Tracheostomy for obstructive sleep apnea: Indications, techniques, and selection of tubes

Flap tracheostomy is our most hygienic and successful operation for bypassing the upper airway in patients with obstructive sleep apnea. The surgical technique involves using a skin incision large enough to elevate subcutaneous and subplatysmal flaps with a full subcutaneous lipectomy. Superior skin flaps are elevated to the level of the hyoid bone and inferiorly to the level of the clavicle. When all of the fat from between the sternomastoid muscles and the deep layer of the superficial cervical fascia has been removed, the trachea is incised with an H-incision. The skin flaps are sutured to the mucous membrane of the trachea and a specially made long Shiley tube is inserted. With maturation of the stoma, a Montgomery tracheal cannula is substituted. Hygiene to the flap provided by medical personnel, as well as in home care and hydration, is paramount to success of the tracheostomy in obstructive sleep apnea.