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Sometimes family is an ex-crime boss who lost everything on a really bad bet and his adoptive daughter who’s completely tapped.

A tracheostomy is a procedure in which a surgeon makes a hole and inserts a tube at the front of the neck, just below the vocal cords, to assist a patient in breathing. The hole is sometimes known as a stoma, while the surgical procedure involved is called a tracheotomy. The patient can freely breathe through the hole, or doctors may connect a tube that goes to a ventilator to assist patients with breathing difficulties.

A tracheostomy prevents fluid buildup in the throat or windpipe. Doctors perform a tracheotomy when patient experiences restricted airways resulting from emergencies where the airways suddenly block, such as after a traumatic accident or when a person has a medical condition that makes it difficult to breathe.

Some medical conditions that require a tracheostomy include anaphylaxis, diaphragm dysfunction, chronic lung disease, birth airway defects, chest injuries, and vocal cord paralysis. A doctor plans a tracheostomy and performs it in a hospital. However, a surgeon may perform it outside the hospital in some cases, such as at an accident scene.

In planned settings, the doctor advises the patient to fast for up to 12 hours if they will perform a tracheotomy under general anesthesia. The physician may also ask an individual to stop taking certain medications.

The tracheotomy performed depends on why the patient requires a stoma and whether the doctor had planned it. There are two types: surgical tracheotomy and minimally invasive tracheostomy. In both cases, a local anesthetic helps numb the neck and throat.

A surgeon performs a surgical tracheotomy in a hospital room or operating room and starts by making a horizontal incision in the front lower part of the neck. The doctor pulls the surrounding muscles and cuts a portion of the thyroid gland, exposing the trachea. The surgeon then makes a tracheostomy at a location near the neck’s base on the trachea.

Also known as percutaneous tracheostomy, minimally invasive tracheotomy happens mostly in a hospital room. The surgeon makes an incision at the neck’s base and inserts a special lens through the mouth to view the throat. This view guides the doctor to make a tracheostomy by inserting a needle into the trachea and expanding it to the required size.

After both procedures, the doctor places a tube into the tracheostomy and attaches a neck strap to a faceplate to prevent the tube from detaching from the hole. Also, temporary stitches may secure the faceplate to the neck’s skin.

In most cases, tracheostomy is temporary, and the doctor may remove the tube, allowing it to heal, or surgically close it up. However, if a patient needs to use a ventilator or has a medical condition that may require long-term use of the tracheostomy, it may remain there permanently.