his article is about the surgical procedure called a tracheotomy. For a similar procedure, see Cricothyrotomy.

Tracheotomy
Intervention

Completed tracheotomy: 1 - Vocal folds 2 - Thyroid cartilage 3 - Cricoid cartilage 4 - Tracheal rings ICD-10-PCS ICD-9-CM MeSH 5 - Balloon cuff 0B110F4 31.1 D014140

Among the oldest described surgical procedures, tracheotomy (also referred to as pharyngotomy, laryngotomy, and tracheostomy) consists of making an incision on the anterior aspect of the neck and opening a direct airway through an incision in the trachea. The resulting stoma can serve independently as an airway or as a site for a tracheostomy tube to be inserted; this tube allows a person to breathe without the use of his or her nose or mouth. Both surgical and percutaneous techniques are widely used in current surgical practice.

Contents
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1 Etymology and terminology 2 Indications 3 Surgical instruments

4 Percutaneous tracheotomy 5 Complications 6 Alternatives 7 History

7.1 Prior to 16th century 7.2 16th-18th centuries 7.3 19th century 7.4 20th century

8 See also 9 References 10 External links

[edit] Etymology and terminology

The etymology of the word tracheotomy comes from two Greek words: the root tom- (from Greek ) meaning "to cut", and the word trachea (Greek ).[1] The word tracheostomy, including the root stom- (from Greek ) meaning "mouth," refers to the making of a semipermanent or permanent opening, and to the opening itself. 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.[2]

[edit] Indications
In the acute setting, indications for tracheotomy include such conditions as severe facial trauma, head and neck cancers, large congenital tumors of the head and neck (e.g., branchial cleft cyst), and acute angioedema and inflammation of the head and neck. In the context of failed orotracheal or nasotracheal intubation, either tracheotomy or cricothyrotomy may be performed. In the chronic setting, indications for tracheotomy include the need for long-term mechanical ventilation and tracheal toilet (e.g. comatose patients, or extensive surgery involving the head and neck). In extreme cases, the procedure may be indicated as a treatment for severe Obstructive Sleep Apnea seen in patients intolerant of Continuous Positive Airway Pressure (CPAP) therapy.

[edit] Surgical instruments

Tracheostomy tube (The bottom item is a guide to help aid insertion) As with most other surgical procedures, some cases are more difficult than others. Surgery on children is more difficult because of their smaller size. Difficulties such as a short neck and bigger thyroid glands make the trachea hard to open.[3] There are other difficulties with patients with irregular necks, the obese, and those with a large goitre. The many possible complications include hemorrhage, loss of airway, subcutaneous emphysema, wound infections, stomal cellulites, fracture of tracheal rings, poor placement of the tracheotomy tube, and bronchospasm".[4] By the late 19th century, some surgeons had become proficient in performing the tracheotomy. The main instruments used were: Two small scalpels, one short grooved director, a tenaculum, two aneurysm needles which may be used as retractors, one pair of artery forceps, haemostatic forceps, two pairs of dissecting forceps, a pair of scissors, a sharp-pointed tenotome, a pair of tracheal forceps, a tracheal dilator, tracheotomy tubes, ligatures, sponges, a flexible catheter, and feathers.[3] Haemostatic forceps were used to control bleeding from separated vessels that were not ligatured because of the urgency of the operation. Generally, they were used to expose the trachea by clamping the isthmus thyroid gland on both sides. To open the trachea physically, a sharp-pointed tentome allowed the surgeon easily to place the ends into the opening of the trachea. The thin points permitted the doctor a better view of his incision. Tracheal dilators, such as the Golding Bird, were placed through the opening and then expanded by turning the screw to which they are attached. Tracheal forceps, as displayed on the right , were commonly used to extract foreign bodies from the larynx. The optimum tracheal tube at the time caused very little damage to the trachea and mucus membrane.[3] The best position for a tracheotomy was and still is one that forces the neck into the biggest prominence. Usually, the patient was laid on his back on a table with a cushion placed under his shoulders to prop him up. The arms were restrained to ensure they would not get in the way later. [3] The tools and techniques used today in tracheotomies have come a long way. The tracheotomy tube placed into the incision through the windpipe comes in various sizes, thus allowing a more comfortable fit and the ability to remove the tube in and out of the throat without disrupting support from a breathing machine. In todays world general anesthesia is used when performing these surgeries, which makes it much more tolerable for the patient. Special tracheostomy tube valves (such as the Passy-Muir valve[5]) have been created to assist people in their speech. The patient can inhale through the unidirectional tube. Upon expiration, pressure causes the valve to close, redirecting air around the tube, past the vocal folds, producing sound.[6] The tracheotomy underwent centuries of denial and rejection as well as much failure. Today, it is accepted and has saved the lives of hundreds of thousands of patients.[citation needed]