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An improved glass tracheostomy tube
NEW INSTRUMENTS
An Improved Glass Tracheostomy Tube JEAN 6. deKERNION, ALFRED S. KETCHAM,
M.D., Bethesda,
Maryland
M.D., Bethesda,
HERBERT SWERDLOW, D.D.S., Bethesda,
According to the American Cancer Society there are about 25,000 people presently in the United States with a laryngeal stoma, the result of surgery for cancer of the pharynx and larynx [I]. Once primary healing has occurred, many of these patients have no difficulty maintaining the airway. However, a significant number find it necessary to wear a prosthesis constantly or intermittently to prevent laryngeal stricture. The standard Luers double cannula tracheostomy tube, which has had extensive application in this institution, has not proved to be completely satisfactory. It is difficult to clean, tarnishes rapidly, and is patent to inhalation of foreign materials. Clothing can not be worn against the prosthesis, making cosmetic concealment difficult. Increased production of tracheobronchial secretions, and crusting of the inner chamber have often discouraged patients from wearing a tracheostomy tube. Maintenance of moisture is a major problem, and tracheitis sicca occasionally occurs. Acute or chronic infection often results from the local irritation. A meticulous retrospective review of ten years, and a four year prospective analysis of experience with various technics of tracheostomy at this institution revealed little difference in the incidence of stoma1 complications. It was also apparent that some patients have a sensitivity to materials used in the manufacture of tracheostomy tubes. AS a result of these observations, it w&s decided to attempt to develop a more effective, less irritating tracheostomy prosthesis. A silicone rubber tube was reported by Moore [g] which has the advantages of flexibility and lack of irritation. The diameter, curvature, and length From the Surgery Branch, National Cancer Institute. and the Dental Services Branch, National Institute of Dental Research, National Institutes of Health, Bethesda, Maryland 20014. Vol. 117, May 1969
Maryland Maryland
of the tube can be readily adjusted to the individual patient’s needs. Initially, in this institution, an acrylic tube was made from denture resin (polymethylmethacrylate). Later a similar prosthesis of milled acrylic plastic was designed. These tubes were nonirritating and easy to clean, but had two distinct disadvantages: t,hey did not conform to the tracheal curvature, causing irritation to the posterior wall; and the materials were eventually damaged by the tracheobronchial secretions. This led to the development of the case-hardened glass tracheostomy tube, (Fig. 1.) The tube is handblown to the proper length, diameter, and curvature, and consists mainly of the curved endotracheal tube, capped by a perforated sphere. (Fig. 2.) The retention ring fits outside of the trachea in the soft tissue and is effective in securing the tube, although initially it must be tied in proper position. More than one hundred patients are now wearing glass prostheses, with no difficulties encountered. These prostheses are easily cleaned in boiling water, and are totally nonirritating. There is virtually no contact with the peristomal skin, accounting for the absence of skin change and infection. The perforated spherical cap provides humidity retention and no cases of tracheitis sicca have been reported. Clothing can be worn directly over the cap, the lateral perforations allowing adequate exchange of air. Breakage in the trachea has not occurred, even after trauma. The cost of production is low, and the tube can easily be made by any skilled glassblower. The only potential disadvantage is the danger of breakage. Less fragile materials are being tested, which will minimize this danger, and still allow preservation of the basic design. Injection-molding acrylic resin tubes meet these requirements, but are expensive to produce. Durable ceramic materials may prove to be more feasible after further investigation. 759
deKernion,
Ketcham,
and Swerdlow
Fig. 1. Glass tracheostomy contact with the peristomal Fig. 2.
Schematic
tube in a postlaryngectomypatient. The spherical cap has little skin and provides moisture retention.
drawing of the glass tracheostomy
Summary The difficulties associated with the standard metal tracheostomy tube are enumerated. -4 casehardened glass tracheostomy tube has been developed, which is less irritating, and provides greater humidity retention. Satisfactory results have been observed in more than one hundred post,laryngectomy patients.
760
tube.
References 1. Rehabilitating
Laryngectomees. Publication of the International Association of Laryngectomees, sponsored by the American Cancer Society, New York, 1965. 2. MOORI,:, 0. S. A new flexible silicone rubber tracheostomy tube. Am. J. Surg., 114: 551, 1967.
The
American
Journal
of Surgery
An Improved Glass Tracheostomy Tube JEAN 6. deKERNION, ALFRED S. KETCHAM,
M.D., Bethesda,
Maryland
M.D., Bethesda,
HERBERT SWERDLOW, D.D.S., Bethesda,
According to the American Cancer Society there are about 25,000 people presently in the United States with a laryngeal stoma, the result of surgery for cancer of the pharynx and larynx [I]. Once primary healing has occurred, many of these patients have no difficulty maintaining the airway. However, a significant number find it necessary to wear a prosthesis constantly or intermittently to prevent laryngeal stricture. The standard Luers double cannula tracheostomy tube, which has had extensive application in this institution, has not proved to be completely satisfactory. It is difficult to clean, tarnishes rapidly, and is patent to inhalation of foreign materials. Clothing can not be worn against the prosthesis, making cosmetic concealment difficult. Increased production of tracheobronchial secretions, and crusting of the inner chamber have often discouraged patients from wearing a tracheostomy tube. Maintenance of moisture is a major problem, and tracheitis sicca occasionally occurs. Acute or chronic infection often results from the local irritation. A meticulous retrospective review of ten years, and a four year prospective analysis of experience with various technics of tracheostomy at this institution revealed little difference in the incidence of stoma1 complications. It was also apparent that some patients have a sensitivity to materials used in the manufacture of tracheostomy tubes. AS a result of these observations, it w&s decided to attempt to develop a more effective, less irritating tracheostomy prosthesis. A silicone rubber tube was reported by Moore [g] which has the advantages of flexibility and lack of irritation. The diameter, curvature, and length From the Surgery Branch, National Cancer Institute. and the Dental Services Branch, National Institute of Dental Research, National Institutes of Health, Bethesda, Maryland 20014. Vol. 117, May 1969
Maryland Maryland
of the tube can be readily adjusted to the individual patient’s needs. Initially, in this institution, an acrylic tube was made from denture resin (polymethylmethacrylate). Later a similar prosthesis of milled acrylic plastic was designed. These tubes were nonirritating and easy to clean, but had two distinct disadvantages: t,hey did not conform to the tracheal curvature, causing irritation to the posterior wall; and the materials were eventually damaged by the tracheobronchial secretions. This led to the development of the case-hardened glass tracheostomy tube, (Fig. 1.) The tube is handblown to the proper length, diameter, and curvature, and consists mainly of the curved endotracheal tube, capped by a perforated sphere. (Fig. 2.) The retention ring fits outside of the trachea in the soft tissue and is effective in securing the tube, although initially it must be tied in proper position. More than one hundred patients are now wearing glass prostheses, with no difficulties encountered. These prostheses are easily cleaned in boiling water, and are totally nonirritating. There is virtually no contact with the peristomal skin, accounting for the absence of skin change and infection. The perforated spherical cap provides humidity retention and no cases of tracheitis sicca have been reported. Clothing can be worn directly over the cap, the lateral perforations allowing adequate exchange of air. Breakage in the trachea has not occurred, even after trauma. The cost of production is low, and the tube can easily be made by any skilled glassblower. The only potential disadvantage is the danger of breakage. Less fragile materials are being tested, which will minimize this danger, and still allow preservation of the basic design. Injection-molding acrylic resin tubes meet these requirements, but are expensive to produce. Durable ceramic materials may prove to be more feasible after further investigation. 759
deKernion,
Ketcham,
and Swerdlow
Fig. 1. Glass tracheostomy contact with the peristomal Fig. 2.
Schematic
tube in a postlaryngectomypatient. The spherical cap has little skin and provides moisture retention.
drawing of the glass tracheostomy
Summary The difficulties associated with the standard metal tracheostomy tube are enumerated. -4 casehardened glass tracheostomy tube has been developed, which is less irritating, and provides greater humidity retention. Satisfactory results have been observed in more than one hundred post,laryngectomy patients.
760
tube.
References 1. Rehabilitating
Laryngectomees. Publication of the International Association of Laryngectomees, sponsored by the American Cancer Society, New York, 1965. 2. MOORI,:, 0. S. A new flexible silicone rubber tracheostomy tube. Am. J. Surg., 114: 551, 1967.
The
American
Journal
of Surgery