Tracheotomy is a surgical procedure that creates a hole called tracheostomy through the front of a person’s neck and in the wind pipe called trachea. The hole is created to provide an air passage to help a person breathe when the usual path for breathing is impaired or obstructed. Tracheostomy is generally needed when the health condition of a patient warrants the use of a ventilator to help the person breathe. In rare cases, tracheotomy is performed out of emergency when the airway is suddenly blocked due to a trauma to the face or neck. If a tracheostomy is not required, it could be allowed to heal and shut by its own self or may be surgically closed. People who may have to spend the rest of their life in ventilator may require a permanent tracheostomy.
A tracheotomy is generally required when the patient needs to be put on a ventilator, blocked airway due to vocal cord paralysis or throat cancer, neurological problems that require suctioning of the windpipe to clear the airway, severe trauma to the head or necks that interrupts breathing or other emergency situations. Most of the time, the procedure is performed in a hospital setting. But, in emergency cases, it may have to be performed at the sight of an accident.
How the procedure is performed
It is performed in an operating room under general anaesthesia. If the surgeon prefers, a local anaesthetic may be used to numb the neck and the throat. Depending on the type of hole required and the time available, two types of tracheostomy are available.
Surgical tracheostomy – is performed in an operating room. During this procedure, the surgeon makes a horizontal incision through the skin at the lower part of the neck. Pulling back the surrounding muscles carefully, he cuts through a small portion of the thyroid gland and the trachea is exposed. At a specific spot on trachea, the surgeon creates a hole and inserts the tube used for tracheostomy into the hole. A strap is attached to the tube to keep it in its place and suturing is done to cover the incisions.
Minimally Invasive tracheotomy
Minimally Invasive tracheotomy – is performed in a hospital room. A small incision is made near the base of the front neck. Using a special lens fed through the mouth, the surgeon views the inner area of the throat and guides a needle into the wind pipe to create a tracheostomy hole. The hole is made large enough to place the tracheostomy tube. A strap is placed to keep the tube in its place. The surgery may require several days of hospital stay. Speech will improve after a few days. You may be on tube feed for several days. The tube has to be cleaned regularly to prevent infection.
Authored by Dr Shailesh Pandey, ENT Specialist
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