Completed tracheotomy:
1 - Vocal cords
2 - Thyroid cartilage
3 - Cricoid cartilage
4 - Tracheal cartilages
5 - Balloon cuff

Tracheotomy and tracheostomy are surgical procedures on the neck to open a direct airway through an incision in the trachea (the windpipe). Surgery (from the χειρουργική cheirourgikē, via chirurgiae meaning "hand work" is a medical specialty that uses operative manual and instrumental The traceartes, or windpipe, is a tube that has an inner diameter of about 20-25 mm and a length of about 10-16 cm in humans They are performed by paramedics, veterinarians, emergency physicians and surgeons. A paramedic is a medical professional usually a member of the emergency medical service, who primarily provides Pre-hospital advanced medical and A veterinarian ( American English) or a Veterinary surgeon ( British English) often shortened to vet, is a Physician A physician, medical practitioner or medical doctor who practices Medicine, and is concerned with maintaining or restoring human Health In Medicine, a surgeon is a person who performs Surgery. Surgery is a broad category of invasive Medical treatment that involves the cutting of a Both surgical and percutaneous techniques are now widely used.

While tracheostomy may have possibly been portrayed on ancient Egyptian tablets,^[1] the first correct description of the tracheotomy operation for suffocating patients was described by Ibn Zuhr in the 12th century,^[2] and the currently used surgical tracheostomy technique was described in 1909 by Dr. Chevalier Jackson from Pittsburgh, Pennsylvania. Ancient Egypt was an Ancient Civilization in eastern North Africa, concentrated along the lower reaches of the Nile River in what is now Abū Merwān ’Abdal-Malik ibn Zuhr ( أبو مروان عبد الملك بن زهر) (also known as Ibn Zuhr, Avenzoar, Abumeron or Ibn-Zohr Chevalier Jackson ( November 4, 1865 in Pittsburgh, Pennsylvania - August 16, 1958 in Philadelphia, Pennsylvania The Commonwealth of Pennsylvania ( often colloquially referred to as PA (its abbreviation by natives and Northeasterners is a state located in the Northeastern

Terminology

Tracheotomy, from the Greek root tom- meaning "to cut," refers to the procedure of cutting into the trachea and is an emergency procedure. Greek (el ελληνική γλώσσα or simply el ελληνικά — "Hellenic" is an Indo-European language, spoken today by 15-22 million people mainly The root is the primary lexical unit of a Word, which carries the most significant aspects of semantic content and cannot be reduced into smaller constituents ^[3]

A tracheostomy, from the root stom- meaning "mouth," refers to the making of a semipermanent or permanent opening, and to the opening itself. ^[4]

Some sources offer different definitions of the above terms. Part of the ambiguity is due to the uncertainty of the intended permanence of the stoma at the time it is created. In Medicine, a stoma (Greek - pl stomata is an opening either natural or surgically created (artificial which connects a portion of the body cavity to the outside ^[5]

Uses of 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. Oral and maxillofacial surgery is surgery to correct a wide spectrum of diseases injuries and defects in the head neck face jaws and the hard and soft tissues of the oral and maxillofacial 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. A branchial cleft cyst is an oval moderately movable Cystic mass that develops under the Skin in the neck between the Sternocleidomastoid muscle and Inflammation ( Latin, inflamatio, to set on fire is the complex biological response of vascular tissues to harmful stimuli such as Pathogens In Medicine, mechanical ventilation is a method to mechanically assist or replace spontaneous breathing when patients cannot do so on their own g. comatose patients, surgery to the head and neck. In Medicine, a coma (from the Greek koma, meaning deep sleep is a profound state of Unconsciousness.

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. In Medicine, intubation refers to the placement of a tube into an external or internal orifice of the body A cricothyrotomy (also called thyrocricotomy, cricothyroidotomy, inferior laryngotomy, intercricothyrotomy, coniotomy or

Tracheotomy procedure

1. Curvilinear skin incision along relaxed skin tension lines (RSTL) between sternal notch and cricoid cartilage.
2. Midline vertical incision dividing strap muscles. The infrahyoid muscles are a group of four pairs of Muscles in the anterior part of the Neck.
3. Division of thyroid isthmus between ligatures. The thyroid is one of the largest Endocrine glands in the body
4. Elevation of cricoid with cricoid hook. The cricoid cartilage, or simply cricoid (from the Greek krikoeides meaning "ring-shaped" is the only complete ring of Cartilage around the
5. Placement of tracheal incision. An inferior based flap or Björk flap (through second and third tracheal rings) is commonly used. The cartilages of the trachea (or tracheal rings) vary from sixteen to twenty in number each forms an imperfect ring which occupies the anterior two-thirds or so of the circumference 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. Pediatrics (also spelled paediatrics) is the branch of Medicine that deals with the medical care of Infants Children and Adolescents
6. Insert tracheostomy tube (with concomitant withdrawal of endotracheal tube), inflate cuff, secure with tape around neck or stay sutures.
7. Connect ventilator tubing.

It is also possible to make a simple vertical incision between tracheal rings (typically 2nd and 3rd) for the incision. rear end flaps may produce more intratracheal granulation tissue at the site of the incisions, making it less favorable to some surgeons.

Percutaneous Tracheotomy procedure

1. Curvilinear skin incision along relaxed skin tension lines between sternal notch and cricoid cartilage.
2. Midline blunt dissection down to the trachea (optional depending on technique).
3. Insertion of 14-gauge plastic cannula and needle with fluid filled syringe attached into trachea. A cannula (from Latin "little reed" plural cannulae) or canula is a tube which can be inserted into the body often for the delivery or removal Aspiration of air confirms correct placement of the tip in the trachea.
4. Removal of needle leaving cannula in place.
5. Insertion of soft tipped guide wire into trachea through cannula.
6. Removal of cannula leaving guide wire in place.
7. Tracheal dilatation is now undertaken - different techniques do this in different ways.
   1. Ciaglia - the sequential insertion and removal of a series (usually 4-5) of increasing larger dilators over the wire into the trachea.
   2. Griggs - insertion of a specially designed pair of guide-wire forceps along the wire into the trachea and then are opened to complete the dilation in one step.
   3. Rhino - insertion of a single large tapered dilator over a plastic guidewire reinforcement.
   4. Frova Percutwist - insertion of a specially designed screw of increasing diameter which rotates to create the dilatation.
8. Insert tracheostomy tube (with concomitant withdrawal of endotracheal tube), inflate cuff, secure with tape around neck or stay sutures.
9. Connect ventilator tubing.

Complications

1. Immediate - pneumothorax or pneumomediastinum, tracheoesophageal fistula, injury to great vessels or recurrent laryngeal nerves, bleeding, e. In medicine a fistula (pl fistulas or fistulae is an abnormal connection or passageway between two Epithelium -lined organs or vessels that normally do not connect The larynx (plural larynges) colloquially known as the voicebox, is an organ in the Neck of Mammals involved in protection of the g. from divided thyroid isthmus. The various rhino techniques may be associated with an increase in fractured tracheal rings the significance of which is unclear.
2. 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 hypoxic drive for respiration). Pulmonary Edema (American English or oedema (British English is swelling and/or fluid accumulation in the Lungs It leads to impaired gas exchange and may cause The hypoxic drive is a form of respiratory drive in which the body uses Oxygen Chemoreceptors instead of Carbon dioxide receptors to regulate
3. Late - bleeding from tracheoinnominate fistula (can be torrential), tracheal stenosis (from ischemia induced by a cuffed tracheostomy tube), tracheoesophageal fistula, tracheocutaneous fistula and cosmetic deformity must be considered upon decannulation. Tracheal stenosis is a narrowing of the Trachea. It can be idiopathic- caused for unknown reasons or because of trauma- accidents chemical exposure intubation etc In Medicine, ischemia ( Greek ισχαιμία, isch- is restriction hema or haema is Blood) is a restriction A cannula (from Latin "little reed" plural cannulae) or canula is a tube which can be inserted into the body often for the delivery or removal

Problems

1. Immune problems - air inhaled through a stoma is not filtered or moistened like it is when inhaled through the nose or the mouth. Immunity is a material term that describes a state of having sufficient biological defenses to avoid Infection, Disease, or other unwanted biological invasion Inhalation (also known as respiration) is the movement of air from the external environment through the air ways and into the Alveoli. In Botany, a stoma (also stomate; plural stomata) is a tiny opening or pore found mostly on the underside of a Plant Leaf Anatomically a nose is a protuberance in Vertebrates that houses the Nostrils or nares which admit and expel air for respiration in conjunction with the The mouth, buccal cavity, or oral cavity is the first portion of the Alimentary canal that receives food and begins digestion by mechanically breaking up
2. Drowning - as little as two teaspoons of water in the stoma can drown the person; therefore, they cannot swim and bathing must be done with extreme care. Drowning is Death as caused by suffocation when a liquid causes interruption of the body's absorption of oxygen from the air leading to Asphyxia.
3. Suffocation - if the stoma is covered, the person will suffocate, as in some cases they cannot breathe through their nose or their mouth.

See also

• Cricothyroidotomy
• Intubation
• Mechanical ventilation
• History of Tracheotomy

References

External links

• Tracheotomy Info (A Community For Tracheotomy-wearers and the people who love them) at tracheotomy. info
• Aaron's tracheostomy page (Caring for a tracheostomy) at tracheostomy. com
• How to perform an emergency tracheotomy (For information purposes only. ) at tracheostomy. com (This page actually depicts cricothyroidotomy, not tracheostomy)
• RT Corner (Educational Site for RT's and Nurses) at rtcorner. net
• (Pictures with video clipping) at drtbalu. com