Tracheostomy

Tracheostomy is of two types according to time when it is done

1. Elective tracheostomy - done electively in some surgeries as in surgery of TM joint when the patient is not able to open the mouth for intubation,before planning for laryngectomy, in long standing medical diseases like CVA for tracheobronchial toilet etc
2. Emergency tracheostomy - done in patients who come in respiratory distress.

In emergency tracheostomy, vertical skin incision is preferred. After incision, the larynx is fixed with one hand and the incision is deepened not bothering about isthmus of thyroid or anything in the way direct to the trachea and then after identifying it, the trachea is opened,wound dilated and the tracheostomy tube inserted. As soon as the airway is made patent most of the bleeding stops automatically. Rest of the bleeders are secured and skin wound is stitched with silk.