Tracheostomy procedure is a type of surgery that opens up the trachea in order to remove obstructions that cause the inability of breathing in individuals. The airflow may be blocked due to several reasons such as swelling, tumors, and foreign objects, paralysis of the muscles of the throat or by severe injury to the neck, nose or mouth. Depending on the case, an emergency tracheostomy or a surgical tracheostomy may be performed.
An emergency tracheostomy is done rapidly as the patient needs prompt help with breathing. There is no time to explain the procedure to the patients, but they are placed on their back and an incision is made by an emergency room physician or surgeon into the cricothyroid membrane (the thin part of the larynx). Through the cut, the surgeon inserts a tracheostomy tube which is connected to an oxygen bag or a mechanical ventilator. Tracheostomy tubes are specially designed tubes made of plastic or metal and which are used as pathways to conduct air into the lungs. The same tracheostomy tubes are used in both emergency and non-emergency tracheostomies.
Surgical tracheostomies are performed by surgeons in an operating room. They consist in making an incision into the skin of the neck over the trachea, between the Adam’s apple and top of the breastbone. The surgeon separates the muscles of the neck and divides the thyroid gland. As the tracheal rings are reached, a cut is made in the tough walls and a tracheostomy tube is then placed. The tube may be held into place with the help of a tracheostomy tube holder or by taping or suturing it. The tube is connected to an oxygen ventilator.
The pediatric tracheostomy is similar to the surgery performed in adults. However, in a pediatric tracheostomy the tracheal incision is usually done vertically.
Post operatory tracheostomies care includes hospital care for up to five days in cases when there are no complications. Postoperative care may include chest x-rays especially in children to detect possible complications or to check if the tube is still correctly placed. Antibiotics may be given to prevent infection and painkillers are usually prescribed to relieve the pain at the operation site. Patients are completely recovered within two weeks after the procedure was performed.
Most of the patients need few days to accommodate with the tracheostomy tube which may impair their ability to speak. After being released from the hospital, patients may use warm compresses to ease the pain caused by the incision. It is recommended that the area of operation is kept dry as well as avoiding contact with water or food or small particles that could go through the tube and cause severe breathing problems. Patients who underwent permanent tracheotomies will need a second surgery to remove the opening; otherwise the tube is taken out four to 10 days after surgery.
Tracheostomy is a safe type of surgery but which carries certain risks, as any type of surgery does. Tracheostomy procedure is more risky in older patients or infants, smokers, alcoholics or patients who suffer from respiratory diseases.