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While intubation will in all probability render the need of tracheotomy less frequent in the future, the latter must and will always remain the classical operation and dernier ressort. Intubation has a rather more limited range of usefulness than tracheotomy, being most applicable in very young children. Even after O'Dwyer's tube is inserted, the surgeon must be in continual readiness to perform tracheotomy, lest the former operation prove insufficient. O'Dwyer's tubes are liable to become displaced; secretions dry in them and are not easily removed; sometimes they occasion difficulty in swallowing; in inserting them the membrane may be detached and pushed into the lumen of the trachea, blocking respiration completely, and sometimes necessitating a hasty tracheotomy to save the patient from immediate suffocation. The pressure of the tube in the larynx and trachea often causes ulceration. Extension of the membrane beyond the end of the tube may eventutually require tracheotomy
LOHRSTORFER F. A RECORD OF CASES TRACHEOTOMIZED.Read before the Northeastern Medical Society of Michigan, March, 1892. JAMA. 1892;XVIII(15):452–454. doi:10.1001/jama.1892.02411190012001b
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