Evaluation of the mobility of the vocal folds after percutaneous translaryngeal tracheostomy intervention (Fantoni technique) on ICU patients

The treatment of a critical respiratory insufficiency during a decompensated phase can cause a prolonged period of mechanical ventilation. So a tracheostomic access may be necessary in order to continue the weaning process from the ventilator.

In our study we wanted to evaluate the mobility of the true vocal chords and occurrence of the dyslocation of cricoarytenoid cartilage after the percutaneous tracheostomy with the Fantoni technique, which we applied on 70 patients from 1997 until 2001. All 70 patients were treated with the same tracheal access method in the space between the first and the second tracheal ring.

Our study required an endoscopic evaluation protocol with a direct fibrolaringoscopic access to the patient. So we evaluated the conformation of the upper respiratory-digestive ways and the mobility of the larynx and of the vocal chords (precisely: symmetric movement in adduction and abduction of vocal folds) and occurrence of cricoarytenoid cartilage lesion. We repeated the measurements 7 days after the intervention when we substituted the endotracheal cannule (Time 1) and after 20 days (Time 2).

In the follow up we controlled our patients 2 months after the tracheostomy (Time 3) to find out about eventual anatomic and functional changes of the larynx. Considering the patient's condition we then decided about the possible weaning from the tracheostomic cannule.

Exclusion criteria from patient enrollment were:

• 1. Patients affected by severe neurologic pathology in which the damage of the central nervous system could eventually interfere with the mobility of the upper respiratory-digestive ways.

• 2. Patients affected by severe peripheral neuropathy.

• 3. Patients with previous surgery of the larynx, the thyroid gland and the laterocervical areas (lymphadenectomy, carotid endarteriectomy, etc.)

Conclusions

We found no change of mobility of the vocal folds in any patient nor dislocation of the cricoarytenoid cartilage at any time.

The complicances we observed were due to the percutaneous technique that consisted in initial lesions like edema (four patients at Time 1, one patient at Time 2) and hematoma (two patients at Time 2) which were not visible anymore after 20 days and cartilage fracture in three patients. On the long run we observed synechie (three patients at Time 2, four patients at Time 3) and cicatric stenosis (three patients at Time 2 and 3).