Tracheotomy Surgical Technique
This procedure allows creating a reversible connection between the tracheal lumen and the skin.
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Tracheotomy Surgical Technique M. Ghirelli, F. Mattioli, G. Molinari, I. Cena, and L. Presutti
This procedure allows creating a reversible connection between the tracheal lumen and the skin. Normally, tracheotomy is performed to guarantee safe ventilation after airways surgery or extensive neck surgery. Tracheotomy is mandatory in all surgical procedures at high risk of neck oedema or acute airway compromise. In cervical spine surgery, the indications to tracheotomy are essentially correlated to avoid an upper airway
obstruction (actual or potential). This event might occur in surgery involving: • Multilevel approach to cervical spine from C3 to C6 (the retropharyngeal space is located at this level) • Anterior and posterior combined approach • Transmandibular approach to upper cervical spine with median lingual split
M. Ghirelli (*) • F. Mattioli • G. Molinari • I. Cena • L. Presutti Head and Neck Surgery Department, University Hospital of Modena, Modena, Italy e-mail: [email protected] © Springer International Publishing Switzerland 2017 S. Boriani et al. (eds.), Atlas of Craniocervical Junction and Cervical Spine Surgery, DOI 10.1007/978-3-319-42737-9_7
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7.1
Surgical Technique
7.1.2 1st Surgical Step: Incision of the Skin
The patient is placed on supine position, with the head extended using a shoulder roll. Hyperextension of the neck is mandatory to obtain an optimal exposition of surgical landmarks.
7.1.1 Landmarks on the Skin
Fig. 7.2 Ideal triangle formed by cricoid cartilage, suprasternal notch and SCM
7.1.2.1 Anatomical Key Points (Fig. 7.2) • Cricoid cartilage • Suprasternal notch • Sternocleidomastoid muscle (SCM) Fig. 7.1 Identification of skin landmarks before incision
The surgeon has to identify (Fig. 7.1): 1. 2. 3. 4.
Notch of thyroid cartilage Cricoid cartilage Skin incision line Suprasternal notch
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7.1.2.2 Pearls and Potential Complications The surgeon normally performs a 3–4 cm horizontal skin incision (Fig. 7.3). The incision is usually placed at least two fingerbreadths below the cricoid cartilage in an inverse triangular space formed by the cricoid cartilage (red line) at the base, the suprasternal notch at the apex and SCM in the lateral border (yellow and green line). The identification of the anterior jugular vein on the skin is useful to prevent its accidental section. The incision must involve the skin, subcutaneous tissue and platysma muscle until exposure of SLDCF (Fig. 7.4).
Fig. 7.4 The black arrow shows SLDCF
Fig. 7.3 Skin incision with 15 or 10 blade
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7.1.3 2 nd Surgical Step: Incision of SLDCF and Identification of Median Line The incision of SLDCF is performed in order to identify the so-called strap muscles.
7.1.3.1 Anatomical Key Points • Sternohyoid muscles • Sternothyroid muscles 7.1.3.2 Pearls and Potential Complications The sternohyoid muscle is more superficial than the sternothyroid (Fig. 7.5). The surgeon has to identify the midline between the strap muscles. Thi
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