{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,11,28]],"date-time":"2025-11-28T17:14:46Z","timestamp":1764350086995},"reference-count":25,"publisher":"Cambridge University Press (CUP)","issue":"4","license":[{"start":{"date-parts":[[2012,1,30]],"date-time":"2012-01-30T00:00:00Z","timestamp":1327881600000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/www.cambridge.org\/core\/terms"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["J. Laryngol. Otol."],"published-print":{"date-parts":[[2012,4]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec id=\"S0022215111003380_sec1\"><jats:title>Objective:<\/jats:title><jats:p>In an era in which percutaneous tracheostomies are frequently performed in \u2018suitable\u2019 necks, more technically complex cases are referred to the otolaryngologist. We describe the surgical technique used and close cooperation required in securing the airway of a morbidly obese patient.<\/jats:p><\/jats:sec><jats:sec id=\"S0022215111003380_sec2\"><jats:title>Case report:<\/jats:title><jats:p>A 52-year-old, morbidly obese man with significant comorbidities was referred for surgical tracheostomy following spinal fractures. This was complicated by a previous percutaneous dilatational tracheostomy scar. Tension-free skin advancement was not possible with a deeply plunging trachea; a vertical skin incision was dropped inferiorly to the sternum for access. A size 8 Shiley XLT Proximal Extension cuffed tracheostomy tube was inserted successfully.<\/jats:p><\/jats:sec><jats:sec id=\"S0022215111003380_sec3\"><jats:title>Conclusion:<\/jats:title><jats:p>We describe safe airway surgery in a morbidly obese man, and outline requirements including the use of a specially designed operating table, the need for an elongated proximal limb tracheostomy tube, and the use of a distal two-flap technique for access to a deeply plunging trachea.<\/jats:p><\/jats:sec>","DOI":"10.1017\/s0022215111003380","type":"journal-article","created":{"date-parts":[[2012,1,30]],"date-time":"2012-01-30T10:47:05Z","timestamp":1327920425000},"page":"435-438","source":"Crossref","is-referenced-by-count":5,"title":["Surgical tracheostomy in morbidly obese patients: technical considerations and a two-flap technique for access"],"prefix":"10.1017","volume":"126","author":[{"given":"S G","family":"Khoo","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"N","family":"Rajaretnam","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"56","published-online":{"date-parts":[[2012,1,30]]},"reference":[{"key":"S0022215111003380_ref24","doi-asserted-by":"publisher","DOI":"10.3109\/14017438309109886"},{"key":"S0022215111003380_ref3","doi-asserted-by":"publisher","DOI":"10.1111\/j.1365-2044.2004.03707.x"},{"key":"S0022215111003380_ref12","doi-asserted-by":"crossref","first-page":"56","DOI":"10.1067\/mhn.2001.112198","article-title":"Adjustable length tracheostomy tube for the morbidly obese and thick neck patient: a prototype","volume":"124","author":"Lim","year":"2001","journal-title":"Otolaryngol Head Neck Surg"},{"key":"S0022215111003380_ref21","doi-asserted-by":"publisher","DOI":"10.1111\/j.1365-2044.1983.tb12261.x"},{"key":"S0022215111003380_ref17","article-title":"Retrosternal percutaneous tracheostomy: an approach for predictably impossible classic tracheostomy","volume":"290","author":"Biderman","year":"2010","journal-title":"Crit Care Res Pract"},{"key":"S0022215111003380_ref2","doi-asserted-by":"publisher","DOI":"10.1186\/cc5725"},{"key":"S0022215111003380_ref6","doi-asserted-by":"publisher","DOI":"10.1155\/DTE.4.13"},{"key":"S0022215111003380_ref13","doi-asserted-by":"publisher","DOI":"10.1016\/j.jcrc.2008.06.001"},{"key":"S0022215111003380_ref22","doi-asserted-by":"publisher","DOI":"10.1111\/j.1365-2044.1984.tb07263.x"},{"key":"S0022215111003380_ref8","doi-asserted-by":"publisher","DOI":"10.1378\/chest.117.5.1426"},{"key":"S0022215111003380_ref10","doi-asserted-by":"publisher","DOI":"10.1097\/00003246-200205000-00006"},{"key":"S0022215111003380_ref11","doi-asserted-by":"publisher","DOI":"10.1016\/j.jamcollsurg.2005.12.009"},{"key":"S0022215111003380_ref25","first-page":"1156","article-title":"A permanent tube-free tracheostomy in a morbidly obese patient with severe obstructive sleep apnea syndrome","volume":"4","author":"Eliashar","year":"2002","journal-title":"Isr Med Assoc J"},{"key":"S0022215111003380_ref1","doi-asserted-by":"publisher","DOI":"10.1186\/cc5147"},{"key":"S0022215111003380_ref4","doi-asserted-by":"publisher","DOI":"10.1378\/chest.96.1.178"},{"key":"S0022215111003380_ref5","doi-asserted-by":"publisher","DOI":"10.1186\/cc1827"},{"key":"S0022215111003380_ref7","doi-asserted-by":"publisher","DOI":"10.1186\/cc10047"},{"key":"S0022215111003380_ref9","doi-asserted-by":"publisher","DOI":"10.1097\/00007632-200209010-00026"},{"key":"S0022215111003380_ref14","doi-asserted-by":"publisher","DOI":"10.1378\/chest.08-0079"},{"key":"S0022215111003380_ref18","doi-asserted-by":"publisher","DOI":"10.1097\/00005537-200211000-00006"},{"key":"S0022215111003380_ref15","doi-asserted-by":"publisher","DOI":"10.1097\/MLG.0b013e3181847a78"},{"key":"S0022215111003380_ref16","doi-asserted-by":"publisher","DOI":"10.1097\/01.MLG.0000163107.80668.12"},{"key":"S0022215111003380_ref19","doi-asserted-by":"publisher","DOI":"10.1093\/bja\/aen065"},{"key":"S0022215111003380_ref20","doi-asserted-by":"publisher","DOI":"10.1016\/j.otohns.2010.03.007"},{"key":"S0022215111003380_ref23","doi-asserted-by":"publisher","DOI":"10.1016\/S0039-6109(16)42291-7"}],"container-title":["The Journal of Laryngology &amp; 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