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figure 39-6 Silicone T-Y tracheal tube for carinal placement. A, The tube with a stout bronchoscopic foreign body forceps beside it. B, The bronchial limbs of the Y tube are squeezed together by the forceps to allow insertion via the stoma. Water-soluble lubricant eases the passage.

a hoarse or a whispered voice, but one that is intelligible. Usually, the patient is able to swallow without aspiration after a short period of time. A speech pathologist can help to train the patient to avoid aspiration. Generally, the epiglottis and false cords protect sufficiently against aspiration.

In order to meet patients' objections to the protrusion of the sidearm of a T tube through a cervical stoma, Keszler removed most of the sidearm in some patients and placed the capped end subcutaneously, depending on the stump to hold the tube in place.101 have not used this technique, which today becomes another form of inlying stent that is complicated in placement.

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