Maintenance of airway during laryngectomy in a patient with carcinoma of the larynx is best done by which if the following?
Tracheostomy has also been divided into high, mid or low. A high tracheostomy is done above the level of thyroid isthmus (isthmus lies against II, III, and IV tracheal rings). It violates the first ring of the trachea. Tracheostomy at this site can cause perichondritis of the cricoid cailage and subglottic stenosis and is always avoided. The only indication for high tracheostomy is carcinoma of the larynx because in such cases, total larynx anyway would ultimately be removed and a fresh tracheostomy made in a clean area lower down. Amid tracheostomy is the preferred one and is done through the II or III ring and would entail the division of the thyroid isthmus or its retraction upwards or downwards to expose this pa of the trachea. A low tracheostomy is done below the level of the isthmus. The trachea is deep at this level and close to several large vessels; also there are difficulties with tracheostomy tube which impinges on the suprasternal notch. Ref: PL Dhingra; Textbook of EAR, NOSE and THROAT; edition 7; page no 359
Tracheostomy
Laryngeal mask airway
Laryngeal tube
Combitube
Larynx