Tracheostomy (Tracheotomy)

What is a tracheostomy?
The term tracheostomy is used to describe a surgically created hole in the neck that extends to the trachea (windpipe) to allow for safe breathing. A tracheostomy tube is the plastic breathing tube that is placed into the hole.

Who needs a tracheostomy?
There are many reasons why a child may need a tracheostomy. Two common reasons  include: 1) upper airway obstruction and 2) the requirement for mechanical ventilation (a breathing machine).

Upper airway obstruction may occur due to bilateral vocal cord paralysis, tracheal or laryngeal stenosis, infection, trauma, or due to a cyst or tumor.  A tracheostomy provides an alternative pathway for air to easily bypass the upper airway and  enter the lungs.

Long-term mechanical ventilation may be required as a result of lower airway obstruction (such as bronchomalacia or tracheomalacia) or due to neurologic conditions or chronic lung or heart disease. A tracheostomy allows for a ventilator to be used without a breathing tube that goes through the mouth or nose (endotracheal tube.)  For long-term ventilation, a tracheostomy is considered safer and more comfortable than an endotracheal tube.

Is a tracheostomy permanent?
For most children the tracheostomy is not permanent. The length of time it stays in place depends on the individual patient and the reason it was initially placed. Although some tracheostomy tubes stay in place for many months or years, many are temporary and can be removed after a shorter period of time. After the tracheostomy tube is removed, the hole frequently closes by itself. If it does not close by itself, the hole can be surgically closed.

How is a tracheostomy performed?
The tracheostomy procedure is performed in the operating room under general anesthesia. A small incision is made in the skin overlying the trachea in the middle of the neck. The surgeon  exposes the airway and makes a small incision into the trachea. The tracheostomy tube is placed in the hole, and secured to the neck.

What can I expect after the tracheostomy?
The tracheostomy tube is changed to a new tube by the surgeon several days after the operation. Occasionally, the ties around the neck are changed during the first week after the operation. After the tracheostomy incision site is noted to be healing well, a tracheostomy care nurse will begin working with the family to learn how to care for a tracheostomy. . 

What are the effects of tracheostomy?
The specific effects of the tracheostomy tube will  depend on the age of the child, the reason the tracheostomy tube was placed, and the need for long-term ventilation.     It is important that you discuss your child’s tracheostomy and the effects of the procedure with your child’s surgeon. When a tracheostomy is present, care must be taken to prevent water or sand from getting into the tracheostomy tube (no swimming.) As a general rule, the tracheostomy tube will not  keep your child from being able to eat normally or use their voice, although some children may not be able to eat orally or speak for other reasons.  Many children with a tracheostomy tube are able to lead  happy lives.