A tracheostomy is a surgical procedure performed for restricted airways
A tracheostomy is a surgical procedure performed for restricted airways

A tracheostomy is a surgical procedure that involves creating an opening in the front part of the neck to place a tube into a person’s windpipe. The tube is inserted through a cut in the neck in the space between the thyroid gland and breastbone. This allows air to enter the lungs. Breathing occurs through the tube, bypassing the mouth, nose, and throat. This procedure may be either temporary or permanent.

A tracheostomy is performed for several reasons, all involving restricted airways. It may be done during an emergency when the airway is blocked, or it could be used when a disease or other problem makes normal breathing impossible. Conditions that may require a tracheostomy include the following:

  • Birth defects of the airway causing breathing problems
  • Anaphylaxis (serious life-threatening allergic reaction)
  • Burns of the airway from inhalation of corrosive materials
  • Cancer in the neck
  • Severe lung disease
  • Coma
  • Diaphragm dysfunction
  • Facial burns or surgery
  • Infection
  • Severe injuries to the lungs, vocal cords, throat, and nose
  • Need for a prolonged respiratory or ventilator support
  • Obstruction of the airway by a foreign body
  • Obstructive sleep apnea (difficulty breathing during sleep)
  • Paralysis of the muscles used in swallowing
  • Severe neck or mouth injuries
  • Vocal cord paralysis

How is a tracheostomy performed?

A tracheostomy is usually done under general anesthesia, but in emergencies, patients are administrated local anesthesia.

The type of procedure depends on why the patient needs a tracheostomy and whether the procedure was planned. There are essentially two options:

  • A surgical tracheotomy can be performed in an operating room or a hospital room. The surgeon usually makes a horizontal incision through the skin at the lower part of the front of the patient’s neck. The surrounding muscles are carefully pulled back, exposing the windpipe (trachea). At a specific spot on their windpipe near the base of their neck, the surgeon creates a tracheostomy hole.
  • Minimally invasive tracheotomy (percutaneous tracheotomy) is typically performed in a hospital room. The surgeon makes a small incision near the base of the front of the patient’s neck. A special lens is fed through the mouth so that the surgeon can view the inside of the throat. Using this view of the throat, the surgeon guides a needle into the windpipe to create the tracheostomy hole, then expands it to the appropriate size for the tube.

For both procedures, the surgeon inserts a tracheostomy tube into the hole. A neck strap attached to the faceplate of the tube keeps it from slipping out of the hole, and temporary sutures can be used to secure the faceplate to the skin of the neck.

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What are risks involved in a tracheostomy procedure?

Every surgical procedure carries the risk of infection and excessive bleeding along with anesthesia complications that include headache, drowsiness, and vomiting. Below are few common risks involved in a tracheostomy procedure:

  • Damage to the thyroid gland in the neck
  • Damage to the larynx (voice box) or airway with resultant permanent change in voice (rare)
  • Lung collapse
  • Airway obstruction and aspiration of secretions 
  • Need for further and more aggressive surgery
  • Air trapping in the surrounding tissues or chest. In rare situations, a chest tube may be required.
  • Scarring of the airway or erosion of the tube into the surrounding structures
  • Need for a permanent tracheostomy. This is most likely the result of the disease process which made the tracheostomy necessary and not from the actual procedure itself.
  • Impaired swallowing and vocal function
  • Scar formation (cosmetic)

What is the outcome after a tracheostomy procedure?

A tracheostomy is usually an emergency procedure. If a tracheostomy is temporary, patients may have a small scar left when the tube is removed. However, patients with a permanent tracheostomy may need assistance to get used to the tube. Doctors may advise cleaning and maintaining the tube. Although people with tracheostomies have initial difficulty speaking, they may adjust and learn to speak within a year.

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Medically Reviewed on 8/19/2020
References
(https://emedicine.medscape.com/article/865068-overview)