7.19.24
Quick Review #183 - #surgery #surgeon #doctorgallagher #oralsurgery #oralsurgeon #omfs #dentist #dentistry #dental #trcheostomy #cricothyrotomy
Definitions:
• Tracheostomy: A surgical procedure where an opening is created directly into the trachea through the neck to establish an airway.
• Cricothyrotomy: An emergency surgical procedure where an incision is made through the skin and cricothyroid membrane to create an airway.
Tracheostomy:
Surgical Technique:
• Preparation: Patient is usually under general anesthesia. Neck is extended, and the surgical area is sterilized.
• Incision: A horizontal or vertical incision is made in the lower part of the neck, just above the sternal notch.
• Dissection: Subcutaneous tissue, platysma muscle, and strap muscles are dissected to expose the trachea.
• Tracheal Opening: An opening is created between the tracheal rings (usually between the second and third tracheal rings).
• Insertion: A tracheostomy tube is inserted into the trachea and secured.
Considerations:
• Indications: Long-term ventilation, obstruction of the upper airway, congenital anomalies, severe neck or facial injuries, neuromuscular diseases.
• Complications: Infection, bleeding, pneumothorax, tracheal stenosis, tracheoesophageal fistula.
• Postoperative Care: Requires regular cleaning and monitoring, humidified air, and suctioning to prevent mucus plugging.
Cricothyrotomy:
Surgical Technique:
• Preparation: Usually performed under emergency conditions with minimal preparation.
• Incision: A vertical incision is made through the skin over the cricothyroid membrane, located between the thyroid cartilage and the cricoid cartilage.
• Membrane Puncture: The cricothyroid membrane is punctured, and the incision is extended.
• Insertion: A tracheostomy tube or endotracheal tube is inserted through the membrane and secured.
Considerations:
• Indications: Emergency situations where airway obstruction is life-threatening, and other airway management techniques are not feasible (e.g., trauma, severe swelling, foreign body obstruction).
• Complications: Bleeding, subglottic stenosis, laryngeal nerve injury, infection, tracheal perforation.
• Postoperative Care: Immediate airway management; typically, a cricothyrotomy is converted to a formal tracheostomy or endotracheal intubation as soon as possible.
References:
1. Sottosanti, K. (n.d.). Tracheotomy. In Encyclopædia Britannica.
2. Kearney, P. A., & Todd, S. R. (2011). Tracheostomy. In C. R. Townsend Jr, R. D. Beauchamp, B. M. Evers, & K. L. Mattox (Eds.), Sabiston Textbook of Surgery: The Biological Basis of Modern Surgical Practice (19th ed., pp. 897-905). Elsevier.
3. Kornblith, L. Z., Howard, B. M., & Cohen, M. J. (2013). Surgical airway management in trauma: Indications, techniques, and outcomes. Journal of Trauma and Acute Care Surgery, 74(3), 453-459. https://lnkd.in/eUuGbPb7
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