ABSTRACT

In addition to the permanent tracheotomy, temporary tracheotomy may be indicated in patients who may not meet the above criteria. Piccirillo and Thawley (7) recommend the use of temporary tracheotomy followed in 6 weeks by uvulopharyngopalatoplasty (UPPP) or tracheotomy at the same time as UPPP. When the patient recovers from UPPP, a polysomnogram (PSG) is performed with the tracheotomy capped and uncapped. If successful, the tracheotomy is decannulated and the wound is allowed to heal by secondary intention (7). Mickelson (4) also advocates tracheotomy for patients scheduled for other operative procedures that cannot tolerate perioperative CPAP. Thatcher and Maisel’s (8) recent retrospective study of 79 patients with severe OSA (mean BMI ¼ 41, RDI ¼ 81) showed that tracheotomy is 100% successful in treating the disease, but that decannulation occurred in only 16 patients (20%). Of the 16, five patients were decannulated after switching to CPAP, three were cured after UPPP, two lost weight and were successfully decannulated, and the remaining requested tracheotomy removal (8). To augment successful decannulation the surgeon should consider UPPP at the time of tracheotomy and include diet and weight loss counseling following surgery.