A Simplified Protocol for Tracheostomy Decannulation in Patients Weaned off Prolonged Mechanical Ventilation

Abstract Introduction The criteria for the removal of the tracheostomy tube (decannulation) vary from center to center. Some perform an endoscopic evaluation under anesthesia or computed tomography, which adds to the cost and discomfort. We use a simple two-part protocol to determine the eligibility and carry out the decannulation: part I consists of airway and swallowing assessment through an office-based flexible laryngotracheoscopy, and part II involves a tracheostomy capping trial. Objective The primary objective was to determine the safety and efficacy of the simplified decannulation protocol followed at our center among the patients who were weaned off the mechanical ventilator and exhibited good swallowing function clinically. Methods Of the patients considered for decannulation between November 1st, 2018, and October 31st, 2020, those who had undergone tracheostomy for prolonged mechanical ventilation were included. The efficacy to predict successful decannulation was calculated by the decannulation rate among patients who had been deemed eligible for decannulation in part I of the protocol, and the safety profile was defined by the protocol's ability to correctly predict the chances of risk-free decannulation among those submitted to part II of the protocol. Results Among the 48 patients included (mean age: 46.5 years; male-to-female ratio: 3:1), the efficacy of our protocol in predicting the successful decannulation was of 87.5%, and it was was safe or reliable in 95.45%. Also, in our cohort, the decannulation success and the duration of tracheotomy dependence were significantly affected by the neurological status of the patients. Conclusion The decannulation protocol consisting of office-based flexible laryngotracheoscopy and capping trial of the tracheostomy tube can safely and effectively aid the decannulation process.

Odontogenic Myxoma Involving the Maxilla: Case Report of a Rare Entity.

Odontogenic myxomas (OMs) are rare, benign, slow-growing tumors that may arise in the maxilla. They are known to have a female predilection and present as a painless mass commonly in the second or third decade of life, comprising 3-6% of all odontogenic tumors. They show a locally aggressive behavior, are radioresistant tumor and hence the need for early recognition and surgical resection. A high rate of recurrence has also been noted owing to its infiltrative pattern of growth and lack of capsule. Clinical and radiological aspects of maxillary OMs are not conclusive hence it is necessary to have a histopathological exam for the final diagnosis. We present a case of OM involving the maxilla in a 51-year-old female patient. The various histopathological differentials are also discussed.