Tracheostomy

• Description

  General anesthesia is used. The neck is cleaned and draped. Surgical cuts are made to expose the tough cartilage rings that make up the outer wall of the trachea. The surgeon then creates an opening into the trachea and inserts a tracheostomy tube.

• Why the Procedure Is Performed

  A tracheostomy may be done if you have:

  • A large object blocking the airway
  • An inherited abnormality of the larynx or trachea
  • Breathed in harmful material such as smoke, steam, or other toxic gases
  • Cancer of the neck, which can affect breathing
  • Breathed in harmful material such as smoke or steam
  • Paralysis of the muscles that affect swallowing
  • Severe neck or mouth injuries
• Risks

  The risks for any anesthesia are:

  • Problems breathing
  • Reactions to medications

  The risks for any surgery are:

  • Bleeding
  • Infection

  Additional risks include:

  • Erosion of the trachea (rare)
  • Nerve damage
  • Scar tissue in the trachea
• After the Procedure

  If the tracheostomy is temporary, the tube will eventually be removed. Healing will occur quickly, leaving a minimal scar.

  Occasionally a stricture, or tightening, of the trachea may develop, which may affect breathing.

  If the tracheostomy tube is permanent, the hole remains open and may require surgical closure when no longer needed.

• Outlook (Prognosis)

  Most patients require 1 to 3 days to adapt to breathing through a tracheostomy tube. It will take some time to learn how to communicate with others. Initially, it may be impossible for the patient to talk or make sounds.

  After training and practice, most patients can learn to talk with a tracheostomy tube. Patients or family members learn how to take care of the tracheostomy during the hospital stay. Home-care service may also be available.

  Normal lifestyles are encouraged and most activities can be resumed. When outside, a loose covering (a scarf or other protection) for the tracheostomy stoma (hole) is recommended. Patients must adhere to other safety precautions regarding exposure to water, aerosols, powder, or food particles as well.

• References

  Goldenberg D, Bhatti N. Management of the impaired airway in the adult. In: Cummings CW, Flint PW, Haughey BH, et al, eds. Otolaryngology: Head & Neck Surgery. 4th ed. Philadelphia, Pa: Mosby Elsevier; 2005:chap 106.

Review Date: 1/16/2009

Reviewed By: Jacob L. Heller, MD, Emergency Medicine, Virginia Mason Medical Center, Seattle, Washington, Clinic. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.