A tube in the throat after the operation( photo).Why put the phone in the throat?
In some cases, a hole is surgically made in the throat. This is necessary for certain injuries or diseases, accompanied by a violation of breathing. A tube in the throat is needed to restore this function.
Possible varieties of
A specially surgically made hole in the throat is called a tracheostomy. Depending on the readings, a temporary or permanent tube can be installed. But in any case, this is a foreign body, which has an irritating effect on the body.
If it is planned that the tube in the throat will be more than a month, then the edges of the skin need to be sewn to the mucosa of the trachea. In this case, a persistent tracheostomy is formed. But if necessary to ensure the supply of air in this way for a shorter period, they act differently. A special cannula is inserted into the incision, and the edges of the formed wound are not hemmed. It is this device that prevents the closure of the created hole. If it is removed, the lumen will close for 2-3 days on its own.
It is not recommended to use the cannula for extended periods because of the possibility of a pathological reaction in the area of paratracheal tissue.
Indications for Tracheostomy
There are several reasons why trachea can not be avoided without dissection. This operation is necessary for acute stenosis of the larynx.
They can be caused by the following factors:
- ingress of foreign bodies;
- burns( chemical or thermal);
- false groats;
- bilateral paralysis of the vocal cords.
Another group of reasons for which a tracheostomy is necessary is a violation of drainage of the tracheobronchial tree. This occurs when:
- severe craniocerebral injury;
- cerebral circulatory insufficiency( including and after strokes);
- brain tumors;
- coma, accompanied by violations of cough and swallowing reflexes;
- with long-term asthmatic status;
- violation of the integrity of the thoracic cage.
Also, when the neuromuscular apparatus is incompetent, a tube in the throat is needed. The photo makes it clear that this is nothing terrible. But many people try to cover the device with their high collars or with their shawls. Problems with the neuromuscular device arise due to:
- bulbar form of poliomyelitis;
- damage in the cervical spinal cord;
- severe myosthenia;
- of neuroinfectious lesions( butulism, tetanus, rabies).
Tracheostomy and intubation of the larynx
In a number of cases, one can not do without surgical intervention. Tracheostomy is carried out in those situations when it is necessary to ensure the possibility of breathing for a long period. Often it is done in order to be able to use the device for artificial ventilation for a long time.
If the patient needs to restore normal breathing, provide full gas exchange in the lungs during surgery, then intubate the trachea. In this case, a tube is inserted into the throat through the nose or mouth. But this method can be used only when additional ventilation is needed for only a few hours or days. True, intubation can damage the inner wall of the trachea. This will cause its narrowing.
When using a tube, air does not pass above the tracheostomy, the anatomically dead part of the airway decreases. At the same time, it becomes possible to control breathing for a long period.
In some cases, during operations, it is necessary to ensure complete gas exchange in the lungs and bronchi. Many do not understand why a tube in the throat in this case. Intubation of the trachea is done to ensure airway patency. This is one of the most reliable methods, which also allows you to suck from the bronchi and trachea emerging secret through special catheters.
Intubation is done in several cases. This is necessary if there is a risk of aspiration - entering the lungs of gastric contents. This procedure is also indicated for violations of drainage functions of the trachea and bronchi.
But in the treatment of larynx cancer, tracheostomy is necessary. It is one of the stages of therapy. A tube in the throat after surgery to remove the larynx in the presence of malignant tumors is mandatory.
The procedure provides the possibility of conducting auxiliary or controlled respiration. The patient, regardless of the position of the body, provides normal airway patency. In addition, the probability of suffocation from aspiration by vomiting masses, mucus, blood or from spasm of ligaments, foreign bodies is excluded.
Types of operations
Direct dissection of the trachea to allow air to enter and remove foreign bodies, if necessary, is called a tracheotomy. A tracheostomy is an imposition on the trachea of the external opening. After such an intervention, a special tube appears in the throat for breathing.
Depending on the site of the incision, the upper, middle and lower tracheostomy are distinguished. It can also be longitudinal, transverse and U-shaped.
In upper tracheostomy, a dissection is made from above the thyroid isthmus. This operation is considered to be the simplest and most often performed.
If a cut is made through the isthmus, then such an intervention is called an average tracheostomy. This is one of the most dangerous and complex cuts due to the fact that there is a risk of damage to the thyroid gland. Such an operation is done only in those cases when there is no possibility to act otherwise, for example, with cancer diseases of the thyroid gland.
Lower tracheostomy is also possible. It is performed under the isthmus. Such an operation is indicated for children under the age of 15 due to the peculiarities of the structure of the organs. Many people are wondering why the tube in the throat is found in children. Often it appears in toddlers suffering from congenital airway pathologies.
Tracheostomy for AID
If a patient needs artificial ventilation, they are considering the question of surgical intervention and cutting the throat. Tracheostomy is able to ensure the stability of the IVL tube, while there will be no risk of damage to the subglottic region and larynx. Often the question of such intervention rises after intubation of the patient for 7-10 days. It is during this period that it becomes clear that ventilation of the lungs will be needed for a long period.
Then it becomes clear to everyone why the tube is inserted into the throat. Exceptions are made only for infants and small patients due to the fact that they have tracheostomy often causes complications. The operation is performed under anesthesia with intubation of the patient.
Indications for tracheostomy in children
In some cases, even the smallest patients need a tube in the throat. What kind of illness provokes such a need? Insert the device with congenital or acquired obstructions, tumors, traumatic lesions, immaturity of the respiratory tract.
The last indicated condition can be detected in the form of tracheomalacia and laryngomalacia. There is also an inspiratory stridor, an intercostal muscle contraction, an inflating of the wings of the nose. This condition can arise because of congenital paralysis of the vocal cords, lesions of the nervous system, diaphragmatic or laryngeal nerve. Congenital indications include trachea agniesia.
But there are a number of acquired pathologies that will require a tube in the throat. After surgery, small patients get used to the foreign body and continue to lead a normal lifestyle. Often a tube is needed after long operations for artificial ventilation. Also, the need for it arises with nocturnal sleep apnea, neuromuscular problems, chronic aspiration and infections.
Features of operating children
Regardless of what led to the need to make a tracheostomy for a child, there are special nuances of procedure for the youngest patients. This is due to the peculiarities of the structure of their organs. So, in all children the thyroid gland is located high enough, so they spend the lower tracheostomy.
Small patients are never excised cartilage formed from the anterior tracheal wall, as this can lead to instability of the trachea itself and cause complications during decanulation. Also, it does not fit the option of crosscutting. In this case, a deformation of the tracheal ring occurs due to the pressure of the tube.
Adults and children may require tracheostomy if they develop teratomas or sarcomas. But in small patients to squeeze the trachea may and such entities as hemangioma or lymphangioma.
When diagnosing cancer of the larynx, the actions of doctors should be directed not only to removing the tumor and preventing its further proliferation, but also to restore protective, voice and respiratory functions. Therefore, the tube in the throat after the operation of the larynx cancer is mandatory in those cases where the patient is undergoing a laryngectomy - an operation to remove the entire larynx.
This can be avoided only if the cancer is diagnosed at stage 1, while only the middle larynx is affected. In such a situation, one voice ligament is removed. Sometimes enough resection of the larynx, which removes part of this organ, but all its functions are preserved.
If you need complete extirpation of the larynx, then you must be prepared for the fact that it will be impossible to use the usual voice device. It will need to be restored.
Care for the tracheostomy
Regardless of the reasons why you need a tube in your throat, you need to remember how to follow it. Care consists of daily washing and disinfection of the device. In addition, in the area of the stoma, it is necessary to constantly lubricate the skin in order to exclude the possibility of irritation. The tube can be processed with ointment to facilitate sliding.
In addition, doctors recommend leaving the stoma without the cannula for a while( about an hour).But at first it is important to closely monitor the clearance. Over time, this period can be increased until the hole is completely formed. After this, the wearing of the cannula becomes unnecessary. At the same time, the patient's condition improves noticeably. After all, a cannula or tracheostomy tube irritates the tracheal wall.
Having worked out why the tube in the throat is necessary, many are upset, because they have a lot of restrictions. With this device you can not take a shower, swim, swim in pools, bathrooms. After all, all this is fraught with chaos. But, the truth, on sale it is possible to find special overlays which prevent an opportunity of hit of water in an ostomy.
Do not forget that in normal life in the gassed and dusty places, the natural protection of the nasopharynx is triggered. And people who have a tube in their throat do not have it. Therefore, it is better to avoid visiting such places. All patients with tracheostomy are more prone to inflammatory and other bronchopulmonary diseases. They need to cover the stoma with a bandage moistened with water in hot weather. And in the cold season, it is desirable to warm the air.
Types of tracheostom
Often there is a tube in the throat during surgery. Therefore, if surgical intervention is not carried out urgently, the patient can consult a doctor, which tracheostomy to establish.
Now there is a large selection of these devices, but most of them are made of special thermoplastic material. Their peculiarity is that at a temperature of about 35-38 ° C the tube in the throat becomes elastic. This allows you to save the entire mucous membrane of the trachea and other adjacent tissues. The outer edge of the tube ends in a design resembling a butterfly in shape. It can protect the outer tissues surrounding the lumen in the throat.