A tracheostomy is a surgery performed on the trachea, whose aim is to improve breathing. to help improve breathing. It may be indicated for various reasons, including air way obstruction (e.g.glottic stenosis, cancer), pulmonary issues, or prolonged intubation in the intensive care unit.

A tracheostomy can be performed under local anesthesia (only the tracheal area is numbed) or under general anesthesia (the entire body is asleep). The choice of anesthesia primarily depends on the urgency of the procedure and the feasibility of intubation (inserting an endotracheal tube into the throat to allow the patient to breathe during general anesthesia).

The ENT surgeon performs this procedure in the operating room. The patient lies on their back, and the anesthesiologist administers either general or local anesthesia to ensure a painless procedure. After making an incision in the lower part of the neck, the tissues are gently separated to reach the trachea. If the procedure is performed under local anesthesia, the anesthesiologist may give additional medication at this stage to keep the patient sedated. The tracheostomy tube is then inserted into the trachea.

The portion of the tube that extends outside the neck is initially secured to the skin with sutures. These sutures are removed a few days later, and the tracheostomy is then maintained with a strap around the neck.

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This is a relatively quick procedure, typically lasting about 30 minutes.

Once the procedure is completed, breathing should be significantly improved. However, this procedure requires an adjustment period during which breathing may feel unusual, and coughing may be more frequent. Depending on the diagnosis, the tracheostomy may be temporary or permanent.

Initially, speaking with the tracheostomy tube in place may be difficult or even impossible. After a few days, the initial tube is replaced with one that allows easier use of the voice. At this stage, the voice is expected to return to its pre-surgery state (neither better nor worse). The procedure should also not affect swallowing ability for the majority of patients (similar to before surgery).

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As with any surgical procedure, a tracheostomy carries postoperative risks, such as bleeding, infection, pain, and poor skin healing. The risks associated with general anesthesia must also be considered.

Once the tracheostomy tube is in place, there is a risk that it may become blocked, move, or dislodge completely. Regular tracheostomy care is essential to prevent these issues.

In some cases, the tracheostomy tube may cause difficulty swallowing, particularly if the patient already had a predisposition before the procedure. Generally, a speech-language pathologist can help address this problem by recommending exercises and providing specialized guidance.

Rare and very rare complications

In a minority of cases, patients may experience significant difficulty swallowing, requiring dietary modifications after the procedure. Even more rarely, tube feeding may be necessary if the patient cannot safely eat or drink.

When the tracheostomy tube is removed, there is also a rare risk of scar formation in the trachea, which can narrow the airway, leading to subglottic stenosis or tracheal stenosis.

Very rare complications include the formation of an abnormal connection (fistula) between the trachea and other structures, such as the esophagus (tracheoesophageal fistula), the skin (tracheocutaneous fistula), or a blood vessel (tracheoinnominate fistula).

After a tracheostomy, it is usually recommended to remain in the hospital for approximately one week. This stay allows the patient to become accustomed to the tracheostomy and to receive care instructions, particularly regarding cleaning, as well as guidance on what to do in case of an emergency (tube blockage, tube dislodgement, etc.). These instructions are generally provided by nursing staff or respiratory therapists. It is important to follow these instructions carefully to avoid complications.

It is normal for this procedure to cause coughing spells, especially during the first few weeks. Coughing is most commonly triggered during tracheostomy care or when the tube is changed.

Complete tracheostomy tube changes are generally performed in the hospital by the ENT surgeon every 3 to 4 months.