A tracheostomy is an opening in the lower part of the neck with a temporary tube placed to allow air to pass directly in to and out of the trachea (sometimes called wind pipe), bypassing the mouth and nose.
The need for tracheostomies will be judged on a case-by-case basis with your surgeon. They provide the surgeons with greater access in the mouth to achieve a safe cancer removal. If they are performed, they are carried out under general anaesthetic at the start of your procedure, and normally only need to stay in for 2-3 days after your operation.
The reason they are used in this context is because patients can experience some acute swelling during and after mouth cancer surgery, which has the potential to threaten your ability to breathe safely. If tracheostomies are not placed in a planned (elective) procedure, then patients run the risk of requiring an emergency or ‘crash’ tracheostomy. This is quite frightening for patients and carries much higher risks of complications than when they are performed under general anaesthetic in a planned way. It is therefore often safer to have the tracheostomy but remove it as soon as it’s no longer required.
After you have been put to sleep under a general anaesthetic but at the start of the operation, a small cut or incision approximately 2cm is made at the base of the neck in the midline.
There are some muscles in the middle of the neck which are parted and a small opening is made into the trachea. A plastic tracheostomy tube is inserted. This tube has a balloon or cuff around it, and this is inflated to form an air tight seal around the edge. The Anaesthetist can then keep you breathing safely under a general anaesthetic.
After the operation has finished, you will be woken up by your specialist anaesthetist and nursing team. The sensation of breathing can feel quite different because the air isn’t moving through your mouth or nose, instead it is coming out of the tracheostomy tube. The team will be with you throughout to reassure you and make sure everything is okay.
Initially because the air is diverted by the tracheostomy from passing through your larynx and mouth you wont be able to speak. All the team are very experienced at helping patients with tracheostomies and will provide boards, pads, tablets etc to help with communication.
After a couple of days the tube can often be changed over to a speaking tube which has a valve to enable air to
pass through the larynx and mouth giving you your voice back. The reality is however that usually
at this point the tube can be safely completely removed anyway.