Airway Bypass Surgery Tracheotomy

Tracheotomy was once the only treatment available for SDB. By creating an external opening in the trachea, the obstructing tissue of the upper airway was bypassed. This provided immediate resolution of airway obstruction during sleep. However, tracheotomy is poorly accepted by patients. This prompted a search for more conservative site-specific surgical procedures. In addition, the advent of CPAP provided a nonsurgical method to prevent upper airway obstruction. The efficacy of CPAP has markedly reduced the number of patients needing tracheotomy (51).

Yet, indications still exist for the insertion of a tracheotomy tube. A tracheotomy should be inserted when there is a need to secure an airway prior to a multi-phased protocol. Furthermore, it should be considered in morbidly obese patients with severe SDB and an oxygen desaturation below 70%, especially in those who cannot tolerate CPAP. Patients with significant cardiac disease may not be able to tolerate hypoxemia following surgery; thus a tracheotomy may be warranted. A tracheotomy may be temporary if the upper airway is subsequently reconstructed to alleviate obstruction.

Sleep Apnea

Sleep Apnea

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