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Tracheostomy Tubes


         Cuffed tracheostomy tube               Cuffed tube with an adjustable flange 

  Fenestrated tracheostomy tube (Portex)             Metal tracheostomy tube

The opening was closed to allow hand-free              with speaking valve.

        phonation in this patient who had

         intermittent airway obstruction

             due to myasthenia gravis.


Fenestration on dorsal asoect of tracheostomy tube to allow

air stream upwards and enable phonation in a functioning glottis.

Tracheostomy : The Position In Cervical Trachea

Tracheostomy position as depicted in sagittal CTscan showing its course ending in tracheal lumen.




A chest X-ray showing a tracheostomy in-situ in a patient having pneumonia with pleural effusion.

Heat and Moisture Exchanger (HME)

This add-on accessory serves to filter, moisten and maintain the temperature of air that the patient breathe (the normal nasal functions deprived by having tracheostomy tube).  It may help to reduce spread of infection as well if the patient cough out infected phlegm or tracheal secretions without wearing tracheostomy bibs or tracheal stopper/cap.  Other modification include oxygen inlet port (if required - not shown here).  [HME - heat and moisture exchange device, arrow - tracheostomy tube with inner cannula in-situ].

Some Intraoperative Issues

Significant goitre (2,3) obstructing tracheostomy tube placement which need to be divided and transfixed. (1- anterior tracheal wall, S - superior towards chin, I - inferior towards chest, R - right side, L - left side)



 Large external jugular vein (V) directly facing the midline area where tracheostomy to be performed.




The vein be separated and prepared to be ligated and cut. 

Tracheostomy-Related Granulations


Figure shows peri-stomal granulations and internally towards tracheal lumen.  [black dots- peristomal granulations, stars- endotracheal granulations]

Endoluminal trachea suprastomal granulation (+).

Close-up view of the granulation (+) with the tracheostomy tube located just below its inferior edge.

Tracheostomy with Fenestra: Endoscopic Appearance

The fenestra allows air stream to be channeled upward and enable phonation

in a functional larynx.  The tube need to be changed as it will becomes dirty after prolonged use and potentially harbour microrganisms and bofilm

to cause tracheitis and granulations.

Percutaneous Tracheostomy (Blue Rhino)

TRACOE smart Cuff Manager


The TRACOE smart Cuff Manager monitors and regulates the internal pressure of Higj Volume Low Pressure cuffs of tracheostomy tubes as well as endotracheal tubes.  The pressure is continuously held between 20 cm H2O and 30 cm H2O.



Montgomery T-Tube




Montgomery T-Tube: Endoscopic View

 In this video, a T-tube (arrow) is seen below the vocal fold and the vocal folds movements were normal.  The tube was inserted to stent the narrow airway segment while enabling breathing through the windpipe (trachea).  The external limb of the tube emerged through the neck at the midline (not shown) which served as an anchor.  (E - epiglottis)

Stents as An Option of Treatment inTracheal Lumen Narrowing or Obstruction

                    Rusch polyflex stent                   Dumont silicone stent


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