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Medical Terminology - Tracheostomy (Surgical Procedures)*

Why have the operation?

Tracheostomy has been understood since the first century BC.  It is an operation to create an opening through the front of the neck and into the windpipe (trachea) in order to allow a patient to breathe.  Tracheostomy is done for two main reasons:

In combination with a ventilation machine, the procedure allows safe artificial respiration and may also be performed:

• in some cases of laryngeal tumor
• following the accidental swallowing of a large foreign body

What is the physical cause of the problem?

If the body is deprived of oxygen for more than a few minutes, the outcome may be brain damage or even death.  A variety of conditions and circumstances can endanger the air supply by causing obstruction.  These include:

• congenital (inherited) abnormality of the larynx or trachea
• acute inflammation of sensitive tissues in the throat
• neck or mouth injury involving major tissue deformity and displacement (such as a cut throat)
• inhalation of corrosive material, smoke, or steam
• the presence of a large foreign body that sticks to the larynx
• paralysis of the muscles in the mouth, throat, or neck, particularly those that affect swallowing and whose impairment might permit food or drink that is swallowed to go into the lungs instead of to the stomach
• longterm unconsciousness or coma (during which saliva may also find its way to the lungs)
• swelling of the laryngeal lining following radiation therapy for cancer
• removal of the larynx to treat cancer

In most of these cases the tracheostomy is only temporary.  A few cases - such as surgical removal of the larynx - demand tracheostomy on a permanent basis.

What is the goal of surgery?

A short tube is passed through the front of your neck and into the windpipe.  This acts as a mouth and nose for the purpose of breathing air freely and normally in and out of the lungs.

Exactly what is involved in the surgical operation?

Preliminary steps.  Preparation demends on whether or not the surgery has to be performed as an emergency.  If there is time, your air passages will be cleared using methods such as:

• the administration of antibiotic drugs
• medication with expectorants or inhalants
• postural drainage (involves positioning the patient so that secretions can be removed by gravity, aided by slapping or thumping)
• physical therapy (the physical therapist helps with postural drainage and teaches effective breathing)

You may also undergo:

• counseling (which will include supporting you in quitting smoking cigarettes if you smoke)
• lung function tests to find out how effectively the oxygen is getting from the atmosphere to the blood

If your breathing is already labored, a tube may be placed in your mouth and down the trachea to assist respiration.  This is an emergency measure necessary to overcome obstruction in the larynx.  It may be done at any time,  Most commonly, a tube is passed after the general anesthetic has been given for surgery but may suddenly become necessary before there is time to arrange surgery.  In an acute emergency a tube may be passed under local anesthetic or even without an anesthetic.  It is often a life-saving procedure.

Step-by-step surgical procedure.  You will be positioned lying on your back, your head tilted up and backward, your neck extended with the support of a pillow.
     The skin of the neck is opened, the neck muscles are carefully separated, and the central part of the thyroid gland is cut through or pulled upward.  This exposes the tough cartilage rings that make up the outer wall of the trachea.  The surgeon then cuts into two of these rings and inserts a tracheostomy tube, which effectively closes off all flow of air in the windpipe above that point.  Each half of the thyroid gland has its own blood supply and its function is not affected by being cut across the isthmus or pulled higher into the larynx.  The neck muscles are replaced, and the skin edges are sewn up around the flange (the flat portion) of the tube where it exits the windpipe.  A surgical gauze dressing is applied under the flange of the tube, which is held firmly in place by a tape passed around the neck and tied to each side of the flange of the tracheostomy tube.
     If you are unable to breathe spontaneously, the tube will be connected to a mechanical ventilator.  The ventilator ensures that blood is at all times fully oxygenated so personal regulation of breathing is not necessary, nor would it be possible.  A person on a ventilator will always be lying quietly in bed.

What is it like immediately after the operation?

On waking up, you should find that you have been provided with some means of communication - like a bell or buzzer to summon, and a scribble pad for messages.  Normal speech will be impossible because air is no longer passing between the vocal cords.  The air in your room will most likely be humidified because air is no longer filtered and moistened through you nose and mouth.  Humidifying should help to reduce mucus production, but the nursing staff will drain the tracheostomy tube, especially during the first two days.
     If your larynx (voice box) is intact and open, you may find it possible to speak by temporarily covering the opening of the tracheostomy tube with one finger so that air once more passes between the vocal cords.
     For a time you may be fed intravenously through a drip attached to one hand or wrist.  But how you feel, what you are able to do, and how quickly you recover is likely to depend on the condition that required you to have the tracheostomy in the first place.

What are the longterm effects?

If the tracheostomy is temporary, the tube will eventually be removed.  The opening in both windpipe and skin will close over and heal very quickly, leaving a minimal scar on the outside.  If the tracheostomy tube is permanent, the hole remains open.  It does tend to close, but the tube prevents this from happening completely.  Sometimes further surgery is needed to widen it.

This is only a guide.  It is not meant to supercede any physician's or manufacturer's instructions.