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| __NOTOC__
| | #REDIRECT [[Tracheostomy]] |
| [[Image:Traqueostomia.png|thumb|left|166px|Completed '''tracheotomy''':<br>
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| 1- Vocal cords<br>
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| 2- Thyroid cartilage<br>
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| 3- Cricoid cartilage <br>
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| 4- Tracheal cartilages<br>
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| 5- Balloon cuff]]
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| {{SI}}
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| {{CMG}}; {{AE}}{{UA}}
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| ==Overview==
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| '''Tracheotomy''' and '''tracheostomy''' are [[surgical]] procedures on the neck to open a direct airway through an incision in the [[Vertebrate trachea|trachea]] (the windpipe). They are performed by [[paramedic]]s, emergency [[physician]]s and [[surgeon]]s.
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| ==Terminology==
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| ''Tracheotomy'', from the Greek root ''tom-'' meaning "to cut," refers to the procedure of cutting into the trachea and is an emergency procedure.
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| A ''tracheostomy'', from the root ''stom-'' meaning "mouth," refers to the making of a semipermanent or permanent opening, and to the opening itself.<ref>{{Dorlands|t_15|12815726}}</ref>
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| Some sources offer different definitions of the above terms. Part of the ambiguity is due to the uncertainty of the intended permanence of the [[Stoma (medicine)|stoma]] at the time it is created.<ref name="titleeMedicine - Tracheostomy : Article by Jonathan P Lindman, MD">{{cite web |url=http://www.emedicine.com/ent/topic356.htm#section~introduction |title=eMedicine - Tracheostomy : Article by Jonathan P Lindman, MD |accessdate=2007-12-30 |format= |work=}}</ref>
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| ==Uses of tracheotomy==
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| The conditions in which a tracheotomy may be used are:
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| * Acute setting - [[Maxillofacial surgery|maxillofacial]] injuries, large tumors of the head and neck, congenital tumors, e.g. [[branchial cyst]], acute [[inflammation]] of head and neck, and
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| * Chronic / elective setting - when there is need for long term [[mechanical ventilation]] and tracheal toilet, e.g. [[coma]]tose patients, surgery to the head and neck.
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| In emergency settings, in the context of failed [[endotracheal intubation]] or where intubation is contraindicated, [[cricothyroidotomy]] or [[mini-tracheostomy]] may be performed in preference to a tracheostomy.
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| == Tracheotomy procedure ==
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| # Curvilinear skin incision along relaxed skin tension lines (RSTL) between sternal notch and cricoid cartilage.
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| # Midline vertical incision dividing strap muscles.
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| # Division of [[thyroid]] isthmus between ligatures.
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| # Elevation of [[cricoid]] with cricoid hook.
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| # Placement of tracheal incision. An inferior based flap or Björk flap (through second and third tracheal rings) is commonly used. The flap is then sutured to the inferior skin margin. Alternatives include a vertical tracheal incision ([[pediatrics|pediatric]]) or excision of an ellipse of anterior tracheal wall.
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| # Insert tracheostomy tube (with concomitant withdrawal of endotracheal tube), inflate cuff, secure with tape around neck or stay sutures.
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| # Connect ventilator tubing.
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| It is also possible to make a simple vertical incision between tracheal rings (typically 2nd and 3rd) for the incision. rear end flaps may produce more intratracheal granulation tissue at the site of the incisions, making it less favorable to some surgeons.
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| ==Complications==
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| # Immediate - [[pneumothorax]] or pneumomediastinum, tracheoesophageal [[fistula]], injury to great vessels or recurrent [[larynx|laryngeal]] nerves, bleeding, e.g. from divided thyroid isthmus.
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| # Early - secretions and mucus plugging, dislodged tube, respiratory arrest and post obstructive [[pulmonary edema]] (when tracheostomy is performed in a patient with longstanding upper airway obstruction, and is dependent on [[hypoxic drive]] for respiration).
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| # Late - [[bleeding]] from tracheoinnominate fistula (can be torrential), [[tracheal stenosis]] (from [[ischemia]] induced by a cuffed tracheostomy tube), tracheoesophageal fistula, tracheocutaneous fistula and cosmetic deformity must be considered upon [[decannulation]].
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| == Problems ==
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| # [[Immune]] problems - air [[Inhalation|inhaled]] through a [[stoma]] is not filtered or moistened like it is when inhaled through the [[nose]], or even the [[mouth]].
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| # [[Drowning]] - as little as two teaspoons of water in the stoma can drown the person; therefore, they cannot swim and bathing must be done with extreme care.
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| # [[Suffocation]] - if the stoma is covered, the person will suffocate, as in some cases they cannot breathe through their nose or their mouth.
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| == See also ==
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| *[[Cricothyroidotomy]]
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| *[[Intubation]]
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| *[[Mechanical ventilation]]
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| ==References==
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| {{reflist|2}}
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| == External links ==
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| * [http://www.tracheotomy.info Tracheotomy Info] (A Community For Tracheotomy-wearers and the people who love them) at tracheotomy.info
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| * [http://www.tracheostomy.com Aaron's tracheostomy page] (Caring for a tracheostomy) at tracheostomy.com
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| * [http://www.tracheostomy.com/resources/surgery/emergency.htm How to perform an emergency tracheotomy] (For information purposes only.) at tracheostomy.com
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| *[http://www.rtcorner.net RT Corner (Educational Site for RT's and Nurses)] at rtcorner.net
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| *[http://www.drtbalu.co.in/tracheostomy.html (Pictures with video clipping)] at drtbalu.co.in
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| {{Respiratory system surgeries and other procedures}}
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| [[Category:Surgical procedures]]
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| [[Category:Emergency medicine]]
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| [[Category:Oral and maxillofacial surgery]]
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| [[Category:Otolaryngology]]
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| [[Category:Surgery]]
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| [[af:Trageotomie]]
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| [[ar:ثقب القصبة الهوائية]]
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| [[da:Tracheostomi]]
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| [[de:Tracheotomie]]
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| [[es:Traqueotomía]]
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| [[fr:Trachéotomie]]
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| [[it:Tracheotomia]]
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| [[nl:Tracheotomie]]
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| [[ja:気管切開]]
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| [[no:Trakeotomi]]
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| [[pl:Tracheotomia]]
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| [[pt:Traqueostomia]]
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| [[ru:Трахеотомия]]
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| [[fi:Trakeostomia]]
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| [[sv:Trakeotomi]]
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| [[zh:氣管切開術]]
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| {{WH}}
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| {{WS}}
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