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Evaluating the neck for percutaneous dilatational tracheostomy
J K Muhammad1, E Major, D W Patton
1Maxillofacial Unit, Morriston Hospital, Swansea, Wales, UK. kama11@breathemail.net
Summary
Neck anatomy variations can complicate percutaneous dilatational tracheostomy (PDT). A deeply lying trachea or secondary tracheal deformity may necessitate open surgical tracheostomy, highlighting the need for pre-procedure assessment.
Area of Science:
- Anatomical variations
- Surgical procedures
Background:
- Percutaneous dilatational tracheostomy (PDT) is a common procedure.
- Understanding anatomical limitations is crucial for procedural success.
Observation:
- Neck anatomy variations, including short neck and deeply lying trachea, were studied in 497 patients.
- A reduced cricoid ring to sternum distance and altered tracheal anatomy were assessed for PDT difficulty.
Findings:
- 6.6% of patients had anatomical variations predisposing to difficult PDT.
- Unfavorable neck anatomy led to 2.2% of patients requiring open surgical tracheostomy.
Implications:
- Neck anatomy variations can increase PDT difficulty and risk.
- Pre-procedure assessment, including imaging, is vital for identifying patients unsuitable for PDT.
- Open surgical tracheostomy remains necessary for select cases with complex neck anatomy.