Comparing tracheostomy techniques: Bjork flap vs. tracheal window

Maeve M. Kennedy, Yassmeen Abdel-Aty, David G. Lott

Research output: Contribution to journalArticlepeer-review


Objectives: Various operative techniques are used to perform tracheostomies. The objective of this study was to evaluate patient factors that influence the decision to perform a Bjork flap or a window. Methods: A retrospective review was conducted of all patients who underwent tracheostomies from January 2015 to December 2019 at a tertiary care medical center. All patients underwent tracheostomy with either a Bjork flap or a window. Charts were reviewed for demographics, comorbidities, indication for tracheostomy, operative details, and complications. Results: A total of 217 tracheostomies were evaluated, of which 104 (47.9%) had a Bjork flap and 113 (52.1%) had a window. Bjork flap was significantly more likely to be performed in patients with a higher average body mass index (p = 0.05), requiring ventilatory support (p = 0.0001), or had a stroke (p = 0.0140). A window was used significantly more in patients with prior neck dissection (p = 0.0110) or neck radiation (p < 0.0001). No significant difference was observed for post-op bleeding, returning to the operating room, or days to decannulation. In all tracheostomies, thrombocytopenia was found to significantly correlate with post-op bleeding (p = 0.0006), while blood thinner use did not. Conclusion: Bjork flaps were more likely to be performed in those with a history of prolonged mechanical ventilation and elevated body mass index. Windows were performed more frequently in patients with a head and neck cancer history. Future prospective studies are needed to compare the outcomes of these techniques and their impacts on the trachea long term.

Original languageEnglish (US)
Article number103030
JournalAmerican Journal of Otolaryngology - Head and Neck Medicine and Surgery
Issue number6
StatePublished - Nov 1 2021


  • Airway
  • Bjork flap
  • Trachea
  • Tracheostomy
  • Tracheotomy

ASJC Scopus subject areas

  • Otorhinolaryngology


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