Redo Tracheostomy: Our Experience, Problems Encountered and How to Overcome Them

Area of Science:

• Otolaryngology
• Head and Neck Surgery
• Surgical Oncology

Background:

• Tracheostomy is crucial for upper airway management in head and neck cancer patients.
• Post-treatment anatomical changes from radiotherapy and chemotherapy complicate redo tracheostomies.
• Redo tracheostomy presents significant surgical challenges in this patient population.

Purpose of the Study:

• To describe a surgical technique for performing redo tracheostomy in patients with head and neck cancer.
• To evaluate the safety and efficacy of the described technique in a challenging patient cohort.

Main Methods:

• A retrospective review of 39 patients undergoing redo tracheostomy by the author over two years.
• Patients included those with primary cancer, recurrence, or planned secondary surgery.
• Specific indications for redo tracheostomy were documented, including tube expulsion and disease recurrence.

Main Results:

• Successful redo tracheostomy was achieved in all 39 patients.
• Mild surgical emphysema occurred in 3 patients, with no other significant complications reported before discharge.
• The technique was effective even in cases requiring takeover due to intraoperative bleeding or difficulty locating the trachea.

Conclusions:

• The presented surgical technique is effective for redo tracheostomy in head and neck cancer patients, including those with post-chemoradiation changes.
• Careful dissection and procedural adherence are vital to minimize intraoperative complications.
• This approach offers a safe solution for managing airway issues in patients requiring repeat tracheostomy.