TRACHEOTOMY

TRACHEOTOMY.—The air-passages may be opened in several different situations—viz. through the thyroid cartilage (thyrotomy; only used for removal of growths, &c.); through the crico-thyroid membrane (see LARYNX; Laryngotomy); through the cricoid cartilage and the upper rings of the trachea (Laryngo-tracheotomy; very rarely used); and through the trachea, either above or below the isthmus of the thyroid gland (Tracheotomy proper, high or low, according to the part chosen). Laryngotomy is more quickly and easily performed, especially in adult males, and is less dangerous; tracheotomy is a more difficult, tedious, and dangerous operation, but in some cases (as, for example, where there is any necessity for introducing the forceps) must be selected. It is unnecessary to enter into details regarding the modes of performing these operations. When the operation is completed a large curved double tube to breathe through is inserted in the aperture, and the outer tube is secured round the neck with a tape. The inner tube should fit quite loosely into the outer, so that if it becomes obstructed it may have a chance of being ejected by the patient's cough, and that it may be readily removed and cleaned. The tube may be re- moved in a few days, or may have to be worn permanently. Tracheotomy may be required for cut throat, laryngitis and other laryngeal disease, croup, diphtheria, tumours or epithelial growths in the larynx, foreign bodies below the glottis, or external tumours (bronchocele, abscesses, &c.).