Tracheotomy_neck_profile.png|thumb|166px|Completed tracheostomy:
1 - Vocal cords
2 - Thyroid cartilage
3 - Cricoid cartilage
4 - Tracheal cartileges
5 - Balloon cuff]]

A tracheotomy or tracheostomy is a surgical procedure performed on the neck to open a direct airway through an incision in the trachea (the windpipe). (Technically, the former term, with the Greek root tom- meaning "to cut," refers to the procedure of cutting into the trachea, whereas the latter term, with the root stom- meaning "mouth," refers to the procedure of making a semipermanent or permanent opening. Tracheostomy can also refer to the result of the procedure, i.e. the opening itself.)

Indications for a tracheotomy

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The indications for tracheotomy are:

• Acute setting - maxillofacial injuries, large tumors of the head and neck, congenital tumors, e.g. branchial cyst, acute inflammation of head and neck, and
• Chronic / elective setting - when there is need for long term mechanical ventilation and tracheal toilet, e.g. comatose patients, surgery to the head and neck.

More on [ Tracheotomy ]

Archives of Otolaryngology current issue

ABOUT THE COVER: Dolphin escort
Mon, 15 Jun 2009 00:00:00 -0000

ABOUT THIS JOURNAL: About This Journal
Mon, 15 Jun 2009 00:00:00 -0000

ORIGINAL ARTICLE: Toxic Shock Syndrome and Rhinosinusitis in Children
Chan, K. H., Kraai, T. L., Richter, G. T., Wetherall, S., Todd, J. K. Mon, 15 Jun 2009 00:00:00 -0000
Objective  To determine the association between toxic shock syndrome (TSS) and rhinosinusitis in children. Design  Eighteen-year retrospective review of medical records. Setting  Tertiary children's hospital. Patients  A total of 76 patients were identified as having TSS. Twenty-three of them were also diagnosed as having either acute or chronic rhinosinusitis, with no other source of infection in 17 cases. Interventions  Of the 23 patients with TSS and rhinosinusitis, 10 were admitted to the intensive care unit, 4 required pressors, and 6 received surgical intervention. Surgical intervention for sinus disease included bilateral antral lavage in 5 patients and bilateral maxillary antrostomy and ethmoidectomy in 1 patient. Main Outcome Measures  Patients with TSS and rhinosinusitis were identified using a rigorous set of definitions and detailed data pertaining to history, imaging studies, microbiologic studies, and hospital course. Results  Correlation of the data revealed 4 patients who met the criteria for proven TSS and proven rhinosinusitis, 2 patients who met the criteria for probable TSS and proven rhinosinusitis, 7 patients who met the criteria for proven TSS and possible rhinosinusitis, and 3 patients who met the criteria for probable TSS and possible rhinosinusitis. Conclusions  Rhinosinusitis was found to be the primary cause of TSS 21% of the time in this series. Rhinosinusitis should be considered the primary cause of TSS when another site of infection has not been identified. Once the link is made, prompt otolaryngology consultation and sinus lavage should be considered.
ORIGINAL ARTICLE: Characterization of Congenital Anomalies in Individuals With Choanal Atresia
Burrow, T. A., Saal, H. M., de Alarcon, A., Martin, L. J., Cotton, R. T., Hopkin, R. J. Mon, 15 Jun 2009 00:00:00 -0000
Objective  To review a tertiary care pediatric hospital's experience with choanal atresia and stenosis (CA/S) related to associated congenital anomalies (birth defects, including minor abnormalities) and genetic disorders. Design  Retrospective case series. Setting  Tertiary care pediatric hospital. Patients  Individuals with CA/S. Main Outcome Measures  Identification of congenital anomalies, neurologic abnormalities, and developmental disabilities in individuals with CA/S. Results  One hundred twenty-nine individuals with CA/S were evaluated between July 1, 1997, and July 1, 2007. Choanal atresia and stenosis was an isolated finding in 34 patients (26.4%) and was associated with other anomalies in 95 patients (73.6%). Specific conditions were diagnosed in 66 patients (51.2%); CHARGE (coloboma, heart defect, atresia choanae, retarded growth, genitourinary abnormalities, and ear anomalies) syndrome was the most common diagnosis (33 patients [25.6%]). Numerous conditions were seen, including chromosomal abnormalities, single-gene defects, deformations, and those caused by teratogens. Choanal atresia and stenosis was unilateral in 62 patients (48.1%) and was bilateral in 60 patients (46.5%). Unilateral cases were more likely to be isolated (30 patients [53.2%]). Bilateral cases were more likely to be associated with specific disorders or multiple congenital anomalies (60 patients [98.4%]). There was no difference in laterality among unilateral cases. Conclusions  Choanal atresia and stenosis is associated with a wide range of disorders. Congenital anomalies, neurologic abnormalities, and developmental disabilities are commonly identified in affected individuals. Bilateral CA/S is more commonly seen in patients in whom specific diagnoses or other congenital anomalies are identified. Unilateral CA/S occurs more frequently in isolated cases. A comprehensive evaluation is recommended in individuals with CA/S to evaluate for other congenital anomalies, neurologic abnormalities, developmental delays, and evidence of a specific underlying disorder.
CORRECTION: Error in Author Name in: Lower Reconstruction and Restoration of Oral Competence With Dynamic Palmaris Longus Vascularized Sling
Mon, 15 Jun 2009 00:00:00 -0000

ORIGINAL ARTICLE: Outcome of Tonsillectomy in Selected Patients With PFAPA Syndrome
Pignataro, L., Torretta, S., Pietrogrande, M. C., Dellepiane, R. M., Pavesi, P., Bossi, A., Drago, L., Capaccio, P. Mon, 15 Jun 2009 00:00:00 -0000
Objective  To assess the practicability of integrated medical and surgical management and the effectiveness of tonsillectomy in children with PFAPA syndrome (periodic fever, aphthous stomatitis, pharyngitis, and cervical lymphadenopathy). Design  A prospective study. Setting  Secondary pediatric and otolaryngological university center. Patients  Of 30 patients evaluated for periodic fever, 18 children with PFAPA syndrome were included in the study. Interventions  Patients underwent long-term pediatric and otolaryngological assessments, and their parents were asked to keep monthly diaries with reports of any subsequent episodes, symptom, and related sign. Patients received traditional medical therapies, and 9 patients underwent tonsillectomy for the lack of lasting recovery. Main Outcomes Measures  The association between postoperative outcomes and age at tonsillectomy and the differences in the patients' condition before and after tonsillectomy were statistically tested. In addition, the removed tonsillar tissue was analyzed molecularly to evaluate concomitant infections. Results  All of the surgical patients reported a symptomatic improvement, with complete clinical recovery in 5 cases (56%) and significant reduction in number (P = .005) and duration (P = .03) of recurrences in the remaining 4 (44%). Results of molecular analysis of tonsillar specimens were negative for bacteria in all but 1 patient. Conclusion  Otolaryngologists should be trained to recognize PFAPA syndrome, for which management consists of a regular and prolonged second-level pediatric and otolaryngological follow-up, with surgery only after the failure of traditional medical therapy.

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