Anatomical particularities and difficulties in tracheostomy: three case reports

Abstract

Three tracheostomies conducted using Fantoni's translaryngeal technique (TLT) are described in patients with particular anatomical conditions of the trachea and neck. The first case is of a patient with tracheal stenosis, which is known to be problematic with regard to gaining adequate endoscopic control, assuring effective ventilation during maneuvers and ensuring the safety of the walls of the trachea. The second case is with regard to a patient with a voluminous thyroid goiter that displaced the trachea to the right, making it difficult to appreciate the tracheal lumen during needle introduction. The third case is of a patient with spastic tetraparesis due to asphyxia neonatorum and kyphoscoliorachitis, which made ventilation and access to the trachea difficult. The peculiarity of the technique and the constitutive elements of the TLT kit were invaluable for the resolution of the problems that occurred during the procedure. In particular, the tracheoscope with a rigid optical lens inside allowed for better protection of the trachea by offering optimal endoscopic vision. The three tracheostomies were performed without intraprocedural or long term complications.