Tracheostomy

What is a tracheostomy?

A tracheostomy is the surgical creation of a stoma (hole) in the front of the neck and through the trachea (windpipe). A tube is usually placed in the opening. The tube provides an airway and access to remove lung secretions and excess mucus. Once the tube is in place, you will breathe through the tube instead of your nose or mouth. A tracheostomy can be temporary or permanent, depending on the condition for which it is needed.

The word tracheostomy is often used interchangeably with tracheotomy. However, tracheotomy is the term for the surgical incision or cut, while tracheostomy is the term for the opening that the incision creates.

A tracheostomy is a common but major surgery with significant risks and potential complications. You may have less invasive treatment options available depending on your specific circumstances. You should consider getting a second opinion about all your treatment choices before having a tracheostomy.

Other procedures that may be performed

In an emergency, an emergency medicine doctor or general surgeon may perform a cricoidotomy. A cricoidotomy creates a hole in the trachea above the spot that may be later used for a tracheostomy. A cricoidotomy is a temporary treatment used to save your life until you are stable or a more permanent tracheostomy can be done.

Why is a tracheostomy performed?

A tracheostomy is a major surgical procedure that your doctor may recommend when air is not getting to your lungs. Your doctor may only consider a tracheostomy for you if other treatment options with less risk of complications have failed. Talk with your doctor about all of your treatment options and consider getting a second opinion.

Your doctor may recommend a tracheostomy for the following conditions:

• Blocked airway
• Congenital (present at birth) airway defects
• Injuries, such as airway burns from smoke, steam, gases or chemicals
• Long-term coma
• Long-term need for a mechanical ventilator because you cannot breathe on your own. This is the most common reason for a tracheostomy.
• Need for removal of excess lung secretions or mucus due to a chronic lung disease
• Paralysis
• Severe allergic reactions or infections
• Spinal cord injuries
• Surgery around or removal of the larynx (voice box). This may be necessary for diseases such as neck or throat cancer.
• Surgery of the head, neck or trachea
• Swallowing problems, which may be due to conditions such as a stroke

How is a tracheostomy performed?           

A general surgeon or an otolaryngologist will lead your surgical team to perform your tracheostomy in a hospital. An otolaryngologist is a doctor who specializes in the treatment of diseases and conditions of the ears, nose and throat. In emergency situations, an emergency medicine physician may perform a  tracheostomy.

A tracheostomy is an open surgical procedure. An open surgery incision allows your doctor to directly view and access the surgical area. Your surgeon will first make cuts to expose your trachea (windpipe). Then, he or she will cut through the rings of cartilage that make up your trachea. Once your surgeon creates the stoma (hole), he or she will place a tracheostomy tube in the opening.

Your surgical team will confirm the position and placement of the tracheostomy tube using a bronchoscope. A bronchoscope isa thin, lighted instrument with a small camera that transmits pictures of the inside of your body to a computer screen. Your doctor sees the surgical area on the video screen as he or she performs the surgery. When the positioning is confirmed, your team will secure the tracheostomy tube in place using tape or ties or straps that go around your neck.

Open surgery causes some trauma to tissues, so it generally takes some time to recover. Your doctor will determine how long you need to stay in the hospital based on your procedure, age, medical history, and general health.

Types of anesthesia that may be used