Advertisement

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

  • Chanmiki SayooEmail author
  • Ashok Kumar Das
  • Anupam Das
  • Tashnin Rahman
  • Raj Jyoti Das
  • Kishore Das
Original Article

Abstract

Tracheostomy is a life-saving procedure done electively or most commonly in emergency basis. In patients with diagnosed case of cancer in upper airway tract they usually require tracheostomy at some point of time during their whole treatment procedure. Patients receiving radiotherapy or chemotherapy or combination of these are at high risk of developing post treatment changes in neck anatomy. Redo tracheostomy due to any reasons in such types of patients is a surgical challenge. The purpose of this article is to share our surgical technique in redo tracheostomy. During a period of two years 39 patients with diagnosed cancer in head neck region underwent redo tracheostomy at the hand of the author. Twenty-six patients were had received chemoradiation for their primary cancer and 6 patients were planned for second surgery due to recurrence disease in oral cavity. Reasons for redo tracheostomy are: sixteen patients were post chemoradiation on follow up with accidental expulsion of tube, 17 patients were recurrence/residual disease and 6 patients were plan for second surgery due to recurrence disease. In 9 cases the surgery was started by other doctor and taken over by the author due to profuse bleeding (5 cases) and failure to localised the trachea (4 cases). Among the 39 patients successful redo tracheostomy was possible in all. Mild surgical emphysema was encountered in 3 patients which was not significant. There was no other complication related to tracheostomy till the patients were discharge from the hospital. When redo tracheostomy is required in a post chemoradiation patients maintaining the proper dissection plane and procedure is important to avoid unnecessary complication intraoperatively.

Keywords

Head neck cancers Tracheostomy Chemoradiation 

Notes

Compliance with Ethical Standard

Conflict of interest

The author declare that they have no conflict of interest.

Informed Consent

Informed consent was taken from all the participants included in the study.

References

  1. 1.
    GLOBOCAN (2012) www.globocan.iarc.fr. Accessed 12 Nov 16
  2. 2.
    Asthana S, Patil RS, Labani S (2016) Tobacco-related cancers in India: a review of incidence reported from population-based cancer registries. Indian J Med Pediatr Oncol 37:152–157CrossRefGoogle Scholar
  3. 3.
    Global Adult Tobacco Survey India (2009–2010) http://mohfw.nic.in/WriteReadData/l892s/1455618937GATS%20India.pdf. Accessed 6 Dec 16
  4. 4.
    Chaturvedi P (2009) Head and Neck Surgery. J Can Res Ther 5:143CrossRefGoogle Scholar
  5. 5.
    National Cancer Registry Programme (ICMR) (2008) Consolidated report of population based cancer registries: 2004–2005. Bangalore, India, 2008. www.ncrpindia.org/Report/PreliminaryPages_PBCR2004_2005.pdf. Accessed 9 Jan 2019
  6. 6.
    Joshi P, Nair S, Chaturvedi P (2014) Delay in seeking specialized care for oral cancers: experience from a tertiary cancer center. Indian J Cancer 51:95–97CrossRefGoogle Scholar
  7. 7.
    Lingen MW, Kalmar JR, Karrison T, Speight PM (2008) Critical evaluation of diagnostic aids for the detection of oral cancer. Oral Oncol 44:10–22CrossRefGoogle Scholar
  8. 8.
    Mallath MK, Taylor DG, Badwe RA et al (2014) The growing burden of cancer in India: epidemiology and social context. Lancet Oncol 15:e205–e212CrossRefGoogle Scholar
  9. 9.
    Patil VP (2007) Airway emergencies in cancer. Indian J Crit Care Med 11:36–44CrossRefGoogle Scholar
  10. 10.
    Forastiere AA, Goepfert H, Maor M et al (2003) Concurrent chemotherapy and radiotherapy for organ preservation in advanced laryngeal cancer. N Engl J Med 349:2091–2098CrossRefGoogle Scholar
  11. 11.
    Forastiere AA, Zhang Q, Weber RS et al (2013) Long-term results of RTOG 91–11: a comparison of three nonsurgical treatment strategies to preserve the larynx in patients with locally advanced larynx cancer. J Clin Oncol 31:845–852CrossRefGoogle Scholar
  12. 12.
    Hanna E, Alexiou M, Morgan J et al (2004) Intensive chemoradiotherapy as a primary treatment for organ preservation in patients with advanced cancer of the head and neck: efficacy, toxic effects, and limitations. Arch Otolaryngol Head Neck Surg 130:861–867CrossRefGoogle Scholar
  13. 13.
    Stone HB, Coleman CN, Anscher MS, McBride WH (2003) Effects of radiation on normal tissue: consequences and mechanisms. Lancet Oncol 4:529–536CrossRefGoogle Scholar
  14. 14.
    Hermans R (2008) Posttreatment imaging in head and neck cancer. Eur J Radiol 66:501–511CrossRefGoogle Scholar
  15. 15.
    Hwang SM, Jang JS, Yoo JI et al (2011) Difficult tracheostomy tube placement in an obese patient with a short neck—a case report. Korean J Anesthesiol 60(6):434–436.  https://doi.org/10.4097/kjae.2011.60.6.434 CrossRefGoogle Scholar
  16. 16.
    Durbin CG Jr (2010) Tracheostomy: Why, when, and how? Respir Care 55:1056–1068Google Scholar

Copyright information

© Association of Otolaryngologists of India 2019

Authors and Affiliations

  1. 1.Head and Neck DepartmentDr B Borooah Cancer InstituteGuwahatiIndia

Personalised recommendations