Information AboutTracheotomy |
| CATEGORIES ABOUT TRACHEOTOMY | |
| surgical procedures | |
| emergency medicine | |
| otolaryngology | |
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1 - Vocal cords 2 - Thyroid cartilage 3 - Cricoid cartilage 4 - Tracheal cartileges 5 - Balloon cuff]] A tracheotomy or '''tracheostomy''' is a Surgical procedure performed on the neck to open a direct airway through an incision in the Trachea (the windpipe). (Technically, the former term, with the Greek root ''tom-'' meaning "to cut," refers to the procedure of cutting into the trachea, whereas the latter term, with the root ''stom-'' meaning "mouth," refers to the procedure of making a semipermanent or permanent opening. ''Tracheostomy'' can also refer to the result of the procedure, i.e. the opening itself.) INDICATIONS FOR A TRACHEOTOMY The indications for tracheotomy are:
In emergent settings, in the context of failed Endotracheal Intubation or where intubation is contraindicated, Cricothyroidotomy or Mini-tracheostomy may be performed in preference to a tracheostomy. HOW A TRACHEOTOMY IS PERFORMED # Curvilinear skin incision along Relaxed Skin Tension Lines (RSTL) between sternal notch and cricoid cartilage # Midline vertical incision dividing strap muscles # Division of Thyroid isthmus between ligatures # Elevation of Cricoid with cricoid hook # Placement of tracheal incision. An inferior based flap or Bjork Flap (through second and third tracheal rings) is commonly used. The flap is then sutured to the inferior skin margin. Alternatives include a vertical tracheal incision ( Pediatric ) or excision of an ellipse of anterior tracheal wall. # Insert tracheostomy tube (with concomitant withdrawal of endotracheal tube), inflate cuff, secure with tape around neck or stay sutures. # Connect ventilator tubing It is also possible to make a simple horizontal incision between tracheal rings (typically 2nd and 3rd) for the incision. Bjork flaps may produce more intratracheal granulation tissue at the site of the incisions, making it less favorable to some surgeons. COMPLICATIONS # Immediate - Pneumothorax or pneumomediastinum, tracheoesophageal Fistula , injury to great vessels or recurrent Laryngeal nerves, bleeding, e.g. from divided thyroid isthmus # Early - secretions and mucus plugging, dislodged tube, respiratory arrest and post obstructive Pulmonary Edema (when tracheostomy is performed in a patient with longstanding upper airway obstruction, and is dependent on Hypoxia Drive for respiration) # Late - bleeding from Tracheoinnominate Fistula (can be torrential), Tracheal Stenosis (from Ischemia induced by a cuffed tracheostomy tube) SEE ALSO EXTERNAL LINKS
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