1. TRACHEOSTOMY Dr. Fadl A. Fadl, FRCSI, FICS, DLO

2. It is a life saving procedure by creating a surgical opening into the trachea bypassing an upper respiratory obstruction. It can be done as an emergency or electively. (stomy = stoma = opening). DEFINITION

3. Trachea & larynx

5. A) Upper airway obstruction : 1- Congenital : laryngeal web, laryngeal stenosis, haemangioma, laryngomalacia… 2- Trauma : ETT injuries, cut throat, gun shot, steam inhalation, corrosives, DXT, flail chest… 3- Infection: Ac. Epiglottitis, L.T.B. , Diphtheria, Ludwick’s angina. 4- Malignant Tumours: Ca tongue Base, ca larynx & upper trachea, ca thyroid. 5- Preoperative procedture of laryngeal or oral surgery. 6- Bilat. Vocal Cord paralysis: - post- thyroidectomy, bulber palsy. 7- Hair-dye Poisoning: angioneurotic oedema. INDICATIONS

6. B) Protection of tracheobronchial tree : (Reduction of secretions): 1- Myathenia Gravis, Polyneuritis. 2- Brainstem Stroke. 3- Multiple rib fractures. INDICATIONS

7. C) Respiratory Failure (Reduction of dead space ): 1- Chronic obstructive airway disease. 2- Severe bronchial asthma. 3- Gillian Barry syndrome. 4- Abnormal thoracic cage (thoracic kyphosis). INDICATIONS

8. D) Assisted ventilation (Prolonged intubation) 1- Prolonged coma for any cause 2- Extensive faciomaxillary surgery. 3- Any condition needing IPPR , artificial or mechanical respiration. INDICATIONS

9. Types of tracheostomy : - High - Mid - Low

10. Procedure : - - G.A. , local , no anaethesia. - Position of the patient: supine, neck extended. - Incision : emergency: Transverse, longitudinal:elective. - Layers: skin , superficial cervical fascia , platysma, strap muscles, pretracheal fascia, thyroid isthmus , stoma in 2 nd , 3 rd & 4 th rings. Insert tube :metal or portex. - Close wound & dressing.