End tracheostomy is performed in patients undergoing surgery for
Answer: a) Laryngectomy (DHINGRA 6th ED, P-316)TRACHEOSTOMY* Emergency tracheostomy* Elective or tranquil tracheostomy* Permanent tracheostomy* Percutaneous dilatational tracheostomy* Mini tracheostomy (cricothyroidotomy)Emergency tracheostomy* It is employed when airway obstruction is complete or almost complete and there is an urgent need to establish the airway.* Intubation or laryngotomy are either not possible or feasible in such cases.Elective tracheostomy (tranquil, orderly or routine tracheostomy)* Almost all operative surgical facilities are available, endotracheal tube can be put and local or general anaesthesia can be given.* Elective tracheostomy is often temporary and is closed when indication is over.* It is of two types:> Therapeutic, to relieve respiratory obstruction, remove tracheobronchial secretions or give assisted ventilation.> Prophylactic, to guard against anticipated respiratory obstruction or aspiration of blood or pharyngeal secretions such as in extensive surgery of tongue, floor of mouth, mandibular resection or laryngofissure.Permanent tracheostomy* This may be required for cases of bilateral abductor paralysis or laryngeal stenosis.* In laryngectomy or laryngopharyngectomy, lower tracheal stump is brought to surface and stitched to the skin.High tracheostomy* Above the level of thyroid isthmus (isthmus lies against II, III, IV tracheal rings)* It violates the I tracheal ring* Can cause perichondritis of the cricoid cartilage and subglottic stenosis* Always avoided* Only indication: carcinoma larynxMid tracheostomy* Preferred one* Through II or III rings (isthmus either divided or retracted)Low tracheostomy* Below the level of isthmus
Laryngectomy
Laryngofissure surgery
Oropharyngeal growth
Obstructive sleep apnea with stridor
Larynx