Tracheotomy

Tracheotomy is a surgical procedure that creates a temporary opening in the trachea.

Tracheotomy is used to treat the patients with upper airway obstruction.

The trachea is the part of the airway (or breathing passage) commonly known as the "windpipe".

Benefits Of Tracheotomy

A tracheotomy is a temporary or permanent treatment for a variety of causes of breathing difficulties in which the creation of a new breathing pathway is required, by-passing the nose, mouth, and throat.

Patients with upper airway obstruction usually have neoplastic, infectious, or functional disorders that compromise ventilation. Common examples include nasopharyngeal tumors, epiglottis, Ludwig's angina, and bilateral vocal cord dysfunction.

Patients are typically stabilized initially with translaryngeal intubation and subsequently converted to tracheotomy if the airway obstruction is not remedial within 10-14 days.

Tracheotomy is also used in patients with poor control of airway secretions. Glottic dysfunction resulting from trauma or cerebrovascular disease may require tracheotomy not only to prevent aspiration of particulates but also to allow their removal by frequent airway suctioning.

Tracheotomy improves the efficiency of airway suctioning in mechanically ventilated patients compared with translaryngeal endotracheal tubes.

Although this benefit may not be clearly important in most patients, instances of airway suppuration with copious secretions or airway hemorrhage warrant tracheotomy to prevent airway obstruction and ventilatory compromise.

Tracheotomy Treatment Procedure:

While tracheotomy used to be done as an emergency, it is now done more on an optional basis to protect the airway, better clean the airway and to provide more oxygen to the lungs.

• The trachea is a tube that runs from the bottom of the larynx into the chest where it divides into the bronchi, the tubes that go to each of the lungs.
• At the back of the mouth and nose the air passages form the pharynx, which continues into the larynx (voice box).
• The thyroid gland lies in front of the trachea. The esophagus (food pipe) lies behind it
• The innominate artery passes in front of the lower tracheal rings of the trachea. This artery is a branch of the aorta and gives rise to the arteries to the right side of the brain and right arm
• The trachea is a firm structure formed from rings of cartilage to ensure that the airway always remains open. Its function is to maintain and protect the airway. The trachea is lined with mucus glands, which humidifies air as it passes through the trachea and catches small particles before they reach the lungs.
• The trachea also has specialized hair like structures called cilia that move rhythmically to clean mucus and particles back up to the throat. The trachea also has many defensive cells that kill organisms that enter the trachea
• The trachea is supplied by nerves that are part of the cough reflex that helps get rid or irritants

Tracheotomy Complications

Early Complications that may arise during the tracheotomy procedure or soon thereafter include:

• Air trapped underneath the skin around the tracheotomy or in deeper layers of skin in the chest that may leak around the lungs
• Injury to the nerve that moves the vocal cords
• Damage to the tube going to the stomach (esophagus)
• Bleeding

However, many of these early complications can be avoided or dealt with appropriately with an experienced surgeon in a hospital setting.

Later Complications that may occur while the tracheotomy tube is in place include:

• Unintentional removal of the tracheotomy tube (accidental decannulation)
• Infection in the trachea and around the tracheotomy tube

Delayed Complications that may outcome after longer-term presence of a tracheotomy include:

• Development of a small connection from the trachea to the esophagus
• Development of bumps (granulomas) that may need to be surgically removed before decannulation can occur
• Thinning (erosion) of the trachea from the tube rubbing against it
• Once the tracheotomy tube is removed, it may leave a small hole between the trachea and the skin, which may need surgical closure.
• Narrowing or collapse of the airway above the place of the tracheotomy, possibly requiring an additional surgical procedure to repair it.