A tracheotome is a

medical instrument A medical device is any device intended to be used for medical purposes. Significant potential for hazards are inherent when using a device for medical purposes and thus medical devices must be proved safe and effective with reasonable assura ...

used to perform an incision in the

trachea The trachea, also known as the windpipe, is a Cartilage, cartilaginous tube that connects the larynx to the bronchi of the lungs, allowing the passage of air, and so is present in almost all air-breathing animals with lungs. The trachea extends ...

with a cutting blade operated by a powered cannula. It is often called a tracheostomy tube because once it enters the

stoma In botany, a stoma (from Greek ''στόμα'', "mouth", plural "stomata"), also called a stomate (plural "stomates"), is a pore found in the epidermis of leaves, stems, and other organs, that controls the rate of gas exchange. The pore is bor ...

in the trachea, a breathing tube is connected to a ventilator and oxygen is provided to the lungs. There are different types of tracheotomes. They can be made of

metal A metal (from Greek μέταλλον ''métallon'', "mine, quarry, metal") is a material that, when freshly prepared, polished, or fractured, shows a lustrous appearance, and conducts electricity and heat relatively well. Metals are typicall ...

plastic Plastics are a wide range of synthetic or semi-synthetic materials that use polymers as a main ingredient. Their plasticity makes it possible for plastics to be moulded, extruded or pressed into solid objects of various shapes. This adaptab ...

silicone A silicone or polysiloxane is a polymer made up of siloxane (−R2Si−O−SiR2−, where R = organic group). They are typically colorless oils or rubber-like substances. Silicones are used in sealants, adhesives, lubricants, medicine, cooking ...

. Plastic and silicone are widely used since they reduce the complications from the tracheotomy procedure such as

subglottic stenosis Subglottic stenosis is a congenital or acquired narrowing of the subglottic airway. It can be congenital, acquired, iatrogenic, or very rarely, idiopathic. It is defined as the narrowing of the portion of the airway that lies between the vocal co ...

and erosion of large

blood vessel The blood vessels are the components of the circulatory system that transport blood throughout the human body. These vessels transport blood cells, nutrients, and oxygen to the tissues of the body. They also take waste and carbon dioxide away ...

s.Types of Tracheostomy Tubes
Aaron’s Tracheostomy Page. 2004. Retrieved November 22, 2009.

History

The tracheostomy procedure is an ancient medical procedure which dates back to 2000 BC.Lindman, Jonathan. 2009
Tracheostomy
Department of Otolaryngology, ENT Care Associates. There are some records of physicians performing

tracheostomy Tracheotomy (, ), or tracheostomy, is a surgical airway management procedure which consists of making an incision (cut) on the anterior aspect (front) of the neck and opening a direct airway through an incision in the Vertebrate trachea, trache ...

to save the lives of children and sick people from choking. However, several complications were also common after the procedure was performed due to the severity of the infections and other diseases causing the oxygen obstruction. It was not until the mid 1900s that this medical tool was improved. The introduction of the mechanized tracheotome illustrates how the procedure and the device were improved. The introduction of the mechanized tracheotome by Joseph John Amato in 1972, North Riverside, provided a quicker, cleaner and precise cut which reduced the possibility of tissue damage and infection.[Amato, Joseph. 1969
Mechanized Tracheotome
North Riverside, Illinois. Previous procedures for tracheotomy were being implemented at the time, but many would lead to severe complications and were difficult to operate. Most of them required special skills and well trained practitioners.

Types of tracheotomes

Mechanized tracheotome

The mechanized tracheotome consisted of a staple, cutting blade, specialized plunger and a motor unit. Once the staple was fixed to the neck of the patient, the blade moved forward the skin,

fascia A fascia (; plural fasciae or fascias; adjective fascial; from Latin: "band") is a band or sheet of connective tissue, primarily collagen, beneath the skin that attaches to, stabilizes, encloses, and separates muscles and other internal organs. ...

and trachea to perform the incision. Then, a plunger moved forward and then backward to hold the tissues . Later, the tracheotome was removed from the patient and only the staple remained in the neck to maintain the trachea open. These were the innovative features of the mechanized tracheotome which were different from the tracheotomes at the time. It was either spring or gas-powered operated.

Spring operated tracheotome

Other tracheotomes such as the spring operated tracheotome designed by Adamson Howard in 1985,

Florida Florida is a state located in the Southeastern region of the United States. Florida is bordered to the west by the Gulf of Mexico, to the northwest by Alabama, to the north by Georgia, to the east by the Bahamas and Atlantic Ocean, and to ...

, improved the design by reducing the size and including a rotatable adjustable cap at the mount of the tracheotome to control the depth of penetration in the incision. Its handle also allowed the recocking of the spring operated cutting blade.[Howard, Adamson. 1985
Spring Operated Tracheotome
. Margate, Florida.

Other adaptations

Leslie William Peterson also made significant contributions to the improvement of the tracheostome. In 2006, his tracheal tube/catheter adaptor cap was introduced and consisted in a cap with two separate projections that allowed the catheter to be in position and prevent their rotation. It also provided heated and/or humidified gas to patients dependent on the breathing machine.[Peterson, Leslie. 2006
Tracheal Tube/Tracheal Catheter Adaptor Cap
. Castle Rock, CO. Once the incisions are made by the tracheotome and the stomas are accessible, tracheotome tubes are placed in the trachea to provide oxygen to the lungs. Tubes have also been improved to reduce complications of infection and tissue damage. For instance, Alain Milhay from

Amiens Amiens (English: or ; ; pcd, Anmien, or ) is a city and commune in northern France, located north of Paris and south-west of Lille. It is the capital of the Somme department in the region of Hauts-de-France. In 2021, the population of ...

France France (), officially the French Republic ( ), is a country primarily located in Western Europe. It also comprises of Overseas France, overseas regions and territories in the Americas and the Atlantic Ocean, Atlantic, Pacific Ocean, Pac ...

, invented a tracheotomy tube with shield for

anesthesia Anesthesia is a state of controlled, temporary loss of sensation or awareness that is induced for medical or veterinary purposes. It may include some or all of analgesia (relief from or prevention of pain), paralysis (muscle relaxation), ...

in 1983. This tube included a conduit for passing on anesthesia and

ventilation Ventilation may refer to: * Ventilation (physiology), the movement of air between the environment and the lungs via inhalation and exhalation ** Mechanical ventilation, in medicine, using artificial methods to assist breathing *** Ventilator, a ma ...

gases. At the time, other tubes were also been implemented for anesthesia application but their material composition was toxic and could give off caustic or

toxic Toxicity is the degree to which a chemical substance or a particular mixture of substances can damage an organism. Toxicity can refer to the effect on a whole organism, such as an animal, bacterium, or plant, as well as the effect on a subst ...

vapors.[Milhay, Alain. 1983
Tracheotomy Tube with Shield for Anesthesia
. Amiens, France.

Advantages

Tracheotomes became very inexpensive medical tools and easy devices to operate. The use of tracheotomes provides immediate oxygen supplies to patients by bypassing obstructions in the upper airway.
Balentine, Jerry. Medicine Net. Retrieved November 22, 2009. Tracheotomes provide another alternative for airflow when there are glottic pathological conditions such as neoplasm and bilateral vocal cord paralysis. Also, air obstruction due to neck trauma and facial fracture can be alleviated with the tracheotome incision and oxygen supply.

Complications

Patients may develop different complications after the incision is made with the tracheotome. Although these may be rare, bleeding, air obstruction, damage to the

larynx The larynx (), commonly called the voice box, is an organ in the top of the neck involved in breathing, producing sound and protecting the trachea against food aspiration. The opening of larynx into pharynx known as the laryngeal inlet is about ...

, change of voice, infection, impaired swallowing and permanent scars may occur. This is why the procedure is only performed in case of emergency. Vessels such as the

carotid arteries In anatomy, the left and right common carotid arteries (carotids) (Entry "carotid"
in
internal jugular veins The internal jugular vein is a paired jugular vein that collects blood from the brain and the superficial parts of the face and neck. This vein runs in the carotid sheath with the common carotid artery and vagus nerve. It begins in the posteri ...

could also be damaged if the incision and penetration of the blade is not accurate, with a higher risk in children and obese patients.

Tracheotome tubes used in conjunction with tracheotomes

*Single Cannula Silicone Tube *Tube with inner cannula *Metal tube with inner cannula and obturator *Fenestrated tubes *Montgomery T-tubes

References

{{reflist Surgical instruments