It is a life saving procedure by creating a surgical opening into the trachea bypassing an upper respiratory obstruction. It can be done as an emergency or electively.(stomy = stoma = opening).

Trachea & larynx

A) Upper airway obstruction: 1- Congenital : laryngeal web, laryngeal stenosis, haemangioma,

laryngomalacia… 2- Trauma : ETT injuries, cut throat, gun shot, steam

inhalation, corrosives, DXT, flail chest… 3- Infection: Ac. Epiglottitis, L.T.B. , Diphtheria, Ludwick’s

angina. 4- Malignant Tumours: Ca tongue Base, ca larynx & upper

trachea, ca thyroid. 5- Preoperative procedture of laryngeal or oral surgery. 6- Bilat. Vocal Cord paralysis: - post- thyroidectomy, bulber

palsy. 7- Hair-dye Poisoning: angioneurotic oedema.

B) Protection of tracheobronchial tree:

(Reduction of secretions):

1- Myathenia Gravis, Polyneuritis.

2- Brainstem Stroke.

3- Multiple rib fractures.

C) Respiratory Failure (Reduction of dead space):

1- Chronic obstructive airway disease.

2- Severe bronchial asthma.

3- Gillian Barry syndrome.

4- Abnormal thoracic cage (thoracic kyphosis).

D) Assisted ventilation (Prolonged intubation)

1-    Prolonged coma for any cause

2-    Extensive faciomaxillary surgery.

3- Any condition needing IPPR , artificial or

mechanical respiration.

Types of tracheostomy : -         High -         Mid-         Low

Procedure :- 

- G.A. , local , no anaethesia.-  Position of the patient: supine, neck extended. - Incision : emergency: Transverse, longitudinal:elective.- Layers: skin , superficial cervical fascia , platysma, strap muscles, pretracheal fascia, thyroid isthmus , stoma in 2nd , 3rd & 4th rings. Insert tube :metal or portex. - Close wound & dressing.

Post-operative Care:

• -         Position: semi-sitting.• -         Humidification.• -         Suctioning . • -         Observe breathing & bleeding.• -         Feeding.• -         Antibiotics & analgesics.• -         Tube care.• -         Decannulation.

Complications:• -         Hemorrhage. • -         Surgical emphysema .• -         Pneumothorax.• -         Respiratory obstruction (tube slipping or obstruction).• -         Injuries to blood vessels, nerves, • esophagus…etc.• -        Wound infection: perichondritis, stenosis,

septicaemia. • -         Difficult extubation .• -         Tracheo-esophageal fistula. • -         Speech problems.