A tracheotomy or a tracheostomy is an opening surgically created through the neck into the trachea (windpipe) to allow direct access to the breathing tube and is commonly done in an operating room under general anesthesia. A tube is usually placed through this opening to provide an airway and to remove secretions from the lungs. Breathing is done through the tracheostomy tube rather than through the nose and mouth.
The term “tracheotomy” refers to the incision into the trachea (windpipe) that forms a temporary or permanent opening, which is called a “tracheostomy,” however; the terms are sometimes used interchangeably.
Reasons for a tracheostomy
- to bypass an obstructed upper airway;
- to clean and remove secretions from the airway;
- to more easily, and usually more safely, deliver oxygen to the lungs.
All tracheostomies are performed due to a lack of air getting to the lungs. There are many reasons why sufficient air cannot get to the lungs.
Airway Problems That May Require a Tracheostomy
- Tumors, such as cystic hygroma
- Infection, such as epiglottitis or croup
- Subglottic Stenosis
- Subglottic Web
- Vocal cord paralysis (VCP)
- Laryngeal injury or spasms
- Congenital abnormalities of the airway
- Large tongue or small jaw that blocks airway
- Treacher Collins and Pierre Robin Syndromes
- Severe neck or mouth injuries
- Airway burns from inhalation of corrosive material, smoke or steam
- Obstructive sleep apnea
- Foreign body obstruction
Lung Problems That May Require a Tracheostomy
- Need for prolonged respiratory support, such as Bronchopulmonary Dysplasia (BPD)
- Chronic pulmonary disease to reduce anatomic dead space
- Chest wall injury
- Diaphragm dysfunction
Other Reasons for a Tracheostomy
- Neuromuscular diseases paralyzing or weakening chest muscles and diaphragm
- Aspiration related to muscle or sensory problems in the throat
- Fracture of cervical vertebrae with spinal cord injury
- Long-term unconsciousness or coma
- Disorders of respiratory control such as congenital central hypoventilation or central apnea
- Facial surgery and facial burns
- Anaphylaxis (severe allergic reaction)
Bleeding: Minor bleeding from the incision is typically not a problem; however, heavy bleeding deeper in the neck can be very serious and can potentially cause difficulty with breathing. Rarely, a return to the operating room is necessary.
Wound infection: Infection after tracheotomy is uncommon. If this was to develop this is managed with local wound care and other medicines as needed.
Pneumothorax (Collapsed lung): The tracheotomy is performed just above the top of the lungs. It is exceedingly rare to injure the lungs, but to be sure this complication hasn’t occurred, a chest x‐ray is ordered just after the surgery. If a pneumothorax was to occur, another procedure would need to be performed to re‐expand the lung.
Airway scarring: This is fortunately very rare, but a serious complication of any airway surgery. Indeed, even the presence of an endotracheal tube (often the tube that we are replacing by tracheotomy) can cause airway scarring. One of the reasons to convert an endotracheal tube to a tracheotomy is to minimize the risk of airway scarring. The scarring can be at the level of the vocal cords, below the level of the vocal cords (subglottic stenosis), or in the trachea itself (tracheal stenosis). If this was to occur, depending on the level of the scar formation, often further surgery or surgeries are necessary to improve this condition. Airway scarring might lead to the need for a permanent trach tube.
Trach tube dislodgement: Fortunately this is rare, but if it occurs it can be devastating and/or fatal. This most often occurs if the ‘trach ties’ around the neck are kept too loose allowing for the tube to become displaced out of the airway. This problem is best avoided by paying close attention to the appropriate ‘snugness’ of the ties.
As with any type of surgery, the risks of anesthesia such as drug reaction, breathing difficulties and even death are possible. Please discuss these risks with your anesthesiologist. Fortunately, with this procedure, anesthetic problems are exceedingly rare.