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January 27, 1975

Airway... Instantly

Author Affiliations

Massachusetts Eye and Ear Infirmary Needham, Mass

JAMA. 1975;231(4):347. doi:10.1001/jama.1975.03240160013016

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To the Editor.—  Otolaryngologists would agree with the author that his technique will certainly produce an "instant airway."Unfortunately, the technique described ensures the production of subglottic stenosis because of damage to the conus elasticus due to the unavoidable scarring when the surgical wound heals. It is true that the incision advocated lies inferior to the level of the true vocal cords, but tentlike membrane that descends as the conus elasticus inferior to the true cords to attach at the cricoid ring will be damaged. I have seen this happen.It is for this reason that "low" tracheotomy through the third, fourth, and fifth rings of the trachea is standard procedure for most laryngologists.Incidentally, the cricothyroid branch of the superior thyroid artery can be damaged on one or both sides by the incision described by the author since this vessel runs transversally across the cricothyroid membrane to communicate with