Tracheotomy

A Tracheotomy, also tracheotomy, is a surgically created access to the trachea. It is performed to secure the airway in special situations, especially in patients who need to be ventilated for a long time. Read all about the tracheotomy, when to use it and the risks involved.

Tracheotomy

What is a tracheotomy?

Tracheotomy is the surgical opening of the windpipe (trachea). The doctor secures this access with a metal or plastic cannula. The opening of the trachea created in this way is called a tracheostoma.

Various procedures are available for accessing the trachea: Standard tracheotomy is distinguished from dilated tracheotomy.

The patient can only speak after a tracheotomy if a special speaking tube has been inserted. These are fenestrated at the back wall, so air flows into the upper larynx as you exhale. This allows the patient to speak.

The tracheotomy is often confused with the coniotomy, in which the connecting tissue between the cricoid and thyroid cartilages of the larynx is punctured. In contrast to the "real" tracheotomy, the coniotomy is only performed in emergency situations with acute danger of suffocation, when other ventilation methods are no longer an option – for example, when the throat swells due to an allergic reaction or something has been inhaled into the trachea.

When to perform a tracheotomy?

A tracheotomy is often performed on patients who are likely to require artificial respiration for a long period of time (coma, chronic respiratory failure, etc.). Other situations in which a tracheotomy is necessary include:

  • Narrowing cancerous tumors in the nasal/throat area
  • Mid-face injuries
  • Skull base fracture
  • Malformations and injuries of the nasal passages, larynx and pharynx where tube ventilation is not possible
  • Nerve injuries associated with dysphagia

The advantage of a tracheotomy over intubation is that there is much less risk of injuring the vocal cords, nose or larynx during the procedure. In addition, the patient does not feel as much of a foreign body as when the tube is placed over the nose or mouth. Eating is also easier for such patients. However, one of the disadvantages is that the procedure is not performed in the patient’s room, but under sterile conditions.

What do you do when you have a tracheotomy?

Before the tracheotomy, the patient is given a general anesthetic by the anesthesiologist, so that he or she can survive the procedure asleep and without pain. In some cases local anesthesia is also sufficient. Then the surgeon disinfects the skin of the neck and covers the patient with sterile drapes, leaving out the neck region.

Standard tracheotomy

The doctor opens the trachea with a cross-section in the upper third of the trachea. For this purpose he also removes a small piece of cartilage. A metal or plastic cannula is inserted into the opening created in this way, which keeps the created access open. To prevent the tube from slipping, the doctor fixes it with sutures or a collar.

Dilated tracheostomy

In a dilated tracheotomy, the doctor punctures the skin and then uses scissors to bluntly push the puncture apart until it meets the trachea. He now punctures this with a needle and inserts a wire into the trachea. Over this wire, he advances a so-called dilator, which is used to expand the opening. Now he inserts the cannula.

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What are the risks of a tracheotomy??

Ventilation via a tracheotomy poses the following risks:

  • Cardiac arrest
  • Obstruction or slippage of the cannula
  • Incorrect placement of the cannula
  • bleeding
  • Air accumulation in the pleural space, with compression of the lungs if necessary
  • Air accumulation in the mediastinal cavity of the thoracic cavity
  • Wound infection
  • Connection between esophagus and trachea (tracheoesophageal fistula)
  • Closure of the windpipe
  • Narrowing of the trachea (tracheal stenosis)

The longer a patient requires the tracheostoma, the more likely said problems will occur.

What to consider after a tracheotomy?

After a tracheotomy, the air no longer flows through your mouth and nose into your lungs, but through the cannula directly into the trachea. This significantly limits your sense of smell and taste. The cannula also makes swallowing difficult, as it weighs down the larynx. This can cause saliva to accumulate and clog the cannula. Therefore, saliva must be aspirated regularly.

Once you no longer need to be ventilated through the tracheostoma, the doctor can remove the cannula. This usually happens when you exhale; anesthesia is usually not necessary.

After a standard tracheostomy, the wound can either be closed surgically with sutures or it will heal on its own after some time. Dilated tracheostomy does not require suturing; the wound usually heals faster than after a standard tracheostomy. A permanently visible scar in the neck region remains after a Tracheotomy nevertheless exist.

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