Background: Tracheal or stomal stenosis is a dreaded complication after tracheotomy. The incidence of tracheal stenosis after tracheotomy reaches up to 21% in certain series. The inferiorly based flap tracheotomy, known as Björk flap tracheotomy, was first described by Björk in 1952 following a patient mortality from a displaced cannula. It involves a flap of the anterior tracheal wall secured to the inferior edge of the skin incision by a non-absorbable silk suture. The Björk flap tracheotomy aims to lower the shearing pressures created by movement of the tracheotomy tube during coughing and breathing. Also, its resulting tract matures quickly. Furthermore, the trachea is pulled up to the skin and fastened even if the stoma has not been fully developed. This makes the tracheotomy tube changes safer and simpler.

Only 11% of Björk flap tracheotomy cases show narrowing of the tracheal lumen. The narrowing never exceeds 50% of the lumen. Furthermore, Björk flap tracheotomy cases show a decreased rate of stomal stenosis than the conventional tracheotomy ones. The chances of tracheal or stomal stenosis are higher in conventional tracheotomy because of the higher risk of stomal injury. Furthermore, the likelihood of peristomal granulation is lower in the Björk flap tracheotomy. These granulations are less likely to block the flap-based mature stoma.

Methodology: We will review the pathogenesis of the post tracheotomy tracheal stenosis. Then we will describe the surgical technique, tips and pearls of the Björk flap tracheotomy, detailing the differences between it and the conventional tracheotomy. We will underline the advantages of the Björk flap tracheotomy, especially in the prevention of tracheal stenosis.

Conclusion: Björk flap tracheotomy is much safer than the conventional tracheotomy. It shows fast recovery and is associated with less incidence of tracheal stenosis. The inverted U-shaped flap preserves the tracheal cartilage and maintains the lumen after tracheotomy. Björk flap tracheotomy is not far from becoming recommended as a best practice technique to lower the incidence and severity of post tracheotomy tracheal stenosis.

This is a panel about advences in Tracheal Regeneration

Diseases of the thyroid and parathyroid glands—both endocrine organs—are frequently encountered in worldwide. Approximately 5–15% of all thyroid nodules are malignant in nature. Thyroid cancers account for about 90% of all endocrine neoplasms. Reported rates of metastasis to the central and lateral neck compartments in thyroid cancers range from 20% to 80%.

Diagnosis, treatment, and follow-up of diseases of these organs require a multidisciplinary approach involving Endocrinology, Nuclear Medicine, Pathology, and Surgery. In recent years, various surgical approaches such as lobectomy, total thyroidectomy, central lymph node dissection, and minimally invasive thyroidectomy have been applied, differing from past practices. With the advancement of technology, endoscopic and robotic surgery have also been introduced into thyroid surgery in recent years.

Although guidelines set forth by the American and European Thyroid Associations exist for surgical management of thyroid diseases, different surgical practices are preferred in various parts of the world. Due to the location of the thyroid in the neck and the potential complications of its surgery—such as recurrent or superior laryngeal nerve injury, tracheal or laryngeal trauma, and swallowing difficulties—this topic is of particular importance to the specialties of Otorhinolaryngology and Head & Neck Surgery.

The most effective way to avoid complications is a thorough knowledge of the surgical anatomy of these organs and mastery of surgical techniques.

In this course, current thyroid surgery techniques and methods to prevent possible complications will be presented, accompanied by visual educational materials.