Surgical Tracheostomy

Abstract

Tracheostomy is the only surgical procedure that completely bypasses the upper airway. This procedure consists of making an incision on the anterior aspect of the neck and opening a direct airway through the trachea to allow the placement of the tracheostomy tube. Through the tracheostomy tube, a patient can breathe without the use of upper airway. In the early twentieth century, when physicians began to use tracheostomy in the treatment of patients afflicted with paralytic poliomyelitis who required mechanical ventilation, the primary indication for surgical tracheostomy shifted from emergent relief of upper airway obstruction to elective airway support in prolonged ventilator dependence. Toy and Weinstein first, and Ciaglia after, introduced the concept of percutaneous tracheostomy. Surgical tracheotomy is among the oldest described procedures and it is preferred to percutaneous techniques when this approach can be difficult or risky.