Tracheostomy

At the level of which tracheal rings is the opening formed during upper and lower tracheostomy?

When forming the opening, one or two tracheal rings are incised, starting from the second. During upper tracheotomy, the approach is made above the isthmus of the thyroid gland, exposing the first tracheal rings. The exact ring numbers for lower tracheotomy are not specified in the sources.

Which layers of the neck are sequentially incised during surgical access to the trachea?

During surgical access to the trachea, the sources describe the layered incision of the following tissues:

• Skin.
• Subcutaneous adipose tissue.
• Superficial fascia; the surgical steps also indicate dissection of the platysma along with the superficial fascia.
• Next, the linea alba colli is exposed and incised strictly in the middle between the edges of the sternohyoid muscles.
• During lower tracheotomy, the 2nd and 3rd fasciae of the neck are opened along a grooved probe, strictly between the edges of the sternothyroid muscles.
• To work with the isthmus, the fascial ligaments fixing it to the cricoid cartilage or trachea are incised, after which the isthmus is displaced.

What special surgical instruments are used when performing a tracheostomy?

A number of special surgical instruments are used during tracheostomy to fix tissues and form the stoma.

• Pointed scalpel — wrapped in gauze (leaving no more than 1 cm exposed) for safe entry into the trachea.
• Sharp single-tooth hook — used to fix and pull the larynx and trachea upward and anteriorly.
• Laminar hook (blunt) — used to retract the isthmus of the thyroid gland.
• Special dilator (or hemostatic clamp) — necessary to widen the incision.
• Tracheostomy cannula — inserted into the lumen to ensure breathing.

What specific diseases and pathological conditions are indications for tracheostomy?

Indications for tracheostomy or tracheostomy placement mentioned in the sources are:

• Asphyxia: edema of the vocal folds, benign or malignant laryngeal tumors, injuries to the larynx or mouth, stenoses, foreign body obstruction.
• Need for prolonged mechanical ventilation or prolonged tracheal breathing.
• Need for bronchial hygiene: impaired drainage, absence of the cough reflex.
• Ischemic stroke: anticipated prolonged mechanical ventilation and diagnosed severe dysphagia.
• 5q SMA: lack of effect from non-invasive ventilation (NIV) or inability to use NIV to sustain life.
• Severe tick-borne encephalitis: cerebral edema and convulsive syndrome are indications for mechanical ventilation, including via a temporary tracheostomy when indicated.

What anatomical structures can be damaged during a tracheostomy?

When gaining access to the trachea, sources indicate a risk of damage to the following structures:

• Posterior wall of the trachea — to prevent damage, the pointed scalpel is wrapped in gauze so that the cutting edge is no more than 1 cm.
• Branches of the thyroid venous plexus in the pretracheal space — during lower tracheotomy, they are ligated and transected.
• Tracheal cartilages — to prevent cartilage necrosis, the ends of the incised rings are resected, forming an oval opening.

What types of tracheostomy are distinguished in relation to the isthmus of the thyroid gland?

In relation to the isthmus of the thyroid gland, two main types of tracheotomy are distinguished.