Why do you have to cut the trachea for thyroid cancer surgery?
The recurrent laryngeal nerve is located immediately behind the thyroid gland, one on each side. Thyroid cancer tends to invade the recurrent laryngeal nerve.
The recurrent laryngeal nerve controls the movement of the larynx. Damage to one side of the nerve can lead to hoarseness; damage to both sides and you can choke. Combined with possible tracheal collapse and laryngeal edema, the surgeon may do an intraoperative tracheotomy to ensure ventilation.
There are also locally advanced or recurrent thyroid cancers with extensive tumor invasion of the esophagus and trachea, which also require a tracheotomy during surgery to ensure airway patency.
Tracheotomy, how do families care?
A tracheotomy brings a lot of inconvenience to life. It is important for you and your relatives to communicate more with your doctor and actively work with your healthcare provider to provide scientific care.
Tracheal cannula and wound care
Disposable tracheal cannulae with air bags need to be changed weekly, and metal cannulae can be reused. The tracheal cannula is cleaned every 3 to 5 hours and disinfected every 12 hours.
The tracheotomy site should be kept clean and dry. Change the dressing daily to avoid bleeding. The wound can be cleaned with saline (0.9% sodium chloride solution) and then wiped with 70% medical alcohol.
Aspiration and humidification
When we breathe, our nose and throat warm, moisten, and filter the air to keep us “safe”. After a tracheotomy, the loss of humidification can cause dryness of the respiratory mucosa and sticky secretions, which can form thick sputum and block the airway, causing breathing difficulties and increasing the chance of lung infection. Therefore, it is also very important to aspirate and moisten the artificial airway after tracheotomy.
During hospitalization, aspiration is usually performed by a nurse. She will select the right suction tube for you and adjust the appropriate negative pressure according to the size of the incision. Suction tubes are usually disposable. Before and after aspiration, the nurse will wash her hands, wear sterile gloves and a mask. The duration of each suction is limited to 15 seconds, and no more than 3 consecutive suctions will be performed to avoid hypoxia due to poor ventilation. Once this happens, the nurse will immediately stop suctioning and give you oxygen.
Wetting is often done by spray delivery, usually with distilled water or saline. The mist droplets can enter the airways and lungs fully and evenly. The spray can be supplemented with phlegmolytic drugs, which have the advantage of achieving better local efficacy with smaller doses of drugs.
An artificial nose is also a good aid to keep the airway moist and warm, so talk to your doctor.
Co-written by Dr. Jiaying Chen, Fudan University Cancer Hospital