Ent Tracheostomy

1. Tracheostomy

2. Trachea anatomy:
Cylindrical structure but is flattened posteriorly
Measures about 11 cm in length
Starts from the inferior part of the larynx(cricoid
cartilage) in the neck, opposite the C6 vertebra,
to the inter-vertebral disc between T4-T5
vertebrae in the thorax
In cross-section, it is D-shaped, with incomplete
cartilaginous rings anteriorly and laterally, and a
straight membranous wall posteriorly
(chondromembranous)

5. Definition:
It is a surgical procedure to
open a direct airway through
an incision in the trachea.

6. Procedure:
The operation should be carried out under
general anesthesia and endotracheal
intubation.
The neck should be extended, the head should
be straight (not turned to one side).
Transverse incision is preferable to vertical
incision.

7. incision
Transverse
Elective
procedures
Vertical
Emergency
Pediatrics

8.  The incision should be centered midway
between the cricoid cartilage and sternal notch .
The strap muscles are identified and retracted
laterally and the thyroid isthmus is divided.
 The cricoid must be identified by palpation and
the tracheal rings counted.
An opening is made into the trachea and stitch is
made in place.

10. Indications:
 Obstruction of the upper airway like foreign body,
trauma, infection, laryngeal tumors and facial
fractures.
 Impaired respiratory function (head trauma lead to
unconsciousness, bulbar poliomyelitis).
 To assist weaning from ventilation support in patient
in the ICU.
 To help clear secretions in the upper airway.
 Prophylaxis (as in preparation for extensive head and
neck procedures and the convalescent period)

11. Complications:
Immediate complications:
Hemorrhage.
Apnea.
Trauma to recurrent laryngeal nerve and
great vessels.
Damage to esophagus.
Pneumothorax.
Subcutaneous emphysema.

12. Early complications:
The critical period is the first 48 hrs.
Tube obstruction or displacement.
Bleeding from tracheostomy site.
Infection (Tracheitis, Cellulites).
Aspiration.
Plugging with mucus .
Subcutaneous emphysema .
Atelectasis.

13. Late complicatios:
Tracheal stenosis.
Fistula formation (tracheo-cutaneous or
trachea-esophagus or trachea-innominate).
Airway obstruction with aspiration.
Bleeding.
Scarring.
Tracheomalacia.

14. Decannulation:
When ventilation or suctioning no longer
needed
Patient can control their own airway
Not be at risk for aspiration.

15. This can be expected when patient
has :
Good cough.
Good ABGs (relative, for the patient).
Clear lungs.
No pathogens in sputum.

16. Contraindications:
A strong relative contraindication to discrete
surgical access to the airway is the
anticipation that the blockage is a laryngeal
carcinoma.
No absolute contraindications

17. Tracheostomy speaking valve: