TRACHEOTOMY (from Gk. rpavia, eheia, trachea, windpipe, rough artery + tomO, a cutting, from repEtr, temnein, to cut) and LARYNGOTOMY ( from Gk. Tarynx, larynx ± 704, tom, a cutting). Opening the trachea by incision in order to admit the en trance of air when suffocation is threatened.
Among the conditions which demand trache otomy are foreign bodies in the air passages, cut throat. diphtheria, (Aetna of the glottis. and tu mors either within the larynx or pressing 111)0D the air passages from without (as a goitre). The air pas sages may be opened in three different situations —n am ely • through the crico thyroid membrane ( see LARYNX ) , when the operation is termed laryngotomy; through the (Timid cartilage and the upper rings of the trachea, the oper ation being known as laryngo-tracheotomy; and through the trachea, below the isthmus of the thyroid gland, constituting tracheotomy proper. Laryngotomy and tracheotomy are more common ly performed than laryng,o-tracheotomy, to which no further allusion is required. Laryngotomy is more quickly and easily performed, especially in adult males, and is less dangerous; tracheotomy is a more difficult, tedious, and dangerous opera tion, but must be employed in some eases (as, for example, where there is any necessity for intro ducing the forceps and in cases where a tracheotomy tube must be allowed to remain in position for some time). The incision is made in the middle line of the neck, longitudinally, the blood vessels being pushed aside as much as possible with the handle of the knife. \\lien the trachea is exposed and is cut through the wound is held apart with tenacula that the tube may be inserted. As haste is generally necessary, a neat dissection can rarely he made, but great care must be exercised to prevent blood from en tering the air passage. When the operation is completed a large curved tube to breathe through is inserted in the aperture, and secured round the neck with tapes.
A double tube or eanula possesses many ad vantages, as, by withdrawing the inner one, which should slightly project at its lower ex tremity, it may be cleared of any mucus or blood that may have accumulated in it, without dis turbing the wound. The calibre of the inner tube should always he sufficiently large to admit as much air as usually passes through the chink of the healthy glottis. If left too long, the patient may die of asphyxia. It is therefore necessary to decide and act quickly, selecting a field of operation certainly below the point of obstruc tion. and a full-sized tube should be inserted. Up to the time of O'Dwyer the operation of tracheotomy was frequently and successfully per. formed. In ISS5 Dr. Joseph O'Dwyer of New York devised instruments wherewith intubation of the larynx was performed as a substitute for tracheotomy. Intubation consists in placing a short tube in position in the larynx, between the vocal cords, its lower end reaching a point as low' as an incision would he made if the air pas sages were opened. and thus admitting air from the throat. The tube may crowd down false membrane ahead of it. and in some such cases tracheotomy may be necessary. Few' other dangers are possible. The tube may be re moved on the fourth day. or may remain in situ till the eleventh day. Its presence causes disintegration of the pseudo-membrane of diph theria; prevents, reflex spasm; and also ohviates the granulations which are common and very annoying after tracheotomy. If ulceration be produced by intubation it is superficial and trivial. The recoveries from diphtheria in cases in which intubation is practical average over 50 per cent.