Ermergency & Elective Tracheotomy
09-10, 17:30–18:00 (Europe/Istanbul), Phoniatrics 3 (Hilton - Liz)

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 instructional course aims to provide participants with a practical and evidence-based understanding of the Björk flap tracheotomy technique and its role in preventing post-tracheotomy tracheal and stomal stenosis. The course will review the pathogenesis and risk factors of tracheal stenosis, compare conventional and flap-based tracheotomy techniques, and demonstrate the surgical steps, technical pearls, and advantages of the Björk flap approach. Particular emphasis will be placed on airway safety, rapid stoma maturation, reduction of tracheal trauma, facilitation of safer tracheostomy tube changes, and prevention of long-term complications, supporting its adoption as a best-practice technique.

Session Chair Session Chair
Mehmet Hakan Korkmaz
Moderator-Speaker Moderator-Speaker
Engin Dursun
Speaker Speaker
Hazem Saleh
Mehmet Hakan Korkmaz

He graduated from Hacettepe University Medical School and completed his Otolaryngology Residency training at the same institution. He did “Head Neck Surgery Clinical Fellowship” at Wayne State University, Michigan-USA, 1998-2000. He worked as Chief of Otolaryngology Depart. at Dışkapı Research and Training Hospital 2005-2011, and at Ankara Yıldırım Beyazıt University between 2011-2022, as a Professor of Otolaryngology. His main area of clinical and research interest has been “Head Neck Cancers and Surgery”, and have many published papers in several esteemed journals. He had been the board member of Turkish ORL-HNS Society (2012-2016), President of Otolaryngology Head Neck Surgery Society (2016-2018). He had been the founder chairman of “Turkish Ear Nose Throat Schools” between 2012 and 2016, which aimed to the postgraduate advanced training of ENT specialists. He is currently the President of Ear Nose Throat online platform (KBBplatform), which is involved in advanced trainings in the area of Otolaryngology, nationally. He is also the board member of Head Neck Cancer Society of Turkey.

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Hazem Saleh

Professor Hazem Mohamed Aly Saleh, MD, PhD, MSc, DEA, is Professor of Otolaryngology–Head and Neck Surgery at Cairo University. He received his specialist training in France more than two decades ago, building a distinguished academic and surgical career bridging the European and Egyptian medical systems.

He earned his Medical Doctorate (MD) in Otolaryngology–Head and Neck Surgery from Université Clermont-Ferrand. His advanced qualifications include a Diploma in Laser Surgery and a Diplôme d’Études Approfondies (DEA) in Neuroscience from Université de Montpellier, as well as a Diploma in Head and Neck Oncologic Surgery from Institut Gustave Roussy. He also holds a Master of Science in Otolaryngology from Cairo University and a French Master of Medical and Biological Sciences. In recognition of his academic merit, he was awarded the prestigious title of “Maître en Otorhinolaryngologie” by the French government.

Professor Saleh is an active member of leading international professional bodies, including the American Head and Neck Society, the French and Egyptian Societies of Otolaryngology–Head and Neck Surgery, the International Association of Phonosurgery, and the Union of European Phoniatricians.

His clinical expertise focuses on conservative laryngeal surgery, transoral laser microsurgery, and phonosurgery. Over a career spanning more than thirty years, he has authored and co-authored over 20 peer-reviewed publications and contributed to two internationally recognized textbooks: Complications of Head and Neck Surgery, edited by David Eisele, and Magnetic Nanoparticles, edited by Nguyen Thanh.

A frequent invited speaker, moderator, and chairperson at national, regional, and international conferences, Professor Saleh has also organized and chaired international meetings and specialized workshops on Laser in Laryngology in Egypt and across the Arab Gulf region. He further served as Organizer and Academic Supervisor of an intensive preparatory program at the French Center for Culture and Cooperation in Cairo, preparing Egyptian medical graduates for the French national residency examination (“Internat”).

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Engin Dursun

Prof. Dr. Engin Dursun was born in 1968 in Erzurum, Türkiye. He graduated from Istanbul University, Istanbul Faculty of Medicine in 1991. After completing his residency training in Otorhinolaryngology at the Ankara Training and Research Hospital, Ministry of Health, in 1995, he worked as a Specialist Physician at the same institution until 2000.

Between 2000 and 2001, Dr. Dursun worked as a Senior Specialist Physician at the 3rd Department of Otorhinolaryngology of the Ankara Numune Training and Research Hospital, Ministry of Health. Between 2001 and 2003, he served as Deputy Chief of Clinic in the Department of Otorhinolaryngology at the Ankara Oncology Training and Research Hospital; and between 2003 and 2011, he continued in the same position at the 3rd Department of Otorhinolaryngology of the Ankara Numune Training and Research Hospital. Between 2011 and 2012, he worked as an Instructor Physician in the same department.

Between 2002 and 2003, he completed a Clinical Fellowship in the Department of Otolaryngology–Head and Neck Surgery at the University of Arkansas for Medical Sciences (UAMS) in Little Rock, Arkansas, USA.

He was appointed Associate Professor in 2005 and promoted to Professor in 2012.

In 2012, he joined the Faculty of Medicine at Recep Tayyip Erdoğan University. Between 2012 and 2021, he served as Head of the Department and as Educational and Administrative Director of the Department of Otorhinolaryngology at the Training and Research Hospital. He also served as Head of the Department of Surgical Medical Sciences, Chairman of the Committee for Specialty Medical Education and Coordination, and as a Founding Board Member of the Undergraduate Medical Education Simulation Center.

In 2021, he was appointed as a faculty member in the Department of Otorhinolaryngology–Head and Neck Surgery, Faculty of Medicine, Lokman Hekim University. He is currently serving at the same institution and continues his duties as Director of the ViTAL (Virtual Training and Learning for Healthcare) Simulation Center; Board Member of the Center for the Treatment, Application, and Research of Cleft Lip and Palate and Related Anomalies (DUDAMER); Advisory Faculty Member of the Center for Innovation in Healthcare and Simulation-Based Education (SİNERG); and Member of the Advisory Board of the Lokman Hekim Health Science Journal. Between 2021 and 2025, he also served as Head of the Department, Clinical Sciences Coordinator for Undergraduate Medical Education, and Year 5 Coordinator.

He has taken active roles in numerous professional societies in Türkiye and currently serves as a Member of the Executive Board and Chair of the Schools Committee of the Turkish Society of Otolaryngology–Head and Neck Surgery. He is also the President of the Otolaryngology–Head and Neck Surgery Association (Ankara) and a member of the General Council of the Turkish Board of Certification in Otolaryngology–Head and Neck Surgery.

His special areas of interest include endoscopic surgery (endoscopic sinus surgery and endoscopic ear surgery), nasal polyposis, head and neck cancers, and medical education with a focus on simulation-based training.

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