Tracheotomy (US /ˌtreɪkiˈɒtəmi/ tray-kee-aw-tə-mee) is a surgical procedure which consists of making an incision on the anterior aspect of the neck and opening a direct airway through an incision in the trachea (windpipe). The resulting stoma (hole), or tracheostomy, can serve independently as an airway or as a site for a tracheostomy tube to be inserted; this tube allows a person to breathe without the use of his or her nose or mouth. Both surgical and percutaneous techniques are widely used in current surgical practice. It is among the oldest described procedures. In the acute setting, indications for tracheotomy include such conditions as severe facial trauma, neck cancers, large congenital tumors of the head and neck (e.g., branchial cleft cyst), and acute angioedema and inflammation of the head and neck. In the context of failed orotracheal or nasotracheal intubation, either tracheotomy or cricothyrotomy may be performed. In the chronic setting, indications for tracheotomy include the need for long-term mechanical ventilation and tracheal toilet (e.g. comatose patients, or extensive surgery involving the head and neck). For comatose patients or such needing long-term sedation, a significant reduction of duration of Intensive-care-unit-stay and administration of sedatives and vasopressors has been shown.[3] In extreme cases, the procedure may be indicated as a treatment for severe Obstructive Sleep Apnea seen in patients intolerant of Continuous Positive Airway Pressure (CPAP) therapy. The reason tracheostomy works well as sleep surgery for obstructive sleep apnea is because it is the only surgical procedure that completely bypasses the upper airway. This procedure was commonly performed in the 1960-1980s for obstructive sleep apnea, until other procedures such as the uvulopalatopharyngoplasty, genioglossus advancement, and maxillomandibular advancement surgeries were described as alternative surgical modalities for OSA.

• published: 04 Nov 2015
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