The trachea, also known as the trachea, is a long tube-shaped structure formed by the merging of 16 to 20 cartilage rings. The cartilages that make up the trachea are approximately 5 millimeters long and 1-2 millimeters thick.
What is a tracheostomy?
At the back of the trachea is the anterior wall of the esophagus, which is the esophagus. While the cartilages outside the first ring are in a "C" shaped half, the cartilage at the beginning of the trachea is in the form of a completed ring.
The first cartilage forms the connection between the trachea and the larynx (larynx) and is called the cricoid cartilage. The thyroid gland is located between the second and fourth cartilages.
Tracheostomy is one of the oldest surgical procedures applied in ancient Egypt in 3600 BC. It describes the process of surgically opening a hole to reach the trachea from the anterior region of the neck and inserting a tube through this hole.
Tracheostomy surgery can be performed in cases where the airways are blocked for various reasons or the respiratory function cannot be fully performed. With tracheostomy, ventilation of the lungs is ensured independently of structures such as the mouth, nose and throat that are involved in breathing.
What are Tracheostomy Indications (Needed Conditions)?
Tracheostomy is required urgently in various ailments. Tracheostomy is urgently required in cases where breathing cannot be performed due to an obstruction in the upper airways and endotracheal intubation (ventilation of the lungs by oral entry) fails.
The presence of a foreign body in the trachea, angioedema, various infections, severe injuries in the upper part of the face or neck, and life-threatening allergic reactions such as anaphylaxis are among the conditions that require urgent tracheostomy. Depending on many conditions and diseases, tracheostomy application may come to the fore:
- Patients who need a long-term ventilator,
- Continuing obstructive sleep apnea despite the applied treatments,
- Repeated aspirations (liquid solids pass into the trachea),
- Persons with some neuromuscular diseases,
- In the presence of congenital anomalies in the airways,
- Cancers of the neck region,
- Coma,
- Burns in the face area,
- Injuries in the larynx area,
- Paralysis of the muscles related to swallowing or coughing,
- Tracheostomy is opened in paralysis of the vocal cords.
How is Tracheostomy Applied?
Tracheostomy is generally performed under emergency conditions and under anesthesia It is a surgical method performed under In some cases, it may be required to be closed with different approaches.
2 physicians are required for a percutaneous (closed) tracheostomy. While one of these physicians performs the operation in the neck region, the other physician ensures the observation of the airway during the procedure with the help of a bronchoscope. makes an incision (tracheotomy). By passing the skin, connective tissue and some muscle structures, the area where the second and third cartilage rings are reached is reached. A tube is then followed by this line and placed.
After tracheostomy, it takes approximately 1-3 days to get used to breathing with the help of a tube. Recovery of functions such as speaking and vocalization also requires a lot of time and practice. The reason why such problems occur is that the air does not pass through the area with the vocal cords during breathing with tracheostomy.
With the help of some special valve structures that can be added to the tracheostomy tube, the air taken with the help of the tube leaves the body from the mouth and nose, and it can be beneficial on speech-related problems.
How is Speech and Nutrition After Tracheostomy?
The area where the tracheostomy tube is placed and the lung Speech-related functions are adversely affected because the air flow between them does not pass through the area where the vocal cords are located. However, thanks to the techniques developed with some apparatus and devices, speech and sound extraction can be performed while the tracheostomy tube is in place. If necessary, assistance can be obtained from a speech therapist in learning the reuse of the voice and in alternative communication techniques. Speech therapists, apart from communication-related problems, can benefit from strengthening and harmonious functioning of the muscles that function in nutrition and especially swallowing. Conditions such as irritation, coughing and excessive sputum production may occur due to dry air. Tools that will provide humidification of the inhaled air can contribute to the control of this problem.
How is Tracheostomy Care Performed?
Another thing to be considered about tracheostomy is the care of the tracheostomy tube. Cleaning and regular replacement of the tube can reduce the risk of developing adverse conditions such as infection. Information on cleaning hands by washing them with soap and water, using gloves, cleaning secretions, separating, cleaning, drying and combining some parts, and which materials to use for these procedures are explained to the patient by the healthcare personnel who perform this care at the hospital.
What are the Negative Conditions That May Occur During Tracheostomy?
As with any medical intervention, there are many risks for tracheostomy procedure.
- Bleeding during the procedure,
- development of infection,
- damage to the thyroid gland,
- lung collapse,
- the formation of scar tissue in the trachea are among the adverse conditions that may occur due to tracheostomy.
A lung collapse that may develop during the procedure can reach life-threatening dimensions. If this situation is suspected, help is taken from x-ray graphies (lung film). As long as the developing infection is superficial, it can be controlled with proper wound care without the need for antibiotics. Obstruction of the tracheostomy tube due to respiratory secretions or bleeding is another negative situation that may be encountered in the early postoperative period.
The opening in the treated area normally closes spontaneously within the first 1-2 days after the removal of the tracheostomy tube. However, in some people, there may be a delay in the healing of that area. This can be controlled with drugs containing silver nitrate. Very rarely, an abnormal connection may occur between the trachea and the esophagus after a tracheostomy procedure. This situation, which may cause food to escape into the lungs, is removed by surgical intervention.
Tracheostomy is usually a temporary method used to ensure breathing until other health problems are resolved. Tracheostomy is important in cases where breathing must be performed with the help of a machine due to various problems. In some cases, such as advanced laryngeal cancer patients, patients may have to continue their lives with a permanent tracheostomy.
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