Anatomical particularities and difficulties in tracheostomy: three case reports

Area of Science:

• Otolaryngology
• Surgical Techniques
• Anesthesiology

Background:

• Tracheostomies in patients with challenging anatomy, such as tracheal stenosis, large goiters, or spinal deformities, present significant procedural risks.
• Ensuring adequate endoscopic visualization and ventilation is critical for safe airway access in these complex cases.

Observation:

• Fantoni's translaryngeal technique (TLT) was employed in three patients with unique anatomical conditions complicating tracheostomy.
• Case 1: Tracheal stenosis impeding endoscopic control and ventilation.
• Case 2: Large thyroid goiter displacing the trachea, hindering needle insertion.
• Case 3: Spastic tetraparesis with kyphoscoliorachitis affecting ventilation and tracheal access.

Findings:

• The TLT kit's unique features and the tracheoscope with its rigid optical lens were crucial for overcoming procedural difficulties.
• Optimal endoscopic vision provided by the tracheoscope enhanced tracheal wall protection.
• All three translaryngeal tracheostomies were completed without immediate or long-term complications.

Implications:

• The translaryngeal tracheostomy technique offers a viable and safe solution for patients with complex neck and tracheal anatomy.
• This approach may expand the applicability of minimally invasive tracheostomy in challenging surgical scenarios.
• The specialized instrumentation, particularly the rigid-lens tracheoscope, contributes significantly to procedural safety and efficacy.