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Tracheotomy
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.)
Uses for a
tracheotomy
The conditions in which a tracheotomy
may be used are:
- Acute setting - maxillofacial
injuries, large tumors of the head
and neck, congenital tumors, e.g.
branchial cyst, acute inflammation
of head and neck, and
- Chronic / elective setting -
when there is need for long term
mechanical ventilation and tracheal
toilet, e.g. comatose patients,
surgery to the head and neck.
In emergency
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.
From
Wikipedia, the free encyclopedia
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