British Journal of Oral and Maxillofacial Surgery (2005) 43, 87—88

TECHNICAL NOTE

The use of the laryngeal mask in surgical

tracheostomy
A.J. Gibbons∗, M.J. Evans, S.G. Fenner, N.R. Grew

Maxillofacial Unit, New Cross Hospital, Wolverhampton, West Midlands WV10 0QP, UK

Accepted 20 August 2004

Available online 27 October 2004

KEYWORDS Summary The laryngeal mask may be used as an airway during surgical tra-
Laryngeal mask; cheostomy. This techniques has several advantages over conventional oral endo-
Tracheostomy tracheal intubation.
© 2004 The British Association of Oral and Maxillofacial Surgeons. Published by
Elsevier Ltd. All rights reserved.

Introduction The muscle relaxant is used to prevent coughing

The laryngeal mask airway (LMA) is a simple de-
vice for obtaining an intra-operative airway that is
generally quicker and easier to use than an endo-
tracheal tube. Although it reduces surgical access
to the mouth it can be used for minor oral surgery.1
LMA’s are used as an alternative to endotra-
cheal tubes during percutaneous dilatational tra-
cheostomy and have been shown to be safe, effec-
tive and to reduce operating time.2 We report the
technique of using LMA’s for surgical tracheostomy.
Technique
A reinforced LMA is introduced after a standard in-
duction using propofol, opioid and muscle relaxant.
* Corresponding author. Tel.: +44 1902 307999;
fax: +44 1902 643147.
E-mail address: andrew gibbons@hotmail.com
(A.J. Gibbons).
during tracheostomy tube insertion rather than to
facilitate ventilation or the introduction of the LMA.
After induction and before surgery the anaesthetist
ensures that easy ventilation of the lungs of the
paralysed patient via the LMA is possible. If this is
not possible then a conventional endotracheal tube
is placed.
The neck is then prepared with antiseptic solu-
tion and the head draped to provide a sterile oper-
ating field. During surgery, both surgeon and anaes-
thetist take care that the LMA is not dislodged. The
tracheostomy is performed and the tracheostomy
tube inserted without disturbing the head towels
or manipulating the airway. The scrub nurse and
surgeons can remain in position at the head of the
table (Fig. 1).
Discussion
The use of the LMA for tracheostomy has several
advantages over conventional endotracheal tech-
niques. Initial placement of the LMA causes less dis-

0266-4356/$ — see front matter © 2004 The British Association of Oral and Maxillofacial Surgeons. Published by Elsevier Ltd. All rights reserved.
doi:10.1016/j.bjoms.2004.08.019
88
Figure 1. Insertion of tracheostomy tube without distur-
bance of operating field.
turbance of the patient’s pulse and blood pressure.
When cutting a window in the trachea no delay in
the procedure is incurred whilst the head towels are
loosened and the anesthetist withdraws the endo-
tracheal tube to a level above the level of the inci-
sion, potentially compromising the operating field
sterility. Most importantly, the surgical team has
more space to work in.
A.J. Gibbons et al.
This technique cannot be applied to all patients.
The patient must not be obese and have good
chest compliance for adequate ventilation. Fur-
thermore, the patient should have no gross defor-
mity of the hypopharynx and not be at risk of gastro-
oesophageal reflux. Reasonable mouth opening is
also necessary but this can be less than that needed
for conventional laryngoscopy. Where there is con-
cern about preserving the airway, the tracheostomy
should be performed under local anaesthetic.
The use of a LMA to enable a tracheostomy to be
performed after a failed attempt at laryngoscopy
for conventional intubation, has been reported.3
The patient had a recurrent nasopharyngeal car-
cinoma with limited mouth opening and neck mo-
bility following previous radiotherapy. Despite the
success of the technique in managing a difficult air-
way, the use of a LMA for more standard surgical
tracheostomies was not proposed.
We have used this technique in over 20 elective
surgical tracheostomies for head and neck malig-
nancy patients with uncompromised airways. The
only complication encountered was dislodgement
of the mask during surgery in one case. The anaes-
thetist adjusting the mask easily rectified this.
We recommend the laryngeal mask airway be
considered for carefully selected surgical tra-
cheostomy patients.
References
1. Malden NJ. The use of the laryngeal mask in minor oral
surgery. Br J Oral Maxillofac Surg 2003;41:343—5.
2. Dosemeci L, Yilmaz M, Gurpinar F, Ramazanoglu A. The use
of the laryngeal mask airway as an alternative to the endo-
tracheal tube during percutaneous dilational tracheostomy.
Intensive Care Med 2002;28:63—7.
3. Critchley LA, Cheang R. The LMA Elective tracheostomy
and nasopharyngeal carcinoma. Anaesth Intensive Care
2002;30:813—8.