Tracheotomy

Tracheotomy 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 thetrachea (windpipe).

The resulting stoma (hole), or tracheostomy, can serve independently as an airway or as a site for a traceostomy tube to be inserted; this tube allows a person to breathe without the use of the 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 tumors of the head and neck (e.g.,Cancers,Branchial Cleft Cysts ), 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). Tracheotomy may result in a significant reduction in the administration of sedatives and vasopressors, as well as the duration of stay in the ICU

In extreme cases, the procedure may be indicated as a treatment for severe obstructive sleep apnea  (OSA) seen in patients intolerant of continuous positive airway pressure (CPAP) therapy

The reason tracheostomy works well for OSA is because it is the only surgical procedure that completely bypasses the upper airway.