A tracheotomy tube is a device that is surgically placed into the trachea low in the neck, with its tip well inside the trachea and its other end anchored to a faceplate that sits on the surface of the neck. A tracheotomy tube allows an individual to breathe directly from the neck opening into the trachea as an alternative to normal breathing through the nose and/or mouth. “Trach” is the colloquial term used by clinicians to refer to a tracheotomy tube.
A fenestrated tracheotomy tube allows voicing when there is stenosis
Tracheotomy (1 of 4)
Tracheotomy (1 of 4)
View below vocal cords (2 of 4)
View below vocal cords (2 of 4)
Fenestra (3 of 4)
Fenestra (3 of 4)
Patient post-trach (4 of 4)
Patient post-trach (4 of 4)
Nuances of Endotracheal Tube Injury
This woman with high-risk comorbidities of diabetes and obesity, was in ventilated in ICU more than a month for pulmonary complications of Covid-19 infection. She had an orotracheal tube in place for 3.5 weeks, and then a tracheotomy tube was placed. Now at her first visit a year later, she remains tracheotomy-dependent, and is told she has bilateral vocal cord paralysis (disproven in the following photo series).
Maximum glottic opening (1 of 8)
Maximum glottic opening (1 of 8)
Undersurface mucosa indraws (2 of 8)
Undersurface mucosa indraws (2 of 8)
Phonation (3 of 8)
Phonation (3 of 8)
Posterior commissure divot (4 of 8)
Posterior commissure divot (4 of 8)
Further evidence of scarring (5 of 8)
Further evidence of scarring (5 of 8)
View into trachea (6 of 8)
View into trachea (6 of 8)
Vibration of trachea (7 of 8)
Vibration of trachea (7 of 8)
Open trachea beyond the tube (8 of 8)
Open trachea beyond the tube (8 of 8)
The plan here is posterior commissuroplasty, followed by placement of a smaller trach tube and a trial of plugging. If plugging is tolerated during the day, she will need a sleep study with it plugged at night, given the tracheomalacia and her obesity.