- Total laryngectomy
- Airway protection, e.g. after major head and neck surgery, neurological disease involving the larynx
- Airway obstruction, e.g. epiglottitis, bilateral recurrent laryngeal nerve palsy, tumour
- Respiratory insufficiency (when endotracheal intubation required for longer than 72h) e.g. severe chest wall injury, Guillain-Barre syndrome
- Incision, horizontal, midway between the cricoid cartilage and suprasternal notch.
- Vertical incision and separation of strap muscles.
- Transfixion and separation of thyroid isthmus.
- Creation of an opening into the trachea. In adults a window is cut out. A vertical slit incision is used in children. A trap-door flap should not be used.
- Insertion of tracheostomy tube. A correctly sized cuffed synthetic tube is used for the first 24h. this can be replaced later on by an uncuffed tube.
Stomal stenosis (造瘻口狹窄) Aetiology:Following laryngectomy the lower end of the trachea is brought out through the neck skin. Local wound infection, radiotherapy and keloid formation all predispose to the later development of a stomal stenosis. The other cause of stomal stenosis is recurrence of tumour.
- Immediate. Pneumothorax, haemorrhage, surgical emphysema and tube displacement can all occur.
- Early. Wound infection, dysphagia and tube obstruction are all common. Tracheal erosion with innominate artery rupture, perichondritis and apnoea in hypercapnoeic bronchitics are rare.
- Late. Tracheal stenosis may result from prolonged or overinflation of the cuffed tube. Decannulation may be difficult in children. Surgical closure of a persistent tracheocutaneous fistula is rarely required after decannulation.
Management of benign stomal stenosis is either by the permanent wearing of a stoma button or laryngectomy tube or by surgical revision of the stoma.