《耳鼻喉科学 Otolaryngology》课程教学课件（PPT讲稿）pharynx and larynx_tracheostomy

Tracheostomy

Tracheostomy

TRACHEOSTOMY>Asurgicalprocedureinwhichanopeningiscreated intheanteriorwall ofthetrachea>Tracheotomy/Tracheostomytemporarypermanent>Types:TemporaryvsPermanentEmergencyvsElective:High/mid/ low

TRACHEOSTOMY ➢ A surgical procedure in which an opening is created in the anterior wall of the trachea. ➢ Tracheotomy / Tracheostomy temporary permanent ➢ Types: Temporary vs Permanent : Emergency vs Elective : High / mid / low

Indications:Upperairwayobstruction:actual-FB,infection,absessallergy,injury,tumouranticipated-any major operationabove larynx

Indications: ➢ Upper airway obstruction : actual – FB, infection, absess, allergy,injury,tumour anticipated – any major operation above larynx

Indications:Upperairwayobstruction:actual-FB,infection,absess,allergy,injury,tumouranticipated-any majoroperation above larynx>Protectionoftracheobronchialtree:coma(head injury,drugoverdosage,CVA)Trauma (burns,facial fractures)Neurological diseases (polyneuritis,tetanusmyastheniagravis,bulbar palsy)>Ventilatory insufficiency:chestinjury(flail chest)pulmonary diseases (COPD,asthma,pneumonia)

Indications: ➢ Upper airway obstruction : actual – FB, infection, absess, allergy,injury,tumour anticipated – any major operation above larynx ➢ Protection of tracheobronchial tree : coma (head injury, drug overdosage,CVA) Trauma (burns, facial fractures) Neurological diseases (polyneuritis, tetanus, myasthenia gravis,bulbar palsy) ➢ Ventilatory insufficiency : chest injury (flail chest) pulmonary diseases (COPD, asthma, pneumonia)

BeneficialeffectsofTracheostomy>Lifesavingmeasure>70%reductionindeadspace>Bypassesresistancetoairflow>AlowSIPPV>Bronchialtoileting

Beneficial effects of Tracheostomy ➢ Life saving measure ➢ 70% reduction in dead space ➢ Bypasses resistance to airflow ➢ Alows IPPV ➢ Bronchial toileting

UnwantedeffectsofTracheostomy>Lossofvoicedepression>Lack of humidification>Lackoffiltration>Lack ofadequatecoughreflexDiminishedsenseofsmell,taste

Unwanted effects of Tracheostomy ➢ Loss of voice depression ➢ Lack of humidification ➢ Lack of filtration ➢ Lack of adequate cough reflex ➢ Diminished sense of smell, taste

Surgical procedure O.T.and sterile conditionAnesthesia-LA/GA/nilPosition-supinewithneckextensionSteps:incision-horizontalmidwaybetweensuprasternalnotch&cricoidvertical- cricoid tosuprasternal notch

Surgical procedure ➢ O.T. and sterile condition ➢ Anesthesia- LA / GA / nil ➢ Position- supine with neck extension Steps : ➢ incision-horizontal - midway between suprasternal notch & cricoid vertical - cricoid to suprasternal notch

Surgical procedureDissection ofsofttissueSeparationofstrapmuscles-,stayinthemidlineLift up or divide thethyroid isthmusDividepretrachealfasciaConfirmthetracheabypalpation&needleaspiration,inject 1mloflocalanesthesia

Surgical procedure ➢ Dissection of soft tissue ➢ Separation of strap muscles - stay in the midline ➢ Lift up or divide the thyroid isthmus ➢ Divide pretracheal fascia ➢ Confirm the trachea by palpation & needle aspiration, inject 1 ml. of local anesthesia

Surgical procedureTracheal incision--2ndand3rdverticaltracheal ring.Iniadult-resect apart of cartilage. Inchildren-separateapart.InsertthetubeInflationofthecuffand fixation of thetube.Closure ofthe woundDressing

Surgical procedure ➢ Tracheal incision - vertical -2nd and 3rd tracheal ring. In iadult￾resect a part of cartilage. In children- separate apart. ➢ Insert the tube. ➢ Inflation of the cuff and fixation of the tube. ➢ Closure of the wound ➢ Dressing

TracheostomyProcedureAtransvorsaincision ismadoacrossthenociatabautonelingerbreedhaboveahesauprastcenatnotchB,TheincisionisretractedandsurroundansisaueissecledsoicerttyhethyroidCTeyroidistnmussdividedtoOKDOSetraceaD,Thesecondtracheatringishendividedandhoostomytueispfacedintoucme