A tracheostomy or tracheotomy is a surgical procedure that creates an opening in the windpipe (trachea) in the neck. It is performed for various medical reasons and may be used to open a hole for breathing if a cancerous tumor blocking the patient’s throat cannot be removed.

Tracheostomies also may be performed after a tumor is removed and swelling of the throat prevents a patient from breathing easily. This indication for tracheostomy is temporary and is designed to provide relief until the swelling subsides and the patient can breathe normally. 

A tracheostomy is a surgical procedure that creates an opening in the windpipe (trachea) in the neck. It is usually performed when an obstruction in the throat prevents proper breathing. Tracheostomies are used to provide an airway in several medical conditions that block the passage of air, including oral or throat cancers or cancers that may have spread to this area.

During a tracheostomy, an incision is made in the windpipe (trachea). The opening made in the trachea is also known as a stoma. A stoma is any opening in the body made surgically to replace a normal opening, (e.g., colostomy).

After the stoma has been created, a plastic or metal tube is inserted through the hole into the trachea. This bypasses the blocked air passage in the trachea or throat and allows air to pass into and out of the lungs. 

After a tracheostomy is performed, individuals no longer breathe through their mouth or nose. Air is exchanged directly from outside the body into the lungs through the stoma. For this reason, the air is not filtered or warmed by the nose or mouth before entering the lungs. In addition, secretions produced by the lungs and bronchi may collect in the trachea. If the secretions cannot be cleared from the stoma by the patient’s coughing, they will need to be suctioned intermittently as needed. This is typically done with small tubing connected to an external suction machine. The secretions must be removed as they can block the patient’s ability to breathe. 

This tracheostomy tube inserted into the patient is composed of three sections:

• Outer cannula. The outer tube that holds the tracheostomy open. A neck plate extends from the sides of the outer tube with two holes. Cloth ties or a velcro strap can be attached to holes in the outer tube, allowing it to be worn secured around the neck.
  
  
• Inner cannula. Fits inside the outer cannula and has a lock to prevent it from being pushed or coughed out. This part of the tracheostomy tube can be removed for cleaning, especially in the morning and at bedtime. It is necessary to keep the inner cannula clean and fere from secretions or debris to facilitate breathing.
  
  
• Obturator. Fits inside the tracheostomy tube and provides a smooth surface that guides the tracheotomy tube during insertion.

Tracheostomies are used in many medical conditions other than cancer. These include:

• Inherited abnormalities of the larynx or trachea
• Severe neck or mouth injuries
• Noncancerous (benign) objects that block the airway
• Paralysis or weakness of muscles that affect breathing and swallowing
• Long-term unconsciousness or coma

When a tracheostomy is planned, patients should follow their physician’s guidelines concerning restrictions in diet or intake of medications. A tracheostomy is an inpatient procedure, so patients should make the appropriate arrangements to inform their work or others that they will be unavailable for at least a few days. However, most tracheostomies are performed while the patient is already hospitalized or as an emergency.

General anesthesia is administered prior to a tracheostomy, which means that the patient will not be awake during the procedure. The neck is cleaned and draped with sterile towels before surgery. During the procedure the surgeon makes incisions through the skin to expose the rigid cartilage rings that compose the outer wall of the trachea. The surgeon then makes additional incisions in a pair of these rings and inserts the tracheostomy tube into the trachea. The size and type of the tubing used in the procedure will depend on a number of factors, including the size of the patient’s trachea. Children have pediatric tracheostomy tubes inserted to accommodate their small size.

Following surgery, patients may be unable to eat or drink or may be able to tolerate only certain foods for a few days because they may experience certain swallowing difficulties. To supplement their nutrition, patients may receive nourishment intravenously or through a feeding tube. This is a thin, flexible tube placed through the nose and into the stomach. It allows liquid nutrition and medications to be provided directly into the stomach. Patients usually will remain in the hospital for three to five days after the procedure. Full recovery from the procedure can take several weeks.  

After a tracheostomy, the hole or stoma remains open. Breathing is performed through the tracheostomy tube in the stoma with direct exchange of the air from the outside into the lungs. Initially, patients may find it difficult to adapt to breathing through the tube. The air is no longer warmed or filtered by the nose or mouth. This discomfort usually passes within a few days. Secretions from the lungs may collect and require more frequent coughing, clearing or suctioning to clear the area.

It is also common for patients to experience difficulty in communicating initially. Air during breathing no longer passes up the trachea and through the vocal cords. The result is the inability to produce speech. During this transition, patients may need to communicate using pen and paper or computer keyboard. A speech pathologist may work with the patient to reduce the swallowing and speech difficulties that can occur following a tracheostomy. Patients will be taught to use certain techniques to improve speech production, such as taking a deep breath and covering the stoma with their finger. With training and practice, most patients learn to eventually adjust to speaking with a tracheostomy.

Following a tracheostomy, air reaching the lungs will be dryer and cooler. The stoma is also open to the environment, creating a risk of dust and debris entering the trachea. Proper care of the stoma is necessary to keep thick or crusty mucus from accumulating in the lining of the breathing tubes and to prevent debris from entering the stoma. Detailed instructions in tracheostomy care are typically provided prior to the patient’s discharge from the hospital. The patient will be given opportunities to clean, change and care for the tracheostomy under medical supervision before leaving the medical facility. Some general recommendations to help with coping with a tracheostomy include:

• Keep the area around the neck and stoma opening clean and free from debris.
  
  
• Keep air moist by using a humidifier or using pans of water near radiators or heaters. In addition, patients may benefit from closing the bathroom door and turning the hot water on to fill the room with steam. Sitting in the room and breathing deeply for 10 to 15 minutes can help moisten the tube and trachea.
  
  
• Keep the tracheal opening free from water while bathing or swimming.
  
  
• Cover the opening with a scarf or shirt made of a breathable material such as cotton that allows air to get through but prevents particles and other debris (aerosols, powders, etc.) from entering the stoma. Or, use a stoma cover, which is made of lightweight, lint-free, washable material and available in many stores that provide medical equipment.

Patients who have a tracheostomy have very few restrictions on activities, although they may be advised to avoid vigorous exercise for six weeks. They should also keep a spare inner cannula tube available in case the inserted tube becomes damaged or needs to be replaced. Individuals will be provided with instructions in how to clean and change the tube during their hospitalization.

Tracheostomies have the same risks common to any surgery or procedure that uses general anesthesia, such as infection and bleeding with surgery and adverse reaction or breathing difficulties during the use of general anesthesia. 

Some patients who receive tracheostomies may be tempted to smoke through the stoma after their procedure. However, the practice is strongly discouraged and presents a serious threat to the patient's health.

Some of the side effects associated with tracheostomies can include:

• Erosion of the trachea. A wearing away of the surface layer of the trachea.
  
  
• Buildup of scar tissue in the trachea.
  
  
• Dysphagia (swallowing difficulties)
  
  
• Infection from exposure of the stoma to bacteria and environmental elements
  
  
• Blockage of the trachea from secretions or debris from the environment resulting in breathing difficulties
  
  
• Irritation or bleeding around the stoma site
  
  
• Difficulty with speech production

Patients who exhibit any of the following symptoms should seek immediate medical attention:

• Bleeding
  
  
• Signs of infection such as swelling, redness, warmth, pus and increasing pain
  
  
• Obstruction of the tube and breathing difficulties

Preparing questions in advance can help patients have more meaningful discussions with their physicians regarding their conditions. Patients may wish to ask their doctors the following questions about tracheostomy:

1. Will my condition require a tracheostomy?
   
   
2. Who will perform the surgery and in what facility?
   
   
3. What are the risks with my condition in getting a tracheostomy?
   
   
4. Will I have any restrictions following my tracheostomy?
   
   
5. Who will provide me with instructions about the care of my tracheostomy?
   
   
6. Is there information I should provide to caregivers or other medical professionals about my tracheostomy?
   
   
7. Does my tracheostomy affect other medical procedures?
   
   
8. What will be done if I have problems eating or swallowing?
   
   
9. If I have problems speaking, what steps will be taken?
   
   
10. What symptoms indicate the need for immediate medical attention?
    
    
11. How will a tracheostomy affect my cancer treatments?
    
    
12. Is my tracheostomy likely to be temporary or permanent?
    
    
13. If my tracheostomy is temporary, how will it be removed?
    
    
14. Will I need surgery to close the hole in my throat?
    
    
15. What will happen if I need a new tracheostomy in the future?