Tracheostomy

A tracheostomy is a procedure where a hole is made in the windpipe (trachea) and a tube inserted to aid with breathing. This keeps the airways open but can also remove any excess fluids produced by the lungs.

A tracheostomy is often performed in an emergency. It can be a temporary measure although in some cases, such as cancer of the larynx, it is a permanent solution.

Reasons for tracheostomy

The 3 main reasons for performing a tracheostomy are:

• Remove a build up of fluid in the airways
• Act as a new airway if the current one is blocked
• Assist with breathing by allowing air to flow through to the lungs.

A tracheostomy is often performed when someone has undergone a partial or total laryngectomy. This is usually undertaken to remove a cancerous growth in the larynx.

A partial laryngectomy means that a section of the vocal cords will have been removed but the person will still be able to speak. They will have a tracheostomy performed and a tube inserted to aid with both healing and breathing but only on a temporary basis.

A total laryngectomy involves the removal of the entire larynx which includes the vocal cords. Someone who has undergone this surgery will require a tracheostomy to enable them to breathe. This type of tracheostomy stays with them for the rest of their life.

What causes a blockage in the airways?

There are several reasons for this which includes:

• Foreign body lodged in the throat
• Injury or severe trauma to the neck or throat
• Congenital defect of the larynx or trachea
• Epiglottitis
• A type of throat cancer, e.g. cancer of the pharynx
• Diptheria
• Swollen throat caused by smoke or a corrosive substance

If your throat becomes swollen and sore to the extent that it is affecting the breathing then a tracheostomy will be needed to resolve this. In some cases this is done in a life threatening situation.

Medical conditions which require a tracheostomy

There are several medical conditions in which someone finds it difficult to breathe or to prevent fluids from entering their lungs. In these situations a tracheostomy is required.

They include:

• Stroke
• Coma
• Brain tumour
• Head trauma
• Tetanus

Severe cases of multiple sclerosis (MS) cause problems such as dysphagia (difficulty in swallowing) which can be eased by a tracheostomy.

The tracheostomy procedure

There are two ways of performing a tracheostomy in cases where it has been arranged in advance. One example of this is if you are about to undergo further throat surgery but need a tracheostomy to help you to breathe.

This is known as ‘planned tracheostomy’.

The two procedures for this are:

• Open surgical tracheostomy
• Percutaneous tracheostomy

Open surgical tracheostomy

This is performed under a general anaesthetic and involves making an incision in the neck over the windpipe. This is made in the lower part of the neck.

The surgeon will move the thyroid gland to one side to enable him/her to have a clear view of the windpipe before making an incision in this.

A tracheostomy tube is passed into the incision in the windpipe.

This tube is attached to either a ventilator or a similar device to enable oxygen to flow into the lungs.

A gauze dressing is placed over the incision in the neck and tape used to hold the tracheostomy tube firmly in place.

Percutaneous tracheostomy

A percutaneous tracheostomy is a less invasive procedure then the traditional open surgical operation and is often performed in an intensive care unit (ICU).

The procedure is very similar but involves the use of dilators and a guiding wire to hold the windpipe open whilst the tracheostomy tube is put in place. This will be followed by a chest X-ray to check that the tube is in the correct position and antibiotics to prevent an infection.

The difference between this and the other procedure is that it can be performed under a local anaesthetic.

This type of procedure is used in situations where someone is obese, has a very short neck or has a deformed thyroid gland.

Emergency tracheostomy

Another type of tracheostomy is that which is done in an emergency. This is required if someone has problems breathing due to an obstruction in their throat or has sustained an injury to their airway.

For example, this procedure can be done by a paramedic at the scene of an accident.

The person affected will be placed on their back and their head tilted back to fully stretch the neck. A local anaesthetic is given and a small incision made in the front of the neck and the larynx.

A tracheostomy tube is then inserted into this incision and attached to an oxygen supply.

Recovery from tracheostomy

It can take a bit of time to become accustomed to a tracheostomy tube but you will be shown how to do so. Talking or making sounds in general will be awkward to start with but with a bit of practice you will know how to speak with a tracheostomy tube.

Cleaning the tube is important to prevent any blockages caused by fluids or mucus. These fluids need to be drained away from the tube and the tube itself cleaned and reinserted.

This is done at least once a day although you may have to do this several times a day.

If you had a temporary tube fitted during a partial laryngectomy then this will be removed once the stoma (opening in the neck) has healed and you are able to breathe easily.

This hole often closes over a period of time so if you have a permanent tracheostomy then this will have to be opened again to enable the tube to be changed where necessary.

What is important is looking after your tracheostomy when outside. Keep your neck covered with a dressing or a loose scarf especially in the winter months. Protect this against dirt, dust or any other substances.

Risks of tracheostomy

This is a very effective procedure but there is a small risk of complications. These tend to happen after a tracheostomy.

They include:

• Bleeding from the isthmus (band of tissue which connects both halves of the thyroid gland).
• Infection
• Hypoxia (lack of oxygen to the tissues)
• Injury to the larynx or oesophagus during surgery
• Chronic obstructive pulmonary disease (COPD)
• Pneumonia
• Bleeding from the tracheostomy incision
• Degeneration of the cartilage of the windpipe
• Blockage in the tracheostomy tube, e.g. mucus

Some of these occur shortly after the tube has been fitted but others will develop some time after the tube has been inserted.

A device called an aspirator can help to keep the tracheostomy tube free from any blockages. This needs to be done on a regular basis to prevent any build up of fluids or mucus within the tube.

It is also a good idea to check that someone has the right size tube fitted. There are several different sizes of tracheostomy tube available and it is important to have the right size to prevent any blockages.

Your surgeon will discuss the pros and cons of a tracheostomy with you.