Tracheostomy
is an operation in which an artificial opening
is made in the front of the windpipe (trachea)
through the skin of the neck. A tube is
inserted, through which breathing may continue
until the normal airway can be restored.
Tracheostomy has saved many lives and may
be carried out as an emergency when life
is threatened by obstruction to the airway.
It is also commonly performed on people
who can't breath for themselves. In this
case breathing can be maintained artificially
by an air pump.
A permanent
tracheostomy is usually necessary after
the voice box (larynx) has been removed
surgically.
When it should be done
Tracheostomy should be done whenever there is
any substantial risk that the air supply
will be cut off or severely reduced. This
is always the most immediate danger to life.
Why it is necessary
Various conditions
and circumstances can lead to an obstructed
airway and require a tracheostomy. These
include:
- An abnormality
present at birth that involves a narrowed
larynx or trachea
- An injury
to the neck that compresses or obstructs
the airway
- A cut
throat
- Swelling
of the lining of the larynx or trachea
from inhaling smoke or steam
- Acute
inflammation of the epiglottis (Epiglottitis)
- Inflammation
of the larynx and air tubes (laryngotracheobronchitis)
- Diphtheria
- Blockage
of the larynx by a foreign body
- Advanced
Cancer of the tongue, throat, larynx or
upper trachea
- Cancer
of the thyroid gland
- Paralysis
of the vocal cords, allowing food or other
material to get into the larynx
- Any other
condition or state (such as coma, Stroke,
Brain tumour, poisoning, head injury,
Tetanus or Multiple sclerosis) that can
allow material other than air to enter
the lungs.
How it is performed
This operation is usually carried out under a
general anaesthetic, but can be performed
under a local anaesthetic (see the article
on Anaesthesia).
A vertical,
midline cut is made in the skin over the
windpipe, between the Adam's apple and the
notch in the top of the breastbone. This
exposes the cartilage rings on the windpipe.
Two of these are cut through and a double-lined
tracheostomy tube is inserted. Tapes attached
to the wings of the flange are then tied
at the back of the neck to keep the tube
in place. If the patient can't breathe spontaneously,
the tube is connected to a mechanical ventilator.
|
Tracheostomy
