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Definition of Tracheostomy Procedure
Tracheostomy is a surgical opening created in the trachea to allow air to enter the lungs, bypassing the upper throat and mouth. A tracheostomy may be temporary or permanent. The doctor may perform a tracheostomy when extensive surgery such as to treat laryngeal cancer results in removing the shared structures of the throat that allow air to flow into the trachea, or when neurologic damage necessitates long-term mechanical ventilation. Swallowing disorders that impede normal epiglottal function (which keeps food and water from entering the trachea) and sleep apnea that fails to respond to other treatments may also make tracheostomy necessary.
In most cases the doctor performs tracheostomy with the person under general anesthesia. The incision is typically between the second and third or third and fourth tracheal cartilages in the front of the neck, to make an opening about an inch to an inch and a quarter (2 to 3 centimeters) in length. The doctor then inserts a tube into the opening to maintain a passageway into the trachea. The kind of tube and finishing process for the incision depends on whether the doctor intends the tracheostomy to be temporary or permanent. An inflatable cuff may hold the tracheostomy tube in place, though some designs are cuffless. Most tracheostomies use an inner and outer cannula (tube), allowing removal of the inner cannula for cleaning. A device called an obturator allows changing of the entire tracheostomy tube and guides reinsertion of the new tube.
Most people who are conscious are able to resume regular eating and speaking. Speech requires closing off the tracheostomy tube to bring air through the throat and past the vocal cords. Potential complications of tracheostomy include bleeding after the operation, infection, and blockage of the tube with mucus or foreign material that enters the tube from the outside. Conscientious hygiene, including daily cleansing of the tracheostomy site and tube, is essential. It is important to humidify the air breathed into the tracheostomy, such as with a room humidifier or moist gauze (rewetted as needed) placed over the tube opening. Home health nursing agencies provide education and training in how to care for a tracheostomy for people who have tracheostomies and their family members or caregivers. Even a long-term stoma will heal closed should the person’s condition improve such that normal breathing ability returns and the doctor can remove the tube.
See also EPIGLOTTIS; OXYGEN THERAPY; SPINAL CORD INJURY; TRAUMATIC BRAIN INJURY (TBI).
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