Tracheostoma

Tracheostoma is a surgically created opening in the trachea through the anterior neck that provides an alternative airway, bypassing the nose and mouth. It is the external opening (stoma) that remains after a tracheostomy procedure, which is the operation used to create the airway. The tracheostoma may be temporary or permanent, depending on the underlying condition and healing.

Location and creation: The tracheostoma is usually located between the second and fourth tracheal rings, just below the cricoid cartilage. It is created by surgical tracheostomy in an operating room or by a percutaneous dilational technique in intensive care. A tracheostomy tube is placed through the stoma to maintain the airway and allow airflow into the trachea.

Indications: Tracheostomy is performed for prolonged ventilation, chronic airway obstruction, airway protection in patients at risk of aspiration, significant hoarseness or obstruction after head and neck surgery or trauma, and in diseases that impair clearance of secretions. It can facilitate weaning from mechanical ventilation and improve pulmonary hygiene in select patients.

Management and care: Ongoing care includes humidified gas, regular suctioning of secretions, and routine cleaning around the stoma to prevent infection. The tracheostomy tube may be cuffed or uncuffed; fenestrated tubes can enable speaking. Tube changes are performed by trained clinicians. Decannulation is pursued when the airway is capable of maintaining patency, and the stoma may gradually close if the tube is removed.

Complications: Early complications include bleeding, pneumothorax, subcutaneous emphysema, tube obstruction, and accidental decannulation. Late issues can involve infection, stomal granuloma, tracheal stenosis, tracheoesophageal fistula, and difficulties with voice or swallowing.