Tracheal incision


Of the Tracheal incision (in the medicine Tracheotomy called) is a surgical procedure create an artificial airway. It is used when it is not possible to get one Breathing tube (in the medicine Tube called) introduce by mouth.

The trachea incision usually only requires a minor operation, in which a small incision is made under the larynx on the neck and the soft tissue is used to access the trachea. Even medical professionals often confuse the so-called tracheotomy with the coniotomy, which has the same purpose, but the incision is made over the windpipe. Thus, the term cricothyrotomy is not to be equated with tracheal incision. In addition, this method is actually out of date, as the risks (bleeding, nerve damage) are greater and is therefore only used in rare emergencies. Both methods should be carried out by a doctor and not a first aid measure by laypeople.


The indications for tracheal incisions are diverse. The trachea incision is used, for example, when the airways are obstructed by swallowing small toys, as is often the case with children, or when swelling in the mouth / throat area, as well as to secure airways during planned operations in the mouth / throat area, for example in tumor operations.

A tracheal incision is used, among other things, for long-term ventilation. Here the patient is often put into an artificial coma. Read more on the subject below: Artificial coma for pneumonia

Illustration of the trachea

Illustration of the trachea from the front (A), cross-section (B), from behind (C) and detail (D)
  1. Windpipe (approx. 20 cm) -
  2. Thyroid cartilage -
    Cartilago thyroidea
  3. Cricoid cartilage -
    Cartilago cricoidea
  4. Ring band -
    Annular ligament
  5. Tracheal cartilage -
    Cartilago trachealis
  6. Cover fabric - Tunica adventitia
  7. Trachea glands -
    Glandulae tracheales
  8. Mucous membrane - Tunica mucosa
  9. Membrane rear wall -
  10. Tracheal Muscle -
    Tracheal muscle
  11. Bronchiole - Bronchiolus
  12. Left lung -
    Pulmo sinister
  13. Left main bronchus -
    Bronchus principalis sinister
  14. Bifurcation of the windpipe -
    Bifurcatio tracheae
  15. Right main bronchus -
    Bronchus principalis dexter
  16. Right lung -

You can find an overview of all Dr-Gumpert images at: medical illustrations

The operation

There are two ways to secure the airway, one with one Tracheal incision and once by one Tracheal puncture. In an emergency, the tracheal puncture has proven to be easier and safer method proven. A hollow needle is taken and placed below the Larynx, between the cricoid and thyroid cartilage. A guide wire can then be inserted, around which a breathing tube (Tube) is pushed. The guide wire is then removed again.

When cutting the trachea, a Incision below the thyroid cartilage set and so the skin up to the windpipe cut across. Then a suitable tube is inserted that makes breathing possible again.

After the airway has been restored, the tube can usually be removed without major problems. The cut can be closed again with seams.

Instructions for a tracheal incision

Of the Tracheal incision (Tracheotomy) is classically included in a surgical procedure anesthesia carried out, but can also be done under local anesthesia. It is usually only performed if the patient cannot be ventilated by other means, as the process is not safe and many complications can occur. A distinction can be made between two methods of performing a tracheal incision. Both are performed under sterile conditions and with the patient lying on his back with the neck hyperextended.

Percutaneous dilatation tracheotomy

This method is used when artificial ventilation of the patient is necessary and other methods, such as mask ventilation or intubation, cannot be used.
This technique is particularly suitable when the patient does not need permanent ventilation. For example with patients in intensive care units or with Diseases of the larynx or the windpipe.

The risk of infection is lower with this procedure. The windpipe is inserted between the cricoid cartilage with a thin, pointed cannula (Part of the larynx) and punctured the first cartilage clasp of the trachea. A guide wire can be inserted into the windpipe via the cannula. The correct position in the windpipe is checked with an endoscope.
If it is in the correct position, a dilator is advanced along the wire, which expands the adjacent tissue and creates an opening for the ventilation tube. After the dilator has been withdrawn, the ventilation cannula is inserted into the windpipe via the wire and the guide wire can be removed. The opening created to the trachea closes spontaneously again within a few days if no cannula is used for ventilation, as the surrounding tissue has only been expanded. In the first few days, however, the ventilation hose must not be changed, as the opening would close again within a short time.

Surgical tracheotomy

A permanent tracheal incision is made, which is more stable and larger than in the first procedure.
If the breathing channel is no longer needed, it must be closed in a new operation. This method is therefore particularly suitable for patients who require permanent ventilation.
First, the thyroid and cricoid cartilage on the neck are palpated and marked. The cut across the trachea is made below the thyroid cartilage and is approximately 3cm big. In the next step, the neck muscles and possibly the connection between the thyroid lobes (Thyroid isthmus) to get a view of the trachea clips. Now the trachea is opened between the 2nd and 3rd cartilage brace.

Parts of the windpipe are now opened like a window sash and sewn to the skin of the neck. A stable connection is created between the room air and the windpipe (tracheostoma) through which a ventilation tube (tracheostomy tube) can now be inserted.


Every operation, however small, has complications. Bleeding or injury to surrounding structures usually represent the most common complications. As is the case here with Tracheal incision.

Surrounding structures / organs here are the thyroid, certain annoy and Vessels. If the patient has a particularly large thyroid gland, one may be necessary Remove part of the thyroid gland to have to. In addition, the thyroid gland is well supplied with blood, so this bleeding can be injured. If nerves are injured, this can lead to Numbness or paralysis of the vocal cords lead, in turn, to a constant hoarse voice can lead. In the worst case, the Sever the nerves on both sides, it comes to a vocal cord paralysis and thus to Difficulty breathing, because the vocal cords close the trachea opening when paralyzed. In addition, speaking is then no longer possible. If the blood vessels are damaged, it can lead to bleeding during the operation, but also to secondary bleeding.

In addition, if the tube is not sewn into place, slip out or slip. When the tube presses on the tissue, it can Swelling, Infections, Scarring and Wound healing disorders come.

Speak is with a tube actually not possible, however, if the patient needs a tube for a long time, a so-called Speech cannula can be used that makes speaking possible again.

Other disadvantages are that of the patient no longer smell can, thereby also the taste sensations are disturbed. Advantages of the tracheal incision in contrast to the introduction of a breathing tube through the mouth are that the patient can eat, the Oral hygiene is possible and that Speaking with a voice tube can also be made possible.


After a Tracheal incision the air no longer gets into the mouth and nose lung, but via the ventilation cannula.
The air flowing in through the nose usually humidifies the nose and thus ensures smelling.

As a result, people with a tracheotomy can no longer smell. Since the incision in the trachea is made below the larynx, which is responsible for speaking, the patient can only speak using a special speaking valve.
In addition to these disadvantages, the operation also harbors certain risks, such as bleeding or infection of the tracheotomy and the inserted cannula. But important nerves can also be damaged, especially here is the Recurrent nerve (Recurrent laryngeal nerve), which supplies the larynx and is important for speaking.
But also an injury to adjacent organs like the thyroid or the esophagus are possible. At Narrowing of the windpipe (Tracheal stenosis) due to infections, mucus plugs or new tissue formation, it is a life-threatening complication.
In this case, a new operation is necessary to ensure further ventilation of the patient.

Tracheal incision with a ballpoint pen

An emergency tracheal incision is only rarely necessary and without anatomical and medical knowledge involves considerable risks.
Laypeople are therefore strongly advised not to do this themselves with a ballpoint pen or similar objects such as straws.

English scientists published a study in which they tested various ballpoint pens for performing a tracheal incision. They came to the conclusion that most ballpoint pen models are not suitable for this.
If the diameter of the ballpoint pen is too narrow at the pointed end (<3mm), the pen cannot get enough air into the lungs for ventilation.

But puncturing the windpipe can also be difficult or even impossible with the blunt end of the ballpoint pen. In addition, an incision like a surgical tracheotomy would therefore be necessary, which can be associated with major bleeding and cannot be correctly placed without anatomical knowledge.
Overall, of eight models tested, only two were theoretically suitable for a tracheal incision. So it's more of a movie myth that shouldn't be copied!

Tracheotomy and speaking

Since inhalation and exhalation take place via the ventilation cannula, which is inserted through the tracheal incision, voiced speech is no longer possible if the tracheal incision is present.

The air flows through the cannula directly into the lungs and exhalation also takes place directly through the cannula. The upper respiratory tract, the Larynx and the vocal cords are therefore bypassed and vocal training does not occur. So-called speaking valves can be used to enable the patient with a tracheotomy to speak.
These can be attached to the ventilation hose.Inhalation takes place through the valve, which closes when you exhale. The air must therefore be exhaled past the larynx and the vocal cords via the mouth and nose when exhaling. The air flowing past the vocal cords can then be used for speaking.

Tracheotomy in COPD

In the COPD (Chronic obstructive pulmonary disease) is a disease with chronic narrowing of the airways.

In severe stages or in the event of acute deterioration, for example in the context of an infection, ventilation of the patient may be necessary. You can non-invasive methods (Mask ventilation) and invasive methods such as trachea incisions.
These methods are designed to relieve the exhausted respiratory muscles and ensure an adequate supply of oxygen to the body. If mask ventilation is not effective enough or if there are other reasons against a non-invasive ventilation method, a surgical tracheal incision with the creation of a tracheostoma may be necessary.

In addition to ventilation, the trachea incision also offers the advantage that secretions in the airways can also be sucked off, thus cleaning the airways.
It may well be that invasive ventilation must be continued at home. The patient can then change the ventilation tube himself at home, and he can also take care of the incision of the trachea himself.