Head & Neck Cancer Surgery

Tracheostomy

Tracheostomy creates a new airway by making an incision in the neck that goes into the windpipe (trachea). A tracheostomy tube is placed into the windpipe, and the patient breathes through that tube until it is removed. This is used to either bypass any swelling or a blockage in the mouth or throat that would prevent breathing, or if a patient is intubated for an extended period of time, or if a patient needs help clearing the mucus from their airway and lungs.

Preoperative Information

• All surgeries carry risks that we try to minimize in the operating room. A tracheostomy is usually left in place for AT LEAST 2 weeks.
• The tracheostomy tube placed during surgery is usually “cuffed,” meaning there is an inflatable balloon to prevent air from going upwards.
• The benefits of a tracheostomy differ depending on the patient. In general, a tracheostomy allows a patient to be more comfortable on a breathing machine. It improves hygiene of the lungs and airway, prevents scarring in the airway, and acts as a bypass to any blockage in the mouth or throat that would prevent the patient from being able to breath.

Post-operative Information

• After a tracheostomy, a patient is kept in the Intensive Care Unit for at least 24 hours for frequent monitoring. It is important to keep the air a patient is breathing warm and humidified.
  • If a patient is not on a ventilator breathing machine, they usually can be switched to a tracheostomy tube without a cuff, which makes speaking easier
    
       
• A tracheostomy can be removed when a patient no longer needs it. This is dependent on the individual patient. Your doctor will tell you when the time is right to start thinking about removing the tube. Once your doctor has removed the tracheostomy tube, a dressing will be placed over the incision site to hold the hole closed so that it can heal. During this time, if the patient speaks or coughs, they must place one or two fingers on top of the dressing and press down to prevent air from escaping. A horizontal scar on the neck is left once it has healed over.
  
  
  
  
• Speaking with a tracheostomy: Your doctor will decide if it is safe for you to attempt to speak with a tracheostomy. The tube itself should not inhibit your ability to speak, if the vocal cords are functioning normally. If a cuffed tube is in place and the cuff is inflated, then air cannot go upward past the tube and through the vocal cords, so speaking is not possible. If the tube is not cuffed, a patient can use speaking valves or can make sounds by putting a finger over the hole of the trach; this movement pushes the air back through your vocal cords and out of your mouth, allowing speech.
• Eating with a tracheostomy: Your doctor will decide if it is safe for you to eat, and in most cases the tracheostomy does not prevent patients from eating or change the ability to eat or swallow.