The tracheostomy procedures are the surgeries performed on the neck to directly open the trachea. There is however important to make a distinction between two similar terms which are often used in the same context. Tracheostomy refers to the incision itself while tracheotomy is the actual operation of performing the opening in the trachea. This article will provide you information on how and why this surgery is performed and also what are the cares after such a procedure.

The emergency tracheostomy procedure is performed in emergency situation which is aimed to help a suffocating person to breathe. It is also called cricothyroidotomy and it is a quite rapid procedure. The surgeon makes an incision in the skin along the relaxed skin tension lines, between the cricoid cartilage and the sternal notch. The neck muscles are divided with a midline vertical incision and also the thyroid isthmus is separated. The cricoid is elevated by using a cricoids hook and a tracheal cut is made into the tracheal walls. The tracheostomy tube is inserted through the cut, the tube may be made of plastic or metal. The tube is held secure on the neck with either tape or sutures. The tube is then connected to a mechanical oxygen ventilator.

The percutaneous tracheostomy procedure is the non emergency surgery performed on the trachea. It is normally done in an operating room and it is scheduled. When performing this type of surgery, the surgeon makes an incision on the skin between the sternal notch and cricoid cartilage. A midline blunt dissection may be performed on the trachea and then a 14-gauge plastic cannula and needle with fluid filled syringe attached is inserted. After air is aspirated, the needle is removed but cannula is left in place. A soft tipped guide wire is then inserted though the cannula and then the cannula is being removed without taking out the guide wire. The surgeon will now proceed to the tracheal dilatation which can be done in several ways. The Ciaglia technique consists in a sequential insertion and removal of a series of larger dilatators into the trachea through the guide wire and the Griggs technique implies using a specially designed pair of guide-wire forceps to dilate the trachea. Another technique that may be used is called Rhino technique and it means dilating the trachea by inserting a single large tapered dilatators over the guide wire. A specially design screw that rotates and increases its diameter may also be used to dilate the trachea, procedure called Frova Percutwist. After the trachea is however dilated the tracheostomy tube is inserted and held into place with tape or sutures and then the ventilator is connected.

Tracheostomies are usually performed to remove obstructions of the trachea that do not allow a person to breath. They may be caused be the existence of foreign objects, by a paralysis of the neck muscle or swelling and other factors.

Tracheostomy procedures are quite safe but they carry certain risks especially in older patients.