The fenestration operation in 1979

While it is rarely indicated today, fenestration of the horizontal semicircular canal has left its mark in otologic history. A significant number of patients with fenestrated ears are alive today requiring continued care. A review of both the technique of fenestration as well as the particular postoperative problems is presented to familiarize younger otologists involved in their management.     

Myocutaneous fenestration in sleep apnea patients

We present a patient with severe obstructive sleep apnea syndrome (OSAS), including O2 desaturations to 11%, who was successfully managed with myocutaneous fenestration tracheostomy. The myocutaneous fenestration technique employs bilateral horizontal skin-platysma advancement flaps sutured directly to a tracheal fenestra created between rings two to four. It conforms ideally to the unique physical and psychological demands of the sleep apnea patient. Rapid healing time and minimal granulation tissue, combined with a permanently functional, yet reversible and minimally disfigurative stoma, highlight the advantages of the technique over standard tracheostomy. The myocutaneous fenestration tracheostomy is uniquely applicable to the surgical treatment of patients with moderate to severe obstructive sleep apnea.