title: Tracheostomy in maxillofacial surgery: a simple and safe technique for residents in training.
abstract: BACKGROUND
  Tracheostomy is a frequently performed surgical procedure and may be required under emergency, semiurgent, or elective conditions. In maxillofacial surgery, it is indicated in congenital, inflammatory, oncologic, or traumatic respiratory obstruction and prolonged intubation. This article presents a simplified tracheostomy procedure based on anatomic markers that gives the best compromise between minimum invasiveness and safety.
  
  
  METHODS
  A retrospective study analyzed the clinical aspects, treatment methods, and clinical course of 198 patients who underwent tracheostomies performed by residents in training under the supervision of surgeons between October 2002 and December 2007 at the Maxillofacial Surgery Department of Carlo Poma Hospital, Mantova, and the Maxillofacial Unit, Head and Neck Department, University of Modena and Reggio Emilia, Italy. Tracheostomies were performed in 127 patients (64.14%) with neoplastic diseases (tumors of the tongue base, tonsils, and oral and pharyngeal regions) and in 71 patients with trauma (35.86%). The patients were followed up for 3 to 65 months.
  
  
  RESULTS
  Acceptable clinical healing and outcomes were obtained in all patients. Intraoperative complications occurred in 35 patients (17.7%): bleeding in 32 patients (16.2%) and pretracheal or paratracheal tube placement in 3 patients (1.51%). Postoperative complications after tracheostomy closure included tracheostomy dehiscence in 5 patients (2.52%) and subcutaneous emphysema in 26 patients (13.12%). Tracheostomy dehiscence occurred in 3 patients with neoplasia (1.51%) and in 2 patients with trauma (1.01%). No symptomatic tracheal stenosis developed.
  
  
  CONCLUSIONS
  The standardized surgical technique presented here reduces the associated surgical risk when the correct anatomic markers are used and important structures are recognized and handled correctly.
authors.affiliation: Unit of Maxillofacial Surgery, Department of Head and Neck, Modena and Reggio Emilia University, Modena, Italy. attiliocarlo.salgarelli@unimore.it
authors.forename: Attilio Carlo
authors.initials: AC
authors.lastname: Salgarelli
authors.forename: Marco
authors.initials: M
authors.lastname: Collini
authors.forename: Pierantonio
authors.initials: P
authors.lastname: Bellini
authors.forename: Paolo
authors.initials: P
authors.lastname: Capparè
mesh_terms: D000328:Adult; D006259:Craniocerebral Trauma / Q000601:surgery*; D004503:Education, Medical, Graduate; D005260:Female; D006258:Head and Neck Neoplasms / Q000601:surgery*; D006801:Humans; D007558:Italy; D008297:Male; D011183:Postoperative Complications; D012189:Retrospective Studies; D014139:Tracheostomy / Q000193:education* / Q000379:methods; D016896:Treatment Outcome