Approved Doctor(s) ; Mamun Rashid , Jeffrey R. Janus • Apr 04, 2024

Table of contents

What is a tracheostomy?

Tracheostomy is the surgical creation of an airway when a person cannot breathe through the mouth or nose. In healthy people, breathing in and out occurs through the nose or mouth. Due to some diseases or other reasons, breathing cannot occur spontaneously and external support is provided. 

An artificial airway is created in the trachea, or windpipe, so that the patient can breathe more easily. A tube is inserted through an incision in the trachea at the front of the neck and a surgical airway is created, either temporarily or permanently. Some people can breathe on their own after the tube is inserted, but in some cases the tube needs to be connected to a ventilator or breathing machine. 

Tracheostomy Cannula 

A tracheostomy cannula is a cannula placed in the hole between the 2nd and 3rd or 3rd and 4th cartilages in the trachea. Patients who undergo tracheostomy usually lose their speech function, but some patients continue to speak with appropriate cannulas. 

The tracheostomy cannula is inserted surgically. An incision is made in the appropriate area of the trachea and the tracheostomy cannula is inserted and secured with sutures or surgical tape. This operation takes between 20-40 minutes on average. 

Why is a tracheostomy opened?

  • Traumas to the neck and head that make breathing difficult
  • In cases such as paralysis, throat cancer, it opens with obstruction of the airway
  • Medical conditions requiring the use of a respirator for more than one or two weeks
  • In order to reduce the risk of some fluids going to the lungs 
  • To facilitate breathing during periods of recovery
  • It is opened during the preparation process of patients who will undergo head or neck surgery. 

How to Open a Tracheostomy?

The patient's history is taken in detail and the patient is evaluated for tracheostomy. The tracheostomy procedure is performed under general anesthesia. An incision is made below the level of the vocal cords and a tracheostomy cannula is inserted into the gap between the 2nd and 3rd rings of the cartilage structure. With this cannula, the airway is sent directly into the trachea. A surgical suture or banding is used to keep the tube in place. Some patients may also have a ventilator attached to the end of the tube because they have difficulty breathing. 

Which Patients Can Have a Tracheostomy?

Tracheostomy is usually done in emergencies to allow the patient to breathe, but it can also be done in some chronic diseases and congenital diseases. A tracheostomy can be temporary or permanent. The following patients can have a tracheostomy; 

  • Larynx and throat cancer patients,
  • Vocal cord disorders,
  • Obstructions in the upper respiratory tract,
  • Diseases affecting the respiratory tract such as COPD
  • Paralysis,
  • Loss of consciousness,
  • Pneumonia,
  • Congenital airway deformations,
  • Anaphylaxis,
  • Burns in the airway,
  • Patients with foreign body obstruction can have a tracheostomy if necessary. 

What is the difference between tracheotomy and tracheostomy?

Tracheotomy is a procedure in which an incision is made in the skin in the anterior region of the neck and a gap is created between the rings of the trachea, through which a tube is inserted. With this tube inserted into the trachea, the patient can continue breathing. In a tracheostomy, the trachea is accessed and the edges of the trachea are sutured to the skin. In short, a tracheotomy is the name given to the incision made during the tracheostomy procedure, which provides external breathing by creating an opening in the trachea. 

Complications of Tracheostomy 

Although the process of opening a tracheostomy is generally safe, complications can occur in some cases. The risk of complications is particularly high in emergency tracheostomies. Some of the complications of a tracheostomy are as follows; 

  • Infection
  • Bleeding 
  • Tracheostomy tube displacement due to improper placement
  • Damage to the nerves in the thyroid gland or neck
  • Damage to the trachea or esophagus
  • Pneumothorax
  • Tracheostomy tube obstruction
  • Infection in the bronchial tubes
  • Stricture of the trachea 

Speech After Tracheostomy 

Some patients who undergo a tracheostomy procedure may lose the ability to speak, while others may continue to speak. In general, it is not possible for patients with a tracheostomy to speak. After the tracheostomy, the air passing through the vocal cords will be cut off. 

Some patients may also have a perforated tracheostomy cannula or a speech cannula. In addition, a speech valve is used, and some valves are designed for patients who are connected to a ventilator and make it easier for the patient to speak. 

Tracheostomy and Nutrition

Nutrition after a tracheostomy is an important consideration. Eating can be challenging for people with a tracheostomy. In the beginning, small sips, liquid and soft foods should be consumed. In the following processes, normal foods can be consumed after the adaptation process, but very hard, bitter, spicy, spicy, large bites, acidic foods should not be consumed. 

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