Tracheostomy

If the trachea is obstructed, an incision should be made immediately in the neck to establish a direct passage to the trachea and outside air. This allows air to bypass the nose and mouth, which can be crucial for saving lives. In cases of suffocation caused by throat obstruction, an immediate neck tracheostomy is necessary.

If a person faints, they should receive rescue breaths by sealing the mouth over theirs to facilitate breathing. Chest compressions can also provoke shortness of breath; however, applying pressure to the heart can help restore its function. If the trachea is blocked during this situation, an alternative tracheostomy may be required to clear the obstruction. Within a minute, the obstruction should be addressed, and then rescue breaths can be administered. Timely intervention is essential for the patient’s survival. Further treatment can then take place in a hospital setting. It is believed that this treatment approach was documented as early as biblical times.

This surgical procedure was initially developed to address suffocation but is now also used to safeguard and clear the lungs of any obstructions or dead space.

When breathing difficulties arise due to nervous system disorders, assistance can be provided through artificial ventilation. Establishing an air passage in the trachea is essential for this process. Individuals who suffer injuries to the head or neck may die from suffocation if immediate action is not taken, and a tracheostomy may be the best preventative measure.

Causes of Bronchial Obstruction

In children, toys can pose a significant risk of airway obstruction. For example, when a torn balloon is accidentally inhaled, its fragments may enter the trachea, leading to a blockage and potential dizziness.

The throat serves as a shared passage for both breathing and eating. Consequently, food particles can become lodged in the windpipe if one eats while talking, crying, or laughing.

Additionally, if a child vomits, leftover food can enter the throat during inhalation. This is why fasting is required before anesthesia for surgery.

Tumors in the throat, alongside other diseases leading to obstruction and shortness of breath, often necessitate a tracheostomy.

Some individuals may only require a breathing tube for a short period, while those who have undergone cancer surgery may need it for life. People in deep unconsciousness often need a breathing tube until they regain consciousness.

A tracheostomy can also affect the ability to speak, leading to issues such as ulcers in the bronchi and potential bleeding. Young children who undergo this procedure may forget how to breathe through the nose, complicating recovery from conditions like asthma. Continued efforts should be made to consider tracheal removal. A trachea with a valve can be fitted to help with speech; when air passes through the throat, it can be used for communication.

Today, numerous devices exist to facilitate speech for individuals without a larynx. Surgical options can also create a new larynx for those who need it.

Individuals using a neck snorkel cannot swim, smoke, or engage in strenuous activities. However, these limitations are becoming less significant due to the availability of modern, well-designed assistive devices.

Benefits of Tracheal Intervention

i) It serves as a substitute for tracheal obstruction, facilitating improved breathing.

ii) Excess bronchial mucus can be effectively expelled.

iii) It reduces airway resistance.

iv) The tracheal tube (specifically, the 040 tracheal tube) is easy to fit, allowing for artificial respiration when necessary.

Indications for Tracheal Puncture

1) Laryngeal web

2) Neck injury

3) Injury to the larynx

4) Laryngeal obstruction

5) Breathing obstruction due to tuberculosis

6) Obstruction from syphilis

7) Benign tumors and carcinomas of the larynx and pharynx

8) Bilateral laryngitis

9) Foreign objects obstructing the larynx

10) Carcinomas of the Kentish gland

11) Needed during removal of neck lymph nodes

12) Depression of the respiratory center

13) Cerebrovascular accident (stroke)

14) Head injury

15) Poliomyelitis

16) Situations where excessive sleeping pills are taken

17) Encephalitis

18) Myasthenia gravis or neuromuscular block

19) Tetanus (during disease progression)

Types of Tracheostomy

i) Temporary tracheostomy 

ii) Permanent tracheostomy 

Surgical Anatomy

The trachea is situated centrally in the neck. The outer part of the trachea is just beneath the skin, while the inner half lies lower. The trachea is covered by skin and subcutaneous tissue. The isthmus of the thyroid gland is located over two to three tracheal rings. The anterior jugular vein lies anteriorly. The sternohyoid muscles are located on both sides.

If an incision is made above the junction of the Kentish gland, it is referred to as an upper colostomy. A puncture made below this junction is called a lower tracheal puncture.

Anesthesia

The procedure is typically performed under general anesthesia, but it can also be conducted without it in certain situations.

Emergency Tracheostomy Procedure

The tracheostomy is positioned with the left middle finger and thumb. An incision is made from the thyroid notch to the superficial notch, cutting through the skin and subcutaneous tissue. The trachea is then stabilized with the left index finger. A tracheal dilator is used to insert a tracheostomy tube through this incision. If significant bleeding occurs, appropriate measures must be taken.

In an elective tracheostomy, a transverse incision is made below the cricoid cartilage over the pretracheal fascia after cutting the skin and overlying connective tissue. The connective tissue of the Kentish gland is displaced upwards, revealing the first three or four tracheal rings.

After controlling any bleeding, the trachea is stabilized with a curved hook passed beneath the cricoid cartilage. An incision is made in the trachea just above the fourth ring, and the tracheal loops are carefully incised from bottom to top. Xylocaine is injected into the incision to minimize coughing.

Small sections are cut away on either side of this incision to create an egg-shaped opening, facilitating the insertion of the tracheal tube, cleaning of the tracheal area, and preventing damage to the tracheal rings.

Adverse Effects of Tracheostomy

High tracheostomy may lead to laryngeal narrowing or injury to the cricoid cartilage and potential damage to the thymus gland.

Side Effects

1) Bronchopneumonia 

2) Mediastinal emphysema 

3) Pneumothorax 

4) Mediastinitis 

5) Necrosis of the anterior tracheal wall 

6) Tracheoesophageal fistula 

7) Blockage of the tracheostomy tube