Tracheotomy

Collier's New Encyclopedia (1921)

the opening of the trachea or windpipe. It may be done in three different positions, viz., between the cricoid and thyroid cartilages, above the thyroid isthmus, and below it, and all three operations are often termed tracheotomy. The operation is performed as follows: An incision is made in the middle line, from an inch and a half to two inches, downward from the cricoid cartilage through the skin and deep fascia. Any arteries wounded in this incision being secured, the subcutaneous connective tissue is divided, fold after fold, the large vessels being pressed aside or ligatured when required. The sterno-hyoid and sterno-thyroid muscles are then separated by the handle of the knife, exposing the upper portion of the trachea, which is usually covered by the isthmus of the thyroid gland, which may be drawn up a hook if it is unusually broad. with The trachea should be carefully dissected till three rings are exposed. A sharp tenaculum is then thrust into it, and it is raised somewhat upward and steadied, and then divided from below upward by a sharp-pointed bistoury inserted into one of the interspaces. The completion of the operation is confirmed by the peculiar hissing sound with which the air rushes out of the open wound. The next step is the introduction of the canula, which soon becomes obstructed with mucus, and the inner tube must often be withdrawn for the purpose of cleansing it. The canula must be secured by a piece of tape round the neck, and the edges of the wound above and below the canula may be brought together by stiches or by adhesive plaster.