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To the Editor.—Dr. Wind's article "Reflections on Difficult Decannulation" approaches this problem philosophically. Some of the opinions seem to be based upon reasoning and hypothesis rather than scientific fact but the exhaustive bibliography reinforces the conclusions.
Some of the questions raised are pertinent and could well afford a field for future research which would increase our knowledge of laryngotracheal physiology and should be pursued further.
Many of the questions posed have little relationship to difficult decannulation in infants and young children. It is hard to correlate the response of the larynx to a sudden fearful situation with decannulation in an infant. Lesions of the recurrent laryngeal nerves and parathyroid glands are only remotely connected with tracheostomy since neither of these structures are directly in the surgical field. Cannulas made of various materials have not appreciably improved the decannulation problem so that the different chemicals involved seem to be insignificant.
PUTNEY FJ. DIFFICULT DECANNULATION. Arch Otolaryngol. 1971;94(4):380–381. doi:10.1001/archotol.1971.00770070572022
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