What is a tracheal stoma?

What is a Tracheal Stoma?

A tracheal stoma is a surgically created opening in the anterior neck that provides direct access to the trachea (windpipe), allowing for breathing when the upper airway is compromised or bypassed. 1

Anatomy and Definition

• A tracheal stoma is an opening created through the skin and anterior tracheal wall, establishing a direct airway passage that bypasses the upper respiratory tract 1
• The stoma connects the external environment directly to the trachea, creating an alternative airway for breathing 1, 2
• It may be temporary or permanent, depending on the clinical indication 1

Types of Neck Stomas

• Tracheostomy stoma: Created during a tracheostomy procedure where the upper airway remains intact and potentially functional, allowing for both upper and lower airway breathing paths 1, 3
• Laryngectomy stoma: Created following total laryngectomy where the upper airway is completely separated from the trachea, making the stoma the only breathing passage 1

Clinical Significance

• Tracheostomy stomas allow for insertion of tracheostomy tubes that facilitate:

  • Management of prolonged mechanical ventilation 2, 4
  • Bypassing upper airway obstruction 2, 4
  • Airway protection in patients with inadequate laryngeal reflexes 4
  • Effective clearance of respiratory secretions 4
  • Support for patients with chronic respiratory failure 4

• The stoma serves as a critical access point for emergency airway management in patients with tracheostomies 1

Management Considerations

• Oxygen can be applied directly to the stoma during respiratory distress 1, 3
• In patients with tracheostomies (not laryngectomies), oxygen should be applied to both the face and stoma when there is uncertainty about the stoma type 1
• Emergency ventilation can be achieved via the stoma using specialized equipment such as pediatric facemasks or laryngeal mask airways applied to the skin over the stoma 1
• Waveform capnography is recommended to confirm airway patency through the stoma 3

Complications

• Stomas may become excessively large, making effective application of tracheostomy tubes difficult 5
• Some stomas may persist after removal of the tracheostomy tube, requiring surgical closure 6, 7
• Immediate complications related to the stoma include hemorrhage and loss of airway 2
• Long-term complications include tracheomalacia and tracheal stenosis 2

Emergency Management

• If a tracheostomy tube becomes blocked or displaced, the stoma provides direct access for emergency airway interventions 1
• In emergencies, the stoma may be intubated with a smaller tracheostomy tube or tracheal tube 1
• For patients with known difficult airways, fiberoptic inspection through the stoma may be necessary 1, 3

Understanding the anatomy and function of a tracheal stoma is essential for healthcare providers involved in the care of patients with tracheostomies or laryngectomies, as proper management can significantly impact patient morbidity, mortality, and quality of life 1.