When hearing the word tracheotomy, many people have terrible images in mind: accident, emergency doctors fighting for the victim’s life and finally saving him by opening his trachea. This may sound dramatic, but according to medical definition it is not a tracheotomy, but a coniotomy.
What is a tracheotomy?
Schematic diagram showing the anatomy of the trachea during a tracheotomy. Click to enlarge. A tracheotomy, or windpipe incision, is used in medicine when a person cannot or should not use their upper airway for an extended period of time. It can be a temporary and provisional procedure, as in Percutaneous Puncture and Dilatation Tracheotomy, or a permanent procedure, such as when the larynx must be removed. Puncture tracheostomy is also used in intensive care units as an alternative to intubation, which is ventilation with a tube inserted through the mouth or nose.
Function, effect, and goals
When patients fall into a coma or need to be placed in an induced coma after an accident, artificial ventilation may also be necessary. If this is necessary for an extended period of time, then puncture tracheostomy offers some advantages. The trachea is punctured with a hollow needle in order to insert a breathing tube later. More complex is the surgical tracheotomy, in which parts of the thyroid gland are also cut off. This procedure is designed for a longer period of time, which also means that the tracheal cannula is changed again and again. This type of tracheotomy is placed when, for example, the upper airways are obstructed. The causes can be very different and range from an insect bite to infectious diseases to tumor formation. Parkinson’s disease can also weaken the muscles of respiration to such an extent that a tracheostomy becomes necessary. In most cases, this type of tracheotomy is still reversible. It depends on how long it takes for the affected person to recover. After successful therapy, the trachea is closed again and the patient can speak normally. In the case of a tracheotomy caused by a laryngectomy, this is no longer possible. The vocal cords are completely missing and have to be replaced by prostheses. The operation is then no longer called a tracheotomy but a tracheostomy. This intervention is irreversible. The patient must relearn how to speak. Tracheostomy offers several advantages over intubation. For example, the tube that is inserted through the mouth can damage the vocal cords and trachea. This risk is eliminated with tracheotomy. Most importantly, the patient can eat or brush his teeth normally, which is impossible with a tube in the mouth and throat. Also, fewer painkillers have to be used. With a special attachment, the patient is even able to speak. Another important point is the shortening of the so-called dead space, i.e. the area between the air entering the body and reaching the lungs. With a tracheotomy, this distance is approximately halved. In reality, this means that the effort required for breathing is no longer as high. So the patient breathes more easily. This plays a role if the patient was previously on a ventilator and now has to get used to breathing on his or her own again.
Risks and dangers
For all the advantages, there are also some disadvantages to consider. Due to the fact that all breathing no longer goes through the head, the necessary humidification of the nose is also missing. This has the unpleasant side effect that the ability to smell is no longer there. Smelling, however, is very much related to tasting. That is, people with a tracheotomy are not able to smell. They can still taste, but this is also only possible to a very limited extent. The air that flows through the throat is also extremely important for something else: for speaking. After all, it is the air that causes the vocal cords to vibrate. If a person breathes through a tracheotomy, no more air gets past the vocal cords. The problem can be solved with a so-called speaking tube.
