Presentations 2020: OMFS

426 - Modification of a Tracheostomy Tube with a Customized Cad-Cam Designed Prosthesis to Improve Ventilation

F Shah MP Sarstedt PMV Clark, R Maggs D Owens LD Addy
Presented by: Fayjel Shah
Cardiff Dental Hospital

Introduction: A case report describing a customised computer aided design-computer aided manufacturing (CAD-CAM) designed approach to create a tracheostomy tube prosthesis to improve ventilation. A 44-year-old male who suffered from Duchenne’s Muscular Dystrophy, a debilitating condition which resulted in weakness of all muscles of his body, was referred secondary care. He required modification of his persistently leaking tracheostomy tube due to changes of the shape of his tracheal window (stoma). Progressive limited neck extension and dysphagia meant that he required a permanent tracheostomy age 27. Age 36 the tracheal window was refashioned, revealing that the stoma was large and ovoid in shape. Continued tightening of straps to achieve ventilation, resulted in difficulty talking due to a compressed trachea. The aim of this presentation is to describe the techniques used to develop a custom prosthesis attached to the standard tracheostomy tube to improve the seal around the stoma. Methods: The technique described used CAD-CAM to design and 3D print a prosthesis that could be easily attached and detached to the tracheostomy tube, allowing for the frequency in which the tubes are replaced. A pick-up impression in silicone putty was made of the site around the tracheostomy tube. Results: A functional prosthesis produced in fewer stages than previously reported in the literature. This technique adapts previously described methods using modern technological advancements where air leakage could not be resolved by conventional methods. An important consideration when impression making for this technique is patients’ neck and head position, in order to produce a comfortable prosthesis considering chest profile and adequate seal in normal positioning. Conclusion: The use of CAD/CAM has resulted in a simple, but accurate prosthesis for this patient suffering from the issue of air escaping and could be adopted for other patients with similar issues.
Consent Statement: Written informed consent for publication of their clinical details and/or clinical images was obtained from the patient/parent/guardian. A copy of the consent form is available for review by the the meeting organisers..

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