What Is a Tracheotomy? Why and Where Is It Performed, Is It Permanent, and How Does It Differ From Tracheostomy?

What Is a Tracheotomy?

A tracheotomy is the surgical incision made to help breathing during a medical procedure called a tracheostomy. Many people use the two terms interchangeably.

An ear, nose and throat (ENT) surgeon or anesthesiologist usually performs a tracheostomy. The doctor makes an incision in the neck and inserts a tube through the opening into the trachea (windpipe). The tube may be temporary or permanent. In either case, it allows the person to breathe through the tube rather than the nose or mouth.

The Difference Between Tracheotomy and Tracheostomy

Tracheotomy and tracheostomy are technically different.

Tracheotomy means the incision made in the neck during a tracheostomy , which creates an opening in the front of the windpipe. However, as a paper published in 2022 notes, most people use the terms interchangeably. The concept of intubation can also be confused with these terms. This article describes the tracheotomy procedure.

-otomy: a suffix meaning to make an incision; -ostomy: a suffix meaning to create an opening.  

Why Is a Tracheotomy Performed?

The main purpose of a tracheotomy is to create an opening in the trachea to help breathing. The procedure allows a person to breathe through an inserted tube instead of the mouth and nose.

Potential uses of a tracheotomy include:

• Weaning a person from mechanical ventilation (a breathing machine)
• Facilitating mechanical ventilation
• Managing secretions
• An emergency obstruction that prevents breathing
• Preparation for head and neck cancer treatment
• Obstructive sleep apnea
• Managing infections
• Managing airway burns

What Risks Can a Tracheotomy Cause?

A tracheotomy is a minor surgical procedure in which a specialist makes an incision and inserts a tube through the neck into the trachea. Although generally safe in an operating room, it can carry risks, including:

• Bleeding during the procedure
• Missing the windpipe
• Damage to the upper part of the lung
• Infection, although this is rare
• Tube blockage by mucus or blood
• Tube displacement
• Possible injury while making the incision
• Fistula formation

How Is a Tracheotomy Performed?

Preparation

Preparation varies according to the purpose of the tracheotomy. In an emergency, the doctor performs it without preparation. For a planned procedure, the person receives detailed instructions on how to prepare. Usually, preparation includes stopping all food and drink several hours beforehand because general anesthesia will be used.

If any medications need to be stopped, the person should discuss when to stop them with the specialist. They should also remember that they may spend several days in hospital and prepare accordingly.

During the Tracheotomy

Most procedures use general anesthesia. After the necessary preparations, the surgeon generally:

1. Makes a vertical or horizontal incision around the midline of the neck, just below the larynx
2. Carefully separates the neck muscles and other tissues to reach the trachea, then makes an incision between its outer rings
3. Inserts a tube into the trachea

Additional supports or a neck strap may be used to hold the tube in place. A ventilator may be connected to assist breathing. In some cases, specialists use local anesthesia alone to perform an awake tracheotomy or a percutaneous tracheotomy .

Generally, a specialist may perform this procedure at the person’s hospital bedside only when a prepared surgical tracheotomy is not possible or has failed.

In a 2018 study, researchers found that candidates for awake tracheotomy for noncancer reasons tended to be younger and had more complications. A separate paper published in 2017 noted that most percutaneous tracheotomies take place in an intensive care unit where the person is already sedated.

Percutaneous tracheotomy involves injecting local anesthetic into the neck. The specialist then uses a needle to insert a guidewire that guides the tube into the trachea. Imaging such as ultrasound may help guide the procedure.

Although complications can occur, specialists generally consider this a safe procedure. According to a 2017 study, an experienced team, advance planning and imaging technologies together can help improve tracheotomy outcomes.

Care After a Tracheotomy

After the procedure, the person will need to spend several days in hospital. Specialists and healthcare staff regularly check the incision and tube for signs of infection and other problems. They ensure that nothing obstructs the airway and clean the tubes.

The opening usually takes approximately 7 days to stabilize. At that point, a specialist may replace the initial tube with a smaller or new tube. A surgical team generally performs the first change. After discharge, the person must follow all care instructions, keep the tube clean and watch for infection. They should also arrange a follow-up appointment so specialists can examine the opening and tube, check for signs of infection, answer questions and help resolve problems.

Is a Tracheostomy Permanent? How Many Years Can Someone Live With One?

A tracheostomy created after a tracheotomy incision can be temporary or permanent. For example, COVID-19 pneumonia may require a prolonged intensive care stay and a temporary tracheostomy, which can be closed once the patient’s general condition improves. By contrast, a person operated on for head and neck cancer, particularly laryngeal cancer, may have a permanent tracheostomy and breathe through it for life.

Summary

Tracheotomy, also called tracheostomy, refers to the surgical incision a doctor makes in the front of the neck to insert a tube into the trachea. It is performed to help breathing before treatment for a condition such as head and neck cancer, or in emergencies such as airway obstruction. Although generally considered safe, it can cause complications ranging from bleeding and infection to more serious problems such as tears in the neck or injury to other structures. A tracheostomy may be temporary or permanent; if permanent, a person can live with it for the rest of their life.