To the Editor.—
I found the article quite well done. However, I did find one point troublesome. The authors give the impression that endotracheal intubation and tracheotomy are mutually exclusive, with tracheotomy the safer procedure.In our experience, this condition is best treated by the combined anesthesia and ear, nose, and throat services.First, a decision is made in the question of nasotracheal intubation vs tracheotomy. In cases where tracheotomy is the chosen treatment, the patients are first orally intubated as an emergency measure. Thus, the chance of acute respiratory decompensation is eliminated. Then tracheotomy may be done, with the endotracheal tube in place, under optimal surgical and respiratory conditions.In skilled hands, tracheal intubation is a small risk as compared to tracheotomy in a severely hypoxic child with impending respiratory collapse.