Description: General anesthesia is used. The neck is cleaned and draped. Incisions are made to expose the tough cartilage rings that make up the outer wall of the trachea. The surgeon then cuts two of these rings and inserts a tracheostomy tube.

Indications: The guidelines for tracheostomy include:

• congenital (inherited) abnormality of the larynx or trachea
• severe neck or mouth injuries
• inhalation of corrosive material smoke or steam
• presence of a large foreign body that occludes the airway
• paralysis of the muscles that affect swallowing causing a danger of aspiration
• long term unconsciousness or coma

What To Expect After: If the tracheostomy is temporary, the tube will eventually be removed. Healing will occur quickly, leaving a minimal scar. If the tracheostomy tube is permanent, the hole remains open and may require surgical closure when no longer needed.

Convalescence: Most patients require 1 to 3 days to adapt to breathing through a tracheostomy tube. Communication will require adjustment. Initially, it may be impossible for the patient to talk or make sounds. After training and practice, most patients can learn to talk with a trach tube. Patients or parents learn how to take care of the tracheostomy during the hospital stay. Home-care service may also be available. Normal lifestyles are encouraged and most activities can be resumed. When outside a loose covering for the tracheostomy stoma (hole) (a scarf or other protection) is recommended. Other safety precautions regarding exposure to water, aerosols, powder or food particles must be adhered to.

Risks: Risks for any anesthesia are:

• reactions to medications
• problems breathing

• bleeding
• infection

• erosion of the trachea (rare)
• scar tissue in the trachea