2. Tracheostomy
ďA tracheostomy is a surgically created opening (stoma)
through the front of neck into the windpipe (trachea).
ďA tube is usually placed through this opening to provide
an airway and to remove secretions from the lungs. This
tube is called a tracheostomy tube
Endotracheal tubeTracheostomy tube
5. Tracheostomy
Objectives of tracheostomy
ďTo assist respiration
ďRelief from airway obstruction
ďReduction of the anatomical dead space(150ml)
ďAccess for tracheobronchial toileting
ďCuffed tube prevents aspiration and allows positive pressure
ventilation
All these objectives can be met by endotracheal intubation
initially. But the need for prolonged endotracheal intubation
requires tracheostomy
7. Tracheostomy
Steps of operation of emergency tracheostomy
1.Patient in supine position with neck extended
2.After local anaesthesia, 1.5â vertical skin incision is given
below cricoid in the midline
3.Skin, platysma,deep fascia and pretracheal fascia are
divided
4.Isthmus of thyroid is divided between ligatures
5.Cricoid hook is used to lift & stabilise trachea
6.The 2nd
, 3rd
& 4th
tracheal rings are divided with a knife
7.Tracheal wound is dilated with tracheal dilator
8.Tracheostomy tube is inserted and cuff inflated
9.The tube is fixed around neck with tapes
9. Tracheostomy
Elective tracheostomy
ďTransverse skin incision is placed
ďInverted U shaped tracheal flap is raised and stitched to
skin incision
Aftercare of tracheostomy
ďHumidification
ďIntermittent suction of tracheobronchial secretions
ďClearance of thick mucus by nebulisation and washing of
inner tube with sodabicarb and changing
ďCare of cuff with low pressure
ďReplacement of tube once in 3-4 days correctly
12. Parathyroid glands
Surgical anatomy
ďFour(2pairs) small, oval, yellowish brown glands located
on the posterior surface of thyroid gland
ďSuperior parathyroids develop with the thyroid gland
from the 4th
branchial arch and are constant in position
ďInferior parathyroids develop with thymus from 3rd
branchial arch descending lower along with thymus and
are variable in position
13. Parathyroid glands
Physiology
Chief cells of parathyroid produce parathormone(PTH)
PTH raises plasma calcium levels by
ďIncreasing calcium absorption from intestine
ďReleasing calcium from bones by osteoclastic stimulation
ďIncreasing the renal resorption of calcium
Calcitonin secreted by parafollicular cells of thyroid has
opposite action on calcium i.e. it lowers the serum calcium
levels.
14. Hypoparathyroidism
ďUsually due to damage to parathyroid gland during
thyroidectomy
ďDue to decreased PTH hypocalcemia develops leading to
tetany.
Clinical features
ďCircumoral tingling and numbness
ďChvostekâs sign
ďTrousseauâs sign
ďCarpopedal smasm
ďLaryngeal stridor
17. Hyperparathyroidism
ďIncreased secretion of PTH leading to hypercalcemia and
its clinical manifestations
Types
ďPrimary hyperparathyroidism
ďAdenoma (solitary)
ďHyperplasia
ďCarcinoma
ďSecondary hyperparathyroidism
ďDecreased calcium levels in CRF & Vit-D deficiency
ďTertiary hyperparathyroidism
ďProlonged stimulation by hypocalcemia
18. Hyperparathyroidism
Clinical features
ďAsymptomatic- detected by biochemical screening
ďSymptomatic cases
ďRenal stones
ďDiseases of bones
ď Bone pains
ď Pathological fractures
ď Cysts and pseudotumours of bones
ď Osteoporosis and subperiosteal erosions in skull and phalanges
ďPsychic moans
ďAbdominal groans
ď Peptic ulcers
ď Pancreatitis
19. Hyperparathyroidism
Diagnosis
ďBiochemical investigations
ďRaised calcium and PTH levels
ďDecreased serum phosphorus levels
ďRaised serum alkaline phosphatase levels
ďRadiological investigations
ďX-ray skull and phalanges
ďUsg neck
ďCT and MRI
ďThallium-Technetium subtraction isotope scan
ďSelective angiography and venous sampling
20. Hyperparathyroidism
Treatment
ďSurgical removal of overactive glands
ďAdenoma-Excision
ďHyperplasia âExcision of all 4 parathyroids and
autotransplantation of one parathyroid in forearm muscles
ďCarcinoma â radical excision along with thyroid