The after-treatment also corresponds to that which is adopted in diphtheria. It is important to keep the tube clean and to prevent it from irritating the trachea. The time for removal of the canula varies according to the condition. Thus, when tracheotomy is performed for a foreign body, the tube may be removed as soon as the object has been extracted; on the other hand, when treating stenosis of the larynx it may be necessary to advise permanent wearing of the canula.
Complications are less common than with tracheotomy for diphtheria. Under favourable conditions there is little danger of pneumonia unless the wound becomes infected, as may happen when the operation is undertaken for the relief of septic inflammations.
Although tracheotomy is in itself a slight operation, it should be reserved for cases that demand it. The mortality of the operation under favourable conditions is probably very small; on the other hand, in acute septic conditions and in patients suffering from bronchitis there are grave dangers of complications.
TRACHEO-FISSURE AND RESECTION OF THE TRACHEA
Although these operations are very rarely performed, advance has been made in their technique during recent years.
Fig. 275. Sarcoma of the Trachea. (From Specimen No. 1658a in the Museum of St. Bartholomew’s Hospital.)
Indications. (i) Tumours of the trachea. These are uncommon. Thiesen[34] in 1906 collected from literature 135 cases, of which 89 were innocent and 46 malignant. The majority of the former were papilloma (25), fibroma (24), enchondroma (17), and intratracheal struma (10). Of the latter, carcinoma (28) was more common than sarcoma (18). More than half of these tumours were situated high up in the trachea. These cases were collected from a period covering seventy-five years, which proves that they are extremely rare as compared with tumours of the larynx.
(ii) Stenosis due to previous inflammation. Stenosis may be caused by diphtheria or other fevers, syphilis, the presence of a foreign body, or the inhalation of corrosive acids or chemical fumes. Such cases are generally treated by endotracheal methods (see [p. 559]).
(iii) Cut-throat, or injury. An operation may be necessary after crushing or bullet wounds, or, in later stages, owing to the development of stenosis.