Preoperative Ultrasonographic Evaluation of Neck Anatomy for Tracheostomy in Adult Patients
Pana Klamkam, MD¹
, Jakkrit Chantavanich, MD¹, Krissamon Limthornbenjapol, MD¹, Suthee Rattanathummawat, MD¹, Metha Aungaphinant, MD², Ekasak Chantrapannik, MD³, Patsorn Worahan, MD¹
Affiliation : ¹ Department of Otorhinolaryngology, Phramongkutklao Hospital, Bangkok, Thailand; ² Department of Radiology, Phramongkutklao Hospital, Bangkok, Thailand; ³ Department of Anesthesiology, Phramongkutklao Hospital, Bangkok, Thailand
Abstract
Background: Tracheostomy is a surgical procedure that involves creating an opening in the anterior tracheal wall to establish a permanent stoma for respiration. Indications for tracheostomy include prolonged mechanical ventilation, pulmonary toilet, surgical access, and airway obstruction. Ultrasound is increasingly used preoperatively due to its wide availability, noninvasive nature, mobility, affordability, and ease of use.
Objective: To evaluate the anatomy of the tracheostomy surgical site, including subcutaneous tissue thickness, thyroid isthmus thickness, and tracheal ring width, and to assess the correlation among these factors, operative time, and intraoperative blood loss.
Materials and Methods: This study was a prospective descriptive design involved 48 patients undergoing tracheostomy. Clinical histories and physical examinations were conducted, indications for tracheostomy documented, and data on operative time and intraoperative blood loss collected. Preoperative ultrasonography was performed in the operating room, followed by the surgical procedure.
Results: Among 48 patients (56.3% male and 43.8% female), the most prevalent comorbidities were hypertension (70.8%), dyslipidemia (50.0%), diabetes mellitus (35.4%), chronic kidney disease (22.9%), and prior cerebrovascular disease (16.7%). The primary indication for tracheostomy was prolonged mechanical ventilation (85.4%). Ultrasound findings revealed an average subcutaneous tissue thickness of 0.54 cm, an average thyroid isthmus thickness of 0.32 cm, and an average tracheal ring width of 2.20 cm. The average operative time was 37.62 minutes, and the average intraoperative blood loss was 14.68 mL. There were no serious post-operative complications.
Conclusion: Using preoperative ultrasound to evaluate neck anatomy is appropriate for patients who struggle to find comfortable positions during surgery. Additionally, increased subcutaneous tissue thickness and thyroid isthmus may extend the operative time.
Received 17 June 2025 | Revised 19 January 2026 | Accepted 9 February 2026
J Med Assoc Thai 2026;109(7):584-90
Keywords : Tracheostomy; Ultrasound; Preoperative assessment; Subcutaneous tissue; Thyroid isthmus; Tracheal ring width
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