486 OPERATIONS ON THE RESPIRATORY APPARATUS. 



tion of the tube. This mode of operating is simple and of easy- 

 performance, especially in the absence of any swelling of the re- 

 gion. It prevents perichondi'itis, and is not followed by changes 

 in the diameter of the trachea. It has, besides, the advantage 

 of allowing the tube to be, to a great extent, concealed, and 

 thus removes one of the principal objections urged against the 

 operation in cases of chronic roaring, for which it might well be 

 recommended. 



The subsequent measures vary somewhat, depending upon 

 whether the operation has been performed as only a temporary 

 expedient, or as a permanent means of rehef for the difficulty in 

 breathing. In the first case, it is not neisessary to remove the 

 tube before the acute symptoms, which have required its intro- 

 duction, have subsided, which is a condition which generally does 

 not continue more than two or three days. If, however, during 

 that time the canula of the tube should become closed by the dis- 

 charge or other pathological secretions, it must be removed, 

 cleansed and rej)laced, to be left until its use becomes unneces- 

 sary, which will be readily discovered by the restored regularity 

 of the respiration when the tube is removed or its canula becomes 

 occluded. 



If the tube is to be worn permanently, careful attention should 

 be paid to its proper fit and adjustment, and its daily removal 

 and thorough cleansing shoiild never be overlooked. It should 

 be ascertained that the instrument fits properly, being held with 

 sufficient firmness in the opening, and making a safe and moder- 

 ate pressure on the soft tissues around. "When the instrument 

 has been worn for a (variable) time, the ojDening of the trachea 

 has a tendency to contract, and becomes smaller by reason of the 

 development of the granulation of the edges of the wound. In 

 this case it may become necessaiy to enlarge the opening, by the 

 excision of the granulations, sufficiently to allow of the ready re- 

 introduction of the tube. When it becomes desirable to close the 

 wound, the removal of the tube, and the application of an ordi- 

 nary dressing, protecting it only by a pad of antisej)tic oakum, 

 kept in place by a few turns of bandage around the neck, is all 

 that is necessary. Usually, after two or three weeks the cicatrix 

 is complete. 



The oi^eration of tracheotomy may be accompanied or followed 

 by various accidents : 



