In some cases, a hole is made in the throat by surgery. 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 hole in the throat specially made by surgery is called a tracheostomy. Depending on the readings, a temporary or permanent tube can be installed. But in any case, it is a foreign body that has an irritating effect on the body.
If it is planned that the tube in the throat will be more than a month old, then it is necessary to hem the edges of the skin to the mucous membrane of the trachea. In this case, a stable tracheostomy is formed. But if 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, and the edges of the formed wound are not hemmed. It is this device that prevents the closure of the created hole. If it is removed, then the lumen will close in 2-3 days on its own.
The use of a cannula for long periods is not recommended due to the possibility of a pathological reaction in the area of paratracheal tissues.
Indications for tracheostomy
There are several reasons why tracheal dissection cannot be dispensed with. This operation is necessary for acute stenosis of the larynx.
They can be caused by the following factors:
- hit of foreign bodies;
- burns (chemical or thermal);
- false croup;
- diphtheria;
- tumors;
- bilateral paralysis of the vocal cords.
Another group of reasons for which a tracheostomy is necessary is a violation of the drainage of the tracheobronchial tree. This occurs when:
- severe head injuries;
- cerebrovascular insufficiency (including after strokes);
- brain tumors;
- coma, accompanied by impaired cough and swallowing reflexes ;
- prolonged asthmatic status;
- violation of the integrity of the chest frame.
Also, with incompetence of the neuromuscular system, a tube in the throat is necessary. The photo makes it clear that there is nothing terrible. But many people try to cover the device with high collars or neck scarves. Problems with the neuromuscular system occur due to:
- bulbar form of poliomyelitis;
- injuries in the cervical spinal cord;
- polyradiculoneuritis;
- severe myosthenia;
- neuroinfectious lesions (butulism, tetanus, rabies).
Tracheostomy and laryngeal intubation
In some cases, surgery is indispensable. A tracheostomy is performed in those situations where it is necessary for a long period to ensure the possibility of breathing. Often it is done in order to be able to use the ventilator for a long enough time.
If the patient needs to restore normal breathing, to ensure full gas exchange in the lungs during surgery, then the trachea is intubated. 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 its narrowing.
When using the tube, the air does not pass above the tracheostomy; the anatomically dead part of the airways decreases. At the same time, it becomes possible to control breathing for a long period.
Surgery
In some cases, during operations it is necessary to ensure full gas exchange in the lungs and bronchi. Many do not understand why the pipe is in the throat in this case. Tracheal intubation is done to ensure airway patency. This is one of the most reliable methods, which also allows you to suck out the secretion from the bronchi and trachea through special catheters.
Do intubation in several cases. This is necessary if there is a risk of aspiration - ingestion of the gastric contents into the lungs. Also, this procedure is indicated for violations of the drainage functions of the trachea and bronchi.
But in the treatment of laryngeal cancer , 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 auxiliary or controlled breathing. The patient, regardless of body position, ensures normal airway patency. In addition, the likelihood of suffocation from aspiration by vomit, mucus, blood, or from spasm of ligaments, or ingestion of foreign bodies is excluded.
Types of operations
Direct dissection of the trachea to allow air to enter and foreign bodies to be removed if necessary is called a tracheotomy. A tracheostomy is an 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, upper, middle and lower tracheostomy are distinguished. It can also be longitudinal, transverse and U-shaped.
With an upper tracheostomy, a dissection is done above the isthmus of the thyroid gland. Such an operation is considered the simplest and most often performed.
If an incision is made through the isthmus, then this intervention is called secondary tracheostomy. This is one of the most dangerous and complex incisions due to the fact that there is a risk of damage to the thyroid gland. Such an operation is done only in cases where there is no way to do otherwise, for example, with cancer of the thyroid gland.
It is also possible to conduct a lower tracheostomy. It runs under the isthmus. Such an operation is indicated for children under the age of 15 due to the peculiarities of the structure of organs. Many people wonder why a tube in the throat is found in children. Often it appears in babies suffering from congenital airway diseases.
Tracheostomy for mechanical ventilation
If the patient needs artificial ventilation of the lungs, then consider whether to conduct surgery and cut the throat. A tracheostomy is able to ensure the stability of the ventilator tube , and there will be no risk of damage to the ligamentous region and larynx. Often the question of such an intervention is raised after intubation of the patient for 7-10 days. It is during this period that it becomes clear that lung ventilation will be needed over a long period.
Then it becomes clear to everyone why they insert the tube into the throat. Exceptions are made only for infants and young patients due to the fact that their tracheostomy often causes complications. The operation is performed under anesthesia with intubation of the patient.
Indications for tracheostomy in children
In some cases, even the smallest patients need a tube in their throat. What kind of disease provokes such a need? Insert the device with congenital or acquired obstruction, tumors, traumatic lesions, immaturity of the respiratory tract.
The last indicated condition can be detected in the form of tracheomalacia and laryngomalacia. An inspiratory stridor, retraction of the intercostal muscles, and swelling of the wings of the nose are also noted. This condition may occur due to congenital paralysis of the vocal cords, damage to the nervous system, phrenic or laryngeal nerve. Agenesis of the trachea is also referred to as congenital indications.
But there are a number of acquired pathologies, in which a tube in the throat will be needed. After surgery, small patients get used to a foreign body and continue to lead a normal lifestyle. Often the tube is needed after lengthy operations for mechanical ventilation. Also, the need for it arises with night apnea, neuromuscular problems, chronic aspiration and infections.
Features of the operation of children
Regardless of what led to the need for a child to have a tracheostomy, there are special nuances of the procedure for the smallest patients. This is due to the structural features of their organs. So, in all children the thyroid gland is located quite high, so they undergo a lower tracheostomy.
Cartilage formed from the anterior tracheal wall is never excised for young patients, as this can lead to instability of the trachea itself and cause difficulties in decanulation. Also, the cross-sectional option is not suitable for them. In this case, deformation of the tracheal ring occurs due to tube pressure.
Tumor-like formations
Adults and children may need a tracheostomy for teratomas or sarcomas. But in young patients, such formations as hemangioma or lymphangioma can also compress the trachea.
When diagnosing laryngeal cancer, the actions of doctors should be aimed not only at removing the tumor and preventing its further growth, but also at restoring the protective, voice and respiratory functions. Therefore, a tube in the throat after surgery for laryngeal cancer is mandatory in cases where a laryngectomy is performed on the patient - an operation to remove the entire larynx.
This can only be avoided if the cancer is diagnosed at stage 1, while only the middle section of the larynx will be affected. In this situation, one vocal cord is removed. Sometimes a laryngeal resection is sufficient, in which part of this organ is removed, but all its functions are preserved.
If full extirpation of the larynx is necessary, then one must be prepared for the fact that it will be impossible to use the vocal apparatus in the usual way. It will need to be restored.
Tracheostomy Care
Regardless of the reasons why you need a tube in your throat, you need to remember how to monitor it. Care consists in daily washing and disinfection of the device. In addition, in the area of the stoma, it is necessary to constantly lubricate the skin in order to exclude 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 some time (about an hour). But at first it is important to carefully monitor the clearance. Over time, this period can be increased until the hole is fully formed. After that, wearing a cannula becomes optional. At the same time, the patient's condition improves markedly. After all, a cannula or tracheostomy tube irritates the walls of the trachea.
Lifestyle features
Having dealt with why a tube in the throat is necessary, many are upset, because they have a lot of restrictions. With this device you can not take a shower, swim, swim in the pools, bathrooms. After all, all this carries a risk of drowning. But, true, on sale you can find special pads that prevent the possibility of water entering the stoma.
Do not forget that in ordinary life in gassy and dusty places, the natural protection of the nasopharynx works. But people who have a pipe in their throats do not have it. Therefore, it is better to avoid visiting such places. All patients with tracheostomy are more susceptible to inflammatory and other bronchopulmonary diseases. In hot weather they need to cover the stoma with a bandage moistened with water. And in the cold season, it is advisable to warm the air.
Types of tracheostomy
Often a tube appears in the throat during surgery. Therefore, if surgery is not carried out urgently, then the patient can consult with a doctor what kind of tracheostomy to install.
Now there is a large selection of these devices, but most of them are made of special thermoplastic material. Their feature is 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 with a butterfly-shaped design. It is able to provide protection for the external tissues surrounding the lumen made in the throat.