Definition and Overview
Tracheotomy is the surgical procedure that creates a hole (called tracheostomy) in the neck to reach the windpipe or trachea, with the ultimate goal to help the patient breathe properly. The tracheostomy may be opened temporarily or permanently depending on its purpose.
Who Should Undergo and Expected Results
The procedure is recommended in cases of:
Blockages – This is the most common problem that causes breathing difficulties. The most common cause of this condition is when a foreign object enters the trachea and gets stuck there. It can also be due to inflammation like tracheal stenosis or the development of an abnormal growth between the trachea and the esophagus (tracheosophageal fistula) wherein food that passes through the esophagus ends up reaching the trachea and causing havoc on the lungs. A tumor can also block the airways like in the case of laryngeal, thyroid gland, or mouth cancers.
Injury – There are occasions when breathing is interrupted due to an injury. These are typically categorized as emergency cases that often require tracheotomy because it is imperative that the patient be able to breathe normally. These conditions include a stroke, paralysis due to spinal cord injury, cystic fibrosis, neck trauma, and facial fractures. Some conditions, like a sudden, severe allergic reaction may also require tracheotomy if the trachea becomes too swollen to allow the patient to breathe.
Presence of fluid in the airways – In cases of edema (a condition characterized by fluid build up in some parts of the body) and injuries that cause blood to fill the trachea or the lungs, tracheotomy is performed to drain the fluid. Also, there are times when phlegm cannot be expelled properly because the patient is too weak or in too much pain.
Preparation for surgery – A tracheotomy may be performed in preparation for major surgery to the head or neck to help the patient breathe normally during the procedure. Also, when a breathing apparatus cannot be inserted into the mouth to provide respiration for the patient while undergoing surgery, a tracheotomy is performed to support the machine. Sometimes, it’s a matter of urgency that necessitates the use of tracheotomy to open that airway passages for the patient to breathe.
How Does the Procedure Work?
A tracheotomy can be done in two ways depending on the conditions that necessitate it.
- Open tracheotomy – also called surgical tracheotomy, this is performed in an operating room under general anesthesia. The surgeon creates a horizontal incision near the lower end of the neck. From this incision, the surgeon deftly cuts the thyroid gland and exposes the windpipe, creating a hole where tracheostomy tube is inserted. The faceplate of the tube will be secured or tethered to a neck strap or it will be sutured onto the neck.
Conditions that make open tracheotomy the best options include:
- If the patient has blood coagulation abnormalities or problems, open tracheotomy makes it easier to see bleeding problems and take care of them before they become worse
If the patient has a weak spine, if the structure of the neck is impaired or when the patient has excessive fat on the neck
Percutaneous Dilational Tracheostomy (PDT)- This is a minimally invasive type of tracheotomy performed under general anesthesia. It is considered less serious that it may be performed in a hospital room instead of an operating room. The doctor makes a small incision in the throat through which a wire is inserted to reach the trachea. This wire is used to guide a medical instrument called a dilator, which will open up and expand the hole so the tracheostomy tube can be inserted. A neck strap is used to tether the tracheostomy tube to the neck to keep it in place. Those with recent neck injuries are good candidates for this procedure.
Possible Complications and Risks
A tracheostomy is considered a major surgical procedure and it involves tissues and nerves that are easily damaged. Common complications are bleeding and infection especially immediately after the procedure. Some patients may experience a collapsed lung or the procedure may cause accidental injury to the larynx or esophagus, both of which are located extremely close to the trachea. Long-term injuries can also happen like a blocked tracheostomy tube (when mucus accumulates in the tube), or a collapsed windpipe (when the tube is not properly placed).
- Lai SY, Mandel SJ, Weber RS. Management of thyroid neoplasms. In: Flint PW, Haughey BH, Lund LJ, et al, eds. Cummings Otolaryngology: Head & Neck Surgery. 5th ed. Philadelphia, PA: Elsevier Mosby; 2010:chap 124.