Education  |   June 2019
Postlaryngectomy Stoma versus Tracheostomy: Implications for Perioperative Airway Management
Author Notes
  • From the Department of Anesthesiology and Perioperative Medicine, University of Texas, M.D. Anderson Cancer Center, Houston, Texas.
  • Address correspondence to Dr. A. Truong: atruong@mdanderson.org
Article Information
Education / Images in Anesthesiology / Airway Management
Education   |   June 2019
Postlaryngectomy Stoma versus Tracheostomy: Implications for Perioperative Airway Management
Anesthesiology 6 2019, Vol.130, 1034-1035. doi:https://doi.org/10.1097/ALN.0000000000002586
Anesthesiology 6 2019, Vol.130, 1034-1035. doi:https://doi.org/10.1097/ALN.0000000000002586
Patients with a postlaryngectomy stoma present important and often unrecognized implications for perioperative airway management. Because of its appearance and location, the stoma (A) is often mistaken for a tracheostomy (B). A tracheostomy is a surgical opening to access the tracheal lumen with the entire larynx remaining intact (D). In contrast, after total laryngectomy, the trachea is brought to the skin as a stoma, which no longer has any anatomical connection with the oropharyngeal cavity and digestive tract (C). Consequently, it is impossible to deliver oxygen to the lungs with nasal cannula, face mask, or bag-mask ventilation. Attempts to intubate the trachea from above the stoma via the oral or nasal route will be unsuccessful. Similarly, because pulmonary aspiration of gastric contents cannot occur, these patients do not need to be kept nil per os for surgery.1  Conversely, the risk of foreign body aspiration is significant because of the direct communication of the stoma with its surroundings.2  Care must be taken when handling small objects such as syringe covers near an uncovered stoma.