Making an opening in the anterior wall of the trachea
Definition 🔹
AIMS OF TRACHEOSTOMY
🔹 To relieve upper airway obstruction
🔹
🔹
To reduce physiological dead space
To do tracheobronchial suction
🔹 To provide artificial respiration
To prevent post op. complications after major head and neck
surgery
🔷
🔹Congenital : 🔷 Neoplastic :
🔹
🔹
Laryngomalacia
Laryngeal web \ cyst
Benign and Malignant in :
Oral cavity
🔹
🔹
Bilateral choanal atresia
Subglotic stenosis
Pharynx
🔷
Larynx
🔹Haemangioma Miscellaneous :
🔷
Tracheo-oesophagal fistula
Foreign body larynx
🔹
Respiratory obstructionupper airway obstruction Inflammatory : Oedema larynx due to ( gasses , drugs ,
🔹
🔹
Peritonsillar , paratonsillar , retrotonsillar abscess
Ludwig’s angina
radiation )
Paralyic lesions
🔹Tongue abscess
🔹Ac. Laryngitis , Laryngo-tracheobronchitis , Ac Epiglottits
Diphtheria , TB , Syphilis 🔷
Pseudotumors : granulomas , cyst
Tauma :Blunt or penetrating trauma to :
larynx , pharynx , mouth , mandible
🔹
INDICATIONS
🔹 Respiratory obstruction 🔹
🔹 COPD
🔹 Respiratory insufficiency Chronic lung conditions : emphysema , ch. Broncitis ,
Retained secreatons Respiratory insufficiency
🔹
bronchiectasis , atelectasis
Neurological disorders : UMNL , polio. , diphtheria myasthenia
gravis
🔷
🔹 1- Inability to cough
🔹 coma of any cause : head injuries , other deseases
Paralysis of respiratory muscle : eg . Spinal injuries ,polio ,
Retained secreations 🔹Spasm of respiratory muscle : tetanus , eclampsia
Guillian-Barre syndrome
🔷
🔹2-chestPainful cough
injuries , multiple rib fracture , pneumonia
There are almost no absolute contraindications to tracheostomy
Contraindication of tracheostomy Once tracheostomy indicated no contraindications
🔷
🔹1- According the site :
🔹
🔹
High Tracheostomy
Mid Tracheostomy
🔷
🔹
Low Tracheostomy
2- According to indication :
🔹Emeregency
🔹Elective
Permanent
🔷
🔹 High Tracheostomy :
Site : opening above thyroid isthmus , in first and second
🔹
tracheal ring
🔹 Indications : emergency and urgent cases
Advantages : trachea is superficial under the skin so it is
Types of Tracheostomy
🔹subglottic
easy procedure.
Disadvantage : cricoid cartilage injury
stenosis
🔷
🔹 Low Tracheostomy :
Site : opening below thyroid isthmus , in 5th and 6th tracheal
🔹
rings
Indicatisons and adventages :
1- Subglotic CA : to avoid extension to tracheostomy orifice
2- Respiratory juvenile papilloma
Types of TracheostomyAccording the site
🔹
3- Upper tracheal and subglottic stenosis
Disadventages :
injury of structures in root of neck ( vessels , pleural )
Tube split
pneumothorax , pneumomediastinum , air embolism
🔷 Mid tracheostomy :
Tracheostomy
🔹
Operation of choice
Site : opening behind thyroid isthmus,in 3rd and 4rd Tracheal
ring
Less traumatic and less complication
The BEST type
🔹 Position of the patient on the op.Table Supine with extreme
extension of neck and head
🔹 Infiltration :
by fatema okoff 🔹
Lidocaine with adrenaline 1:200000 injected in incision line
Incision :
-Horizantal : good cosmetic results but difficult
-Vertical : bad cosmetic results , direct
🔹
🔹 Division of subcutaneous tissue
🔹
🔹
Vertical incision in deep cervical fascia
Separation of strap muscle
🔹
🔹
Division of thyrioid isthmus
Inscision in the trachea
Insertion of tracheostomy tube
Technique of tracheostomy Closure of the wound
🔹 Portex tubes :
Costly , less traumatic and
cleansing difficult
Types of tracheostomy tubes
🔹 Mettalic tubes :
Cheaper , more traumatic and
cleansing easy
🔹
🔹Semisitting position
🔹
🔹
Regular monitoring
Humidification , Oxygen , steam inhalation
🔹Antibiotic , Mucolytic , Analgesics
🔹Plain X-ray neck and chest
Care of the tube :
Patency
Post Operative Care Suction
Cleaning
🔷 Home Care
Education and training of the patient
Should have suction catheter and suction machine
Educate them when to come to hospital
🔷
🔹 Immediate complication: during operation
🔹
🔹
Haemorrhage
Apnea
🔹
🔹
Aspiration of blood
Cardiac arrest
🔹 Air embolism
Injury to :
-Apical pleura ( pneumothorax )
-Recurrent laryngeal nerve
-Esophagus
🔷
🔹Intermediate complication : within first few days
🔹
🔹
Bleeding : reactionary or secondary
Displacement or Blocking of the tube
🔹
🔹
Subcutaneous emphysema
Atlectasis and lung abscess
🔹Tracheitis and crusting
Wound infection
Complications
🔷
🔹Late complications : after weeks and months
🔹
🔹
Tracheal stenosis
Tracheo-esophageal fistula
🔹
🔹
Tracheo-cutaneous fistula
Tracheoinnominate fistula
🔹Difficult
Scar
decannulation
Definition 🔹
AIMS OF TRACHEOSTOMY
🔹 To relieve upper airway obstruction
🔹
🔹
To reduce physiological dead space
To do tracheobronchial suction
🔹 To provide artificial respiration
To prevent post op. complications after major head and neck
surgery
🔷
🔹Congenital : 🔷 Neoplastic :
🔹
🔹
Laryngomalacia
Laryngeal web \ cyst
Benign and Malignant in :
Oral cavity
🔹
🔹
Bilateral choanal atresia
Subglotic stenosis
Pharynx
🔷
Larynx
🔹Haemangioma Miscellaneous :
🔷
Tracheo-oesophagal fistula
Foreign body larynx
🔹
Respiratory obstructionupper airway obstruction Inflammatory : Oedema larynx due to ( gasses , drugs ,
🔹
🔹
Peritonsillar , paratonsillar , retrotonsillar abscess
Ludwig’s angina
radiation )
Paralyic lesions
🔹Tongue abscess
🔹Ac. Laryngitis , Laryngo-tracheobronchitis , Ac Epiglottits
Diphtheria , TB , Syphilis 🔷
Pseudotumors : granulomas , cyst
Tauma :Blunt or penetrating trauma to :
larynx , pharynx , mouth , mandible
🔹
INDICATIONS
🔹 Respiratory obstruction 🔹
🔹 COPD
🔹 Respiratory insufficiency Chronic lung conditions : emphysema , ch. Broncitis ,
Retained secreatons Respiratory insufficiency
🔹
bronchiectasis , atelectasis
Neurological disorders : UMNL , polio. , diphtheria myasthenia
gravis
🔷
🔹 1- Inability to cough
🔹 coma of any cause : head injuries , other deseases
Paralysis of respiratory muscle : eg . Spinal injuries ,polio ,
Retained secreations 🔹Spasm of respiratory muscle : tetanus , eclampsia
Guillian-Barre syndrome
🔷
🔹2-chestPainful cough
injuries , multiple rib fracture , pneumonia
There are almost no absolute contraindications to tracheostomy
Contraindication of tracheostomy Once tracheostomy indicated no contraindications
🔷
🔹1- According the site :
🔹
🔹
High Tracheostomy
Mid Tracheostomy
🔷
🔹
Low Tracheostomy
2- According to indication :
🔹Emeregency
🔹Elective
Permanent
🔷
🔹 High Tracheostomy :
Site : opening above thyroid isthmus , in first and second
🔹
tracheal ring
🔹 Indications : emergency and urgent cases
Advantages : trachea is superficial under the skin so it is
Types of Tracheostomy
🔹subglottic
easy procedure.
Disadvantage : cricoid cartilage injury
stenosis
🔷
🔹 Low Tracheostomy :
Site : opening below thyroid isthmus , in 5th and 6th tracheal
🔹
rings
Indicatisons and adventages :
1- Subglotic CA : to avoid extension to tracheostomy orifice
2- Respiratory juvenile papilloma
Types of TracheostomyAccording the site
🔹
3- Upper tracheal and subglottic stenosis
Disadventages :
injury of structures in root of neck ( vessels , pleural )
Tube split
pneumothorax , pneumomediastinum , air embolism
🔷 Mid tracheostomy :
Tracheostomy
🔹
Operation of choice
Site : opening behind thyroid isthmus,in 3rd and 4rd Tracheal
ring
Less traumatic and less complication
The BEST type
🔹 Position of the patient on the op.Table Supine with extreme
extension of neck and head
🔹 Infiltration :
by fatema okoff 🔹
Lidocaine with adrenaline 1:200000 injected in incision line
Incision :
-Horizantal : good cosmetic results but difficult
-Vertical : bad cosmetic results , direct
🔹
🔹 Division of subcutaneous tissue
🔹
🔹
Vertical incision in deep cervical fascia
Separation of strap muscle
🔹
🔹
Division of thyrioid isthmus
Inscision in the trachea
Insertion of tracheostomy tube
Technique of tracheostomy Closure of the wound
🔹 Portex tubes :
Costly , less traumatic and
cleansing difficult
Types of tracheostomy tubes
🔹 Mettalic tubes :
Cheaper , more traumatic and
cleansing easy
🔹
🔹Semisitting position
🔹
🔹
Regular monitoring
Humidification , Oxygen , steam inhalation
🔹Antibiotic , Mucolytic , Analgesics
🔹Plain X-ray neck and chest
Care of the tube :
Patency
Post Operative Care Suction
Cleaning
🔷 Home Care
Education and training of the patient
Should have suction catheter and suction machine
Educate them when to come to hospital
🔷
🔹 Immediate complication: during operation
🔹
🔹
Haemorrhage
Apnea
🔹
🔹
Aspiration of blood
Cardiac arrest
🔹 Air embolism
Injury to :
-Apical pleura ( pneumothorax )
-Recurrent laryngeal nerve
-Esophagus
🔷
🔹Intermediate complication : within first few days
🔹
🔹
Bleeding : reactionary or secondary
Displacement or Blocking of the tube
🔹
🔹
Subcutaneous emphysema
Atlectasis and lung abscess
🔹Tracheitis and crusting
Wound infection
Complications
🔷
🔹Late complications : after weeks and months
🔹
🔹
Tracheal stenosis
Tracheo-esophageal fistula
🔹
🔹
Tracheo-cutaneous fistula
Tracheoinnominate fistula
🔹Difficult
Scar
decannulation
