic stenosis, and the procedure is swiftly executed with very low probability for external tracheal placement of the tracheostomy tube. The QRT is not a blind procedure. No special instruments are required for its execution nor is concurrent tracheoscopy required at any stage while performing a QRT as is specified for percutaneous tracheotomies.

Tracheoesophageal fistula managed with tracheal stent through flexible bronchoscopy without fluoroscopy

Inoperable malignant tracheoesophageal fistula (TEF) is characterised by an extremely poor prognosis. Tracheal or double (tracheal-esophageal) stenting through rigid bronchoscopy has been suggested as a valuable therapeutic option. We report on a patient with a large TEF successfully sealed by deployment of a self-expandable stent through flexible bronchoscopy (FB) without fluoroscopy. Dramatically improved health status permitted him to undergo radiation, attaining further clinical improvement. Four months after stent placement no sequelae were observed. During the fifth month a new fistula developed distally to the stent finally leading to death from septic complication. Palliative management of inoperable malignant TEF by tracheal stent placement through FB without fluoroscopy, is feasible, safe and rewarding leading to important clinical improvement.

When everything failed, glidescope prevailed.

Sir, We report the successful management of an unanticipated difficult airway secondary to an asymptomatic large vallecular cyst obscuring the glottic opening using glidescope after repeated failed attempts at mask ventilation and laryngoscopy. A 70-year-old, 60 kg, American Society of Anesthesiologists (ASA) I male patient was scheduled to undergo re-exploration for persistent bleeding following transurethral resection of the prostate. The preanesthetic checkup and airway examination was unremarkable. General Anesthesia was planned in view of ongoing blood loss. Patient was shifted to the operating room and connected to the multichannel monitor (Datex-Ohmeda, Finland). Intravenous access (i.v.) was established with 18G cannula, and i.v. glycopyrrolate 0.2 mg and morphine 6 mg was given. Patient was preoxygenated with 100% oxygen for 3 min and then induced with sleep dose of thiopentone. After confirming assisted mask ventilation, i.v vecuronium (0.1 mg/kg) was given but, immediately after full muscle relaxation was achieved, absent capnography trace along with minimal movement of the chest was noticed. Guedel's airway was inserted, mask position and adequate seal reconfirmed and any leaks or equipment failure was ruled out. With failure to ventilate even now, it was decided to perform direct laryngoscopy to facilitate endotracheal intubation. Meanwhile, the anesthesia technician was also requested to bring a glidescope as the fiberoptic bronchoscope was not available. Since the patient was routinely preoxygenated with 100% oxygen, the SpO2 could be maintained at around 93% throughout till successful intubation could be accomplished. A large vallecular cyst was detected arising from the right vallecula obscuring the glottic opening entirely [Figure 1]. After two unsuccessful attempts to visualize the glottis, it was decided to use glidescope which revealed a small aperture glottic opening, distorted and displaced by the cyst. 7.0 mm cuffed oral endotracheal tube was passed beyond the cyst into the trachea and confirmed by capnogram. The cyst was then aspirated to prevent any problems at extubation. Patient was maintained on controlled ventilation using 66% nitrous oxide in oxygen with 1% isoflurane. He also received i.v 8 mg of dexamethasone following intubation. The surgery continued uneventfully for 1 h. At the end of surgery, neuromuscular blockade was reversed with 50 μg/kg of i.v neostigmine and 10 μg/kg of i.v glycopyrrolate. His trachea was extubated uneventfully. He was then shifted to postanesthesia care unit and discharged from the ward 2 days later.Figure 1: Vallecular cyst obstructing the laryngeal inletGlidescope is a new addition to the armamentarium for managing a difficult airway. Although it has been used to achieve primary airway control in anticipated, symptomatic large vallecular cyst,[1] it also helps in unanticipated difficult airway by improving the Cormack-Lehane grading and making part of the airway visible. By virtue of its inherent design of bent tip at 60°, the structures that are obscured on direct laryngoscope may be readily observed with the use of glidescope.[23] It is already established that the use of glidescope has a high success rate in both primary airway control as well as failed direct laryngoscopy.[4] The ASA difficult airway guidelines have also incorporated glidescope for improved laryngeal view and increased successful intubations.[5] This equipment use avoids multiple attempts at successful tracheal intubation. Therefore, it may be used as a tangible alternative device in a situation where tracheal placement seems to be rather difficult or impossible.

Outcome of Tracheostomy Closure in Oral Cancer Surgery Patients

Objective: We investigated the outcome of tracheal fistula in patients with oral cancer who underwent tracheostomy at the time of initial surgery. Study Design: retrospective study Methods: We retrospectively investigated the outcome of tracheal fistula in 57 patients with oral cancer who underwent tracheostomy. The patients were classified into three groups, which were patients in whom the tracheal fistula closed spontaneously (Group A), patients in whom closure of the tracheal fistula did not occur spontaneously and surgical closure was required (Group B), and patients in whom closure of the tracheostomy could not be achieved (Group C). The following factors were examined for associations with failure of spontaneous closure: patient demographics, primary tumor site, T classification, N classification, stage classification, presence or absence of neck dissection, presence or absence of reconstructive surgery, presence or absence of postoperative (chemo)radiotherapy, presence or absence of postoperative aspiration pneumonia, and duration of tracheal cannula placement. Results: Among the 57 subjects, Group A were 27 (47.4%), Group B were 23 (40.4%), and Group C were 7 (12.3%). In Group B, surgical closure with a hinge flap was performed in all 23 patients. We found that neck dissection and postoperative (chemo) radiotherapy were both factors that had an independent influence on whether closure of the tracheostomy could be achieved. Conclusion: Although early removal of the tracheal cannula is advantageous for improving the QOL of the patient, long-term cannulation does not interfere with spontaneous closure. Accordingly, it is necessary to carefully consider the timing of decannulation.

Posterior Mesh Tracheoplasty for Cervical Tracheomalacia: A Novel Trachea-Preserving Technique

Tracheal resection or placement of airway prostheses (stents, tracheostomy tubes, or T tubes) are techniques currently used to treat severe cervical tracheomalacia. We have developed a new technique to secure a polypropylene splint to the posterior membrane of the cervical trachea in a patient with diffuse, acquired tracheobronchomalacia. This novel posterior tracheoplasty avoids anastomotic and intraluminal adverse events that may occur with existing techniques.