Everyday Oral Surgery Tracheotomy procedure, management, and complications with Dr. Ben Hechler
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Jun 28, 2023 Dr. Ben Hechler, an oral and maxillofacial surgeon at Duke Health, shares his expertise on tracheotomy management. He clarifies the differences between tracheotomy and tracheostomy, discussing when and how to perform the procedure safely. Listeners gain valuable insights into awake tracheotomies, anesthesia coordination, and the types of tracheostomy tubes. Dr. Hechler also addresses post-operative emergencies and the critical distinctions between planned tracheotomies and cricothyroidotomies. This discussion is essential for both surgeons and dental practitioners!
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Tracheotomy vs Tracheostomy Clarified
- 'Tracheotomy' names the cutting procedure while 'tracheostomy' refers to the resulting stoma or opening.
- A tracheostoma after laryngectomy removes the airway connection to the pharynx, preventing oral/nasal intubation.
Positioning And OR Communication
- Position the patient with shoulder rolls and neck extension to expose a palpable trachea before incision.
- Communicate with anesthesia and coordinate cuff deflation, tube retraction, and immediate connection to the circuit when entering the airway.
Handle Tracheal Flaps Pragmatically
- You may suture tracheal flaps or leave them unstabilized; the tube itself often stents the opening until healing occurs.
- Use a Bjork flap in selected obese or tenuous-airway patients to facilitate recannulation if needed.