A tracheostomy is a surgical procedure that creates an opening (stoma) in the neck to access the windpipe (trachea), helping a person breathe. The stoma allows air to bypass the upper airway, which may be blocked due to injury, illness, or swelling, or it can provide a secure connection for a mechanical ventilator. The tracheostomy tube and its securing accessories give the neck a distinct visual appearance that changes based on the patient’s needs.
The Appearance of the Stoma
The stoma is the physical opening made in the front of the neck, serving as the entry point into the trachea. It is typically located in the lower neck, just above the sternal notch (the dip between the collarbones). The stoma is usually small, often comparable to the size of a coin, and is only large enough to accommodate the tracheostomy tube.
When new, the skin surrounding the stoma may appear pink or slightly red due to the recent surgery. As the area heals, the skin tone typically blends closer to the person’s normal color. The skin must be kept clean and dry to prevent irritation, which is why the tube’s external components rest flat against the neck.
Components of the Tracheostomy Tube
The most visually prominent element is the tube itself, a curved piece inserted into the stoma. Tracheostomy tubes are generally made of durable, lightweight materials, such as plastic or silicone, though some specialized tubes are made of stainless steel. The design includes three main parts that function together to maintain the airway.
Outer and Inner Cannulae
The outer cannula is the main curved shaft that remains inside the trachea, keeping the airway open. The inner cannula is a removable liner that fits inside the outer one for easy cleaning and maintenance. Both cannulae are curved to match the natural anatomy of the neck and windpipe.
The Flange
The flange, or neck plate, is the flat, rectangular piece of material that rests against the skin of the neck and is a defining visual feature. The flange extends outward from the tube and includes small holes, or eyelets, used to secure the tube in place.
Specialized Features
Many tubes feature a pilot balloon, a small bulb connected to an internal cuff, which allows medical staff to visually confirm if the cuff is inflated. A fenestrated tube, designed to allow air to pass up to the vocal cords for speech, will have small holes in the outer cannula.
Securing Devices and Visual Management
The tube is held securely against the neck by a securing device to prevent movement or accidental removal. These mechanisms, often called tracheostomy ties or tube holders, are typically made of soft fabric or a strong Velcro-like material. The ties attach to the eyelets on the flange and circle the neck, providing a contrasting visual element against the skin.
The appearance of the ties varies, ranging from narrow cotton twill straps to wider, padded bands designed for comfort and moisture-wicking. Patients may also use small, round caps known as speaking valves, which attach to the outer end of the tube and redirect air up through the vocal cords for speech. For protection or aesthetic purposes, some people wear soft stoma covers, which are small pieces of cloth or mesh that cover the tube opening.
Appearance After Removal
When the patient no longer requires the tracheostomy, the tube is removed in a process called decannulation. In many cases, the stoma is allowed to close naturally, which typically happens within one to two weeks, though healing time varies based on how long the tube was in place. The stoma heals from the inside out, gradually reducing the size of the external opening.
Once the stoma is fully closed, the visible result is a small scar on the neck. The appearance of this scar varies among individuals, but it is often less noticeable than the active stoma and tube. If the stoma does not close on its own, a simple surgical procedure may be performed to stitch the edges together, resulting in a small, closed scar.