Tracheotomy

Encyclopedia : T : TR : TRA : Tracheotomy

Completed tracheostomy:
1 - Vocal cords
2 - Thyroid cartilage
3 - Cricoid cartilage
4 - Tracheal cartileges
5 - Balloon cuff

A tracheotomy or tracheostomy is a surgical procedure performed on the neck to open a direct airway through an incision in the trachea (the windpipe). (Technically, the former term, with the Greek root tom- meaning "to cut," refers to the procedure of cutting into the trachea, whereas the latter term, with the root stom- meaning "mouth," refers to the procedure of making a semipermanent or permanent opening. Tracheostomy can also refer to the result of the procedure, i.e. the opening itself.)

Contents

1 Indications for a tracheotomy
2 How a tracheotomy is performed
3 Complications
4 In Sport/Popular Culture
5 See also
6 External links

Indications for a tracheotomy

The indications for tracheotomy are:

Acute setting - maxillofacial injuries, large tumors of the head and neck, congenital tumors, e.g. branchial cyst, acute inflammation of head and neck, and
Chronic / elective setting - when there is need for long term mechanical ventilation and tracheal toilet, e.g. comatose patients, surgery to the head and neck.

In emergent settings, in the context of failed endotracheal intubation or where intubation is contraindicated, cricothyroidotomy or mini-tracheostomy may be performed in preference to a tracheostomy.

How a tracheotomy is performed

Curvilinear skin incision along relaxed skin tension lines (RSTL) between sternal notch and cricoid cartilage
Midline vertical incision dividing strap muscles
Division of thyroid isthmus between ligatures
Elevation of cricoid with cricoid hook
Placement of tracheal incision. An inferior based flap or Bjork flap (through second and third tracheal rings) is commonly used. The flap is then sutured to the inferior skin margin. Alternatives include a vertical tracheal incision (pediatric) or excision of an ellipse of anterior tracheal wall.
Insert tracheostomy tube (with concomitant withdrawal of endotracheal tube), inflate cuff, secure with tape around neck or stay sutures.
Connect ventilator tubing

It is also possible to make a simple horizontal incision between tracheal rings (typically 2nd and 3rd) for the incision. Bjork flaps may produce more intratracheal granulation tissue at the site of the incisions, making it less favorable to some surgeons.

Complications

Immediate - pneumothorax or pneumomediastinum, tracheoesophageal fistula, injury to great vessels or recurrent laryngeal nerves, bleeding, e.g. from divided thyroid isthmus
Early - secretions and mucus plugging, dislodged tube, respiratory arrest and post obstructive pulmonary edema (when tracheostomy is performed in a patient with longstanding upper airway obstruction, and is dependent on hypoxia drive for respiration)
Late - bleeding from tracheoinnominate fistula (can be torrential), tracheal stenosis (from ischemia induced by a cuffed tracheostomy tube)

In Sport/Popular Culture

In an episode of M*A*S*H, Father Mulcahy performs a tracheostomy on a patient whose swollen tongue prevents them from breathing.
At the 1994 San Marino Grand Prix, Brazilian Ayrton Senna had an emergency tracheotomy performed on track after his fatal accident. Senna died later that afternoon.
At the 1995 Australian Grand Prix, Finnish Mika Häkkinen crashed out due to a tyre failure and had his life saved by an emergency tracheotomy performed on track.

External links

[Aaron's tracheostomy page] (Caring for a tracheostomy)
[tracheostomy tube pictures]