THROAT - Tracheostomy

 What is tracheostomy?

Tracheostomy is making an opening on the anterior wall of the trachea for  establishing an airway.

 Classification of tracheostomy :

I. On site :
High tracheostomy: This is done about 2 cms above the isthmus ·of the thyroid gland al the level of 1 st tracheal ring. It is done only in emergency cases of severe stridor.

The patients neck is extended and the cricothyroid membrane is punctured. This can be done by using a cricothyrotome or wide bore needle.

2) Mid tracheostomy: This clone at the level of the isthmus of the thyroid gland at the level of 2nd or 3"1 tracheal ring. However, the thyroid isthmus needs to be clamped, cut and ligated.

3) Low tracheostomy: This is clone just below the isthmus of the thyroid gland. The 4th tracheal ring in incised. However one has to be careful not to damage the pleura. 

II. On Clinical status of patient:-

Emergency                                                                              Elective
If patient is in severe stridor or
in complete airway obstruction
intubation not possible.

Therapeutic                                                          Prophylactic
- Remove secretions                                   Prior to surgery the
- Assisted ventilation                                  a) Extensive tongue base surgery
                                                                   b) Mandibular resection
                                                                   c) Neurosurgery and
                                                                   cardiovascular surgery

1.      Temporary tracheostomy: Tracheostomy done only for a short period of         time. The patient is expected to be weaned off the tracheostomy tube    shortly.

2.      Permanent tracheostomy : The patient may need the tracheostomy for a prolonged period of time. Commonly seen in bilateral abductor cord      palsy, and after laryngectomy surgery.



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