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formal tracheostomy
- When the patient is in immediate danger of death, and there is no time to do a formal tracheostomy
- The isthmus of the thyroid gland may interfere with the approach towards the trachea. The anatomy can vary considerably however
- When the isthmus of the thyroid is small, there is no need to divide it and can sometimes be retracted (by using a isthmus retraction hook). When it's large and interferes with your approach to his trachea, it needs to be divided
- Avoid incising more than 40% of the circumference of the trachea, since this may lead to severe future stenosis
- Percutaneous dilatational tracheostomy (PDT) is as safe and as effective as a formal (surgical) tracheostomy, without significant differences in early and late complications
Literature
1. Isthmus retraction hook for open tracheostomy Technical note. Kovács AF. Int J Oral Maxillofac Surg. 2009 Jun 10
2. Comparison of percutaneous dilatational tracheostomy with surgical tracheostomy. Turkmen A et al et al. 2008 Jun;19(5):1055-67.
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