In some cases, a hole is surgically made in the throat. This is necessary for certain injuries or diseases, accompanied by respiratory failure. A tube in the throat is needed to restore this function.
Possible varieties
A specially made surgical hole in the throat is called a tracheostomy. Depending on the indications, a temporary or permanent tube can be installed. But in any case, it is a foreign body that irritates the body.
If it is planned that the tube in the throat will be more than a month, then the edges of the skin must be sutured to the mucous membrane of the trachea. In this case, a persistent tracheostomy is formed. But if it is necessary to ensure the flow of air in this way for a shorter period, they act differently. A special cannula is inserted into the incision made, and the edges of the formed wound are not sutured. It is this device that prevents the closure of the created hole. If it is removed, the lumen will close on its own in 2-3 days.
The use of the cannula for extended periods is not recommended due to the possibility ofpathological reactions in the region of paratracheal tissues.
Indications for tracheostomy
There are several reasons why a tracheal incision is indispensable. This operation is necessary for acute stenosis of the larynx.
They can be caused by the following factors:
- foreign bodies;
- burns (chemical or thermal);
- false croup;
- diphtheria;
- tumors;
- bilateral vocal cord paralysis.
Another group of reasons for which a tracheostomy is necessary is a violation of the drainage of the tracheobronchial tree. This occurs when:
- severe traumatic brain injury;
- insufficiency of cerebral circulation (including after strokes);
- brain tumors;
- coma, accompanied by impaired cough and swallowing reflexes;
- prolonged status asthmaticus;
- violation of the integrity of the skeleton of the chest.
Also, if the neuromuscular apparatus is incompetent, a tube in the throat is necessary. The photo makes it clear that there is nothing terrible in this. But many people try to cover the device with high collars or neckerchiefs. Problems with the neuromuscular apparatus arise due to:
- bulbar form of polio;
- damage to the cervical spinal cord;
- polyradiculoneuritis;
- severe myosthenia;
- neuroinfectious lesions (botulism, tetanus, rabies).
Tracheostomy and laryngeal intubation
In some cases, surgery is indispensable. Tracheostomy is performed in situations where it is necessary to ensure the possibility of breathing for a long period. Often it is done in order to be able to use the ventilator for a long time.
If the patient needs to restore normal breathing, to ensure full gas exchange in the lungs during surgical interventions, then tracheal intubation is performed. In this case, a tube is inserted into the throat through the nose or mouth. But this method can only be used when additional ventilation is needed for only a few hours or days. True, intubation can lead to damage to the inner wall of the trachea. This will cause it to narrow.
When using a tube, the air does not pass above the tracheostomy, the anatomically dead part of the respiratory tract is reduced. In this case, it becomes possible to control breathing for a long period.
Surgical interventions
In some cases, during operations, it is necessary to ensure full gas exchange in the lungs and bronchi. Many do not understand why the tube is in the throat in this case. Tracheal intubation is done to secure the airway. This is one of the most reliable methods, which also allows you to suck the resulting secret from the bronchi and trachea through special catheters.
Intubate in several cases. This is necessary if there is a risk of aspiration - the entry of stomach contents into the lungs. Also thisthe procedure is indicated for violations of the drainage functions of the trachea and bronchi.
But in the treatment of cancer of the larynx, a tracheostomy is necessary. Its implementation is one of the stages of therapy. A tube in the throat after surgery to remove the larynx in the presence of malignant tumors is mandatory.
The procedure provides the possibility of assisted or controlled breathing. The patient, regardless of the position of the body, is provided with normal airway patency. In addition, the possibility of suffocation from aspiration by vomit, mucus, blood or from ligament spasm, foreign bodies is excluded.
Types of transactions
The direct incision of the trachea to allow air to enter and remove foreign bodies if necessary is called a tracheotomy. A tracheostomy is the imposition of an external opening on the trachea. After such an intervention, a special tube appears in the throat for breathing.
Depending on the location of the incision, there are upper, middle and lower tracheostomy. It can also be longitudinal, transverse and U-shaped.
In an upper tracheostomy, the incision is made from above the isthmus of the thyroid gland. This operation is considered the simplest and is performed most often.
If the incision is made through the isthmus, then this intervention is called a middle tracheostomy. This is one of the most dangerous and difficult incisions due to the risk of damage to the thyroid gland. Such an operation is performed only in cases where it is not possible to do otherwise,for example, with cancer of the thyroid gland.
It is also possible to perform a lower tracheostomy. It is performed under the isthmus. Such an operation is indicated for children under the age of 15 due to the structural features of the organs. Many people wonder why the tube in the throat occurs in children. Often it appears in babies suffering from congenital pathologies of the respiratory tract.
Ventilator Tracheostomy
If the patient needs mechanical ventilation, then consider whether to conduct surgery and cut the throat. A tracheostomy can provide stability to the ventilator tube without the risk of damage to the subglottis and larynx. Often the question of such an intervention is raised after the patient has been intubated for 7-10 days. It is during this period that it becomes clear that ventilation will be needed for a long period.
Then it becomes clear to everyone why the tube is inserted into the throat. Exceptions are made only for infants and young patients due to the fact that tracheostomy often causes complications in them. The operation is performed under anesthesia with patient intubation.
Indications for tracheostomy in children
In some cases, even the smallest patients need a tube in the throat. What kind of disease provokes such a need? Insert the device for congenital or acquired obstructions, tumors, traumatic lesions, immaturity of the airways.
The last indicated state can be detected inform of tracheomalacia and laryngomalacia. There is also inspiratory stridor, retraction of the intercostal muscles, swelling of the wings of the nose. This condition can occur due to congenital paralysis of the vocal cords, damage to the nervous system, phrenic or laryngeal nerve. Congenital indications also include tracheal agnosis.
But there are a number of acquired pathologies that will require a tube in the throat. After the operation, small patients get used to the foreign body and continue to lead a normal life. Often a tube is needed after long operations for artificial ventilation of the lungs. It is also needed for sleep apnea, neuromuscular problems, chronic aspiration and infections.
Peculiarities of operating on children
Regardless of what led to the need to do a tracheostomy for a child, there are special nuances of the procedure for the smallest patients. This is due to the peculiarities of the structure of their organs. So, in all children, the thyroid gland is located high enough, so they undergo a lower tracheostomy.
In young patients, the cartilage formed from the anterior tracheal wall should never be excised, as this can lead to instability of the trachea itself and make it difficult to decannulate. Also, they do not fit the option of transverse dissection. In this case, deformation of the tracheal ring occurs due to the pressure of the tube.
Tumor-like formations
Adults and children may need a tracheostomywith the appearance of teratomas or sarcomas. But in young patients, formations such as hemangioma or lymphangioma can also compress the trachea.
When diagnosing cancer of the larynx, the actions of doctors should be aimed not only at removing the tumor and preventing its further growth, but also at restoring protective, voice and respiratory functions. Therefore, a tube in the throat after surgery for laryngeal cancer is mandatory in cases where the patient undergoes a laryngectomy - an operation to remove the entire larynx.
This can only be avoided if the cancer is diagnosed at stage 1, and only the middle part of the larynx will be affected. In such a situation, one vocal cord is removed. Sometimes a resection of the larynx is enough, in which part of this organ is removed, but all its functions are preserved.
If, however, a complete extirpation of the larynx is necessary, then one must be prepared for the fact that it will be impossible to use the voice apparatus in the usual way. It will need to be restored.
Tracheostomy care
Regardless of the reasons why you need a throat tube, you need to remember how to look after it. Care consists of daily washing and disinfection of the device. In addition, in the stoma area, it is necessary to constantly lubricate the skin in order to eliminate the possibility of irritation. The tube can be treated with ointment to facilitate sliding.
In addition, doctors recommend leaving the stoma without a cannula for a while (about an hour). But at first, it is important to carefully monitorbehind the light. Over time, this period can be increased until the hole is completely formed. After that, wearing a cannula becomes optional. This significantly improves the patient's condition. After all, a cannula or tracheostomy tube irritates the walls of the trachea.
Lifestyle features
Having figured out why a tube in the throat is necessary, many are upset, because they have a lot of restrictions. With the specified device, you can not take a shower, swim, swim in pools, bathrooms. After all, all this is associated with the risk of choking. But, the truth is, on sale you can find special pads that prevent the possibility of water entering the stoma.
Do not forget that in ordinary life in gassed and dusty places, the natural protection of the nasopharynx works. And people who have a tube in their throat don't have it. Therefore, it is better to avoid visiting such places. All patients with tracheostomy are more prone to inflammatory and other bronchopulmonary diseases. They need to cover the stoma with a bandage moistened with water in hot weather. And in the cold season, it is desirable to warm the air.
Types of tracheostomy
It is not uncommon for a tube to appear in the throat during surgery. Therefore, if the surgical intervention is not carried out urgently, then the patient can consult with the doctor about which tracheostomy to install.
Now there is a large selection of these devices, but most of them are made of a special thermoplastic material. Their featurelies in the fact that at a temperature of about 35-38 ° C, the tube in the throat becomes elastic. This allows you to save the whole mucous membrane of the trachea and other tissues adjacent to it. The outer edge of the tube ends in a butterfly-shaped design. It is able to provide protection to the outer tissues surrounding the opening made in the throat.
