Tracheotomy

What is a tracheostomy?

A tracheostomy is a surgical maneuver in the trachea, performed to facilitate breathing when the oxygen supply is insufficient.
Specifically, the tracheotomy involves two very important and distinct phases:

Dilation (opening) temporary of the cervical tracheal wall by means of an incision in the skin at the level of the trachea
Subsequent placement of a special tracheal cannula able to ensure the passage of air from the outside to the lungs and vice versa

By creating a direct relationship between the tracheo-bronchial pathway and the external environment, the tracheotomy guarantees correct ventilation to the patient who - due to edema, neoplasms or other factors - is unable to breathe correctly in a natural way.
Born as an extreme life-saving attempt, the tracheotomy is one of the oldest surgical procedures documented to date, performed essentially to ensure "adequate breathing for the patient.
Contrary to what one might imagine, tracheotomy is today a rather simple operation to perform for an expert hand; nevertheless, errors during the execution of the maneuver - certainly not rare - can give rise to complications of various entities.
We remind you, however, that performing a tracheotomy does not simply mean giving rise to a new passageway for air to optimize breathing: cutting the tracheal wall also means altering the respiratory physiology and modulating the cervical anatomy.

Anatomy review to understand ...

The trachea is a flexible and elastic fibrocartilaginous duct very similar to a flattened cylinder in its posterior portion. Its function is to convey the air from the outside to the bronchi and lungs (inspiratory phase) and vice versa (expiratory phase).
The trachea is a connecting structure between the larynx and the bronchi:

In the upper extremity, the trachea originates from the cricoid cartilage of the larynx (at the height of the sixth cervical vertebra)
In the lower extremity, the trachea ends at the thoracic level dividing into the two primary bronchi (at the height of the fifth thoracic vertebra)

The trachea is made up of 15-20 cartilage rings superimposed on each other, connected to each other by connective tissue. The tracheotomy can be performed between the second and fourth tracheal rings, therefore positioned immediately under the cricoid cartilage.

Tracheostomy or tracheostomy?

Before going into the treatment of the surgical act, it is good to distinguish two terms that are often mistakenly confused as synonyms.

Tracheostomy: opening temporary of the trachea (after removal of the cannula, the hole created - called tracheal stoma - closes spontaneously, thus restoring natural breathing)
Tracheostomy: opening permanent of the trachea. It is performed by connecting the tracheal breach (ie the cut created) at the edge of the skin where the incision was made: in this way, the tracheal lumen is directly connected with the external environment.

Why is it performed?

The tracheostomy can be performed on all occasions when the air cannot reach the lungs in sufficient quantity.
The operation can be performed both in urgent and non-urgent conditions (for further information, read "types of tracheotomy"):

Presence of mucus or other secretions in the trachea (phenomenon linked in particular to swallowing difficulties)
Upper airway obstruction due to facial trauma, infections, strictures (narrowing), angioedema
Airway obstruction due to paralysis of the throat muscles or cancer
Need for continuous ventilation in patients with chronic respiratory failure
Severe obstructive sleep apnea in patients intolerant to so-called CPAP therapy (Continuous Positive Airway Pressure, which consists in the use of positive pressure dispensers)
Prevention of bronchial obstruction induced by respiratory failure
Severe burns of the oral cavity
Chronic stenosis of the larynx and trachea
Prevention of aspiration of gastric contents
Other situations that make endotracheal intubation impractical