Common head and neck surgery includes the removal of the voice box: largyngectomy and tracheostomy: making an incision on the anterior aspect of the neck and opening an airway through an incision in the trachea. The removal of the larynx occurs in cases of laryngeal cancer and in this case the airway is separated from the mouth, nose and oesophagus meaning that the patient will breathe through a stoma in the neck. In tracheostomy cases the resulting stoma can act as an airway and a tracheotomy tube is inserted, enabling the individual to breathe without the use of their nose and mouth. Tracheostomys may be required for long term control of excessive bronchial secretions, particularly in those with reduced consciousness or to maintain an airway and protect the lungs in those with impaired pharyngeal and laryngeal reflexes (Clark & Kumar, 2009). They can be used for patients with an obstruction in the upper airway, for example trauma, infection, largyngeal tumour, and facial fractures. It can also be used when there is impaired respiratory function for example, head trauma. They may be temporary to preserve the airway from post op oedema associated with oropharyngeal surgical procedures. Patients in intensive care will sometimes have a tracheostomy to assist weaning from ventilator support. There are different types of tracheostomy tubes that can be inserted into the stoma. These include plastic or silver tubes, silver tubes cannot stay in for more than a week and do not have an inner tube that can be removed, unlike plastic tubes which can stay in for up to 30 days. There is also the option of the tube being cuffed or uncuffed, cuffed meaning that there is a small balloon around the far end that can be inflated tubes with air to protect the airway and they tend to be used in ventilated patients whereas when the balloon is deflated it allows air around the tube for vocalisation. There are also fenestrated tubes which have an opening in the tube that allows...
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