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Tracheostomy during tongue cancer surgery | CION Cancer Clinics
A tracheostomy in tongue cancer surgery is a small, temporary opening in the front of the neck with a short tube to breathe through. It is made because the mouth and throat swell after the operation and can block the normal airway. It is a safety step, not a sign that something went wrong. The tube usually comes out while you are still in hospital and the opening closes on its own. This page explains when it is used, what happens to the tube and what to ask. CION Cancer Clinics’ surgical oncologists in Hyderabad can talk this through with you.
MI
Medically reviewed by Dr. Mohammed ImaduddinConsultant Surgical Oncologist · MBBS, MS (General Surgery), MCh (Surgical Oncology) · last reviewed September 2026, next review due September 2027
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On this page
- Why would I need a tracheostomy for tongue cancer surgery?
- When is a tracheostomy usually planned, and when is it not?
- What happens to the tube from the operation to going home?
- Words you will hear around the tube, in plain language
- Four things families say about the tube, and what is true
- What this page cannot tell you
- Common questions about tracheostomy in tongue surgery
The short answer
Why would I need a tracheostomy for tongue cancer surgery?
A tracheostomy is a small opening made in the front of the neck, into the windpipe, with a short tube placed through it to breathe. In tongue cancer surgery it is made as a safety measure, because the mouth and throat swell after the operation and can block the normal way of breathing. It is almost always temporary. The tube is removed once the swelling has gone down, usually while you are still in hospital, and the opening closes on its own.
What it is protecting you from
After part of the tongue is removed, especially if a flap is added to rebuild it, the tongue, floor of the mouth and throat swell for several days. In a bad case that swelling can close the airway. A tracheostomy sits below the swelling, so you breathe safely through the neck no matter what the mouth does. It also lets the nurses clear secretions while you cannot cough well.
Who does not need one
Most small operations on the side or tip of the tongue, done through the mouth without a flap, do not need a tracheostomy. The swelling is limited and you breathe normally from the start. Your surgeon decides before the operation, and sometimes on the table, and will tell you which is planned for you.
A tracheostomy does not affect the voice box. Once the tube is out and the opening has closed, the voice is the same as it was before.What the team weighs
When is a tracheostomy usually planned, and when is it not?
Usually planned
Where the surgeon expects heavy swelling or a long recovery of the airway.
Typical situations
- More than half the tongue removed
- A flap used to rebuild the tongue
- Surgery on the floor of the mouth or jaw as well
- Neck glands removed on both sides
Usually not needed
Where the swelling will be small and the airway is easy to watch.
Typical situations
- A small partial glossectomy through the mouth
- No flap and no jaw surgery
- Neck surgery on one side only, or none
The alternative
In some centres the breathing tube from the anaesthetic is left in through the nose for a day or two in intensive care instead. Each approach has trade-offs. Ask which your centre uses and why, and whether the plan could change during the operation.
This page does not say which is right for you. That is your surgical and anaesthetic team's call.Not sure whether this applies to you?
Ask an oncologistStart to finish
What happens to the tube from the operation to going home?
-
Made in theatre
The opening is made under the same anaesthetic as the tongue surgery, at the start or the end. You wake up with the tube already in place and breathing through it.
-
The first day or two
Usually in intensive care or a high-dependency bed. Warm, moist air is blown over the tube, and a nurse clears it with a suction catheter when needed. You cannot speak, so you communicate by writing or gestures.
-
Cuff down
Many tubes have a small balloon, the cuff, that seals the windpipe at first. Once you are safe, it is let down so that some air can pass up past the tube to the voice box.
-
Smaller tube, or a speaking valve
The tube may be changed for a smaller one, or fitted with a one-way valve that lets you speak. Some centres cap the tube for a trial period to see if you breathe comfortably around it.
-
Out, and the opening closes
When the swelling has settled and you breathe well with the tube capped, it is removed. A dressing goes over the opening, which closes on its own within days and leaves a small scar.
On the ward
Words you will hear around the tube, in plain language
- Stoma
- The opening in the neck. After tongue surgery it is temporary and closes once the tube is out.
- Cuff
- A small balloon around the tube inside the windpipe. Inflated, it seals the airway and stops secretions going down. Deflated, air can pass up to the voice box.
- Suction
- A thin catheter passed down the tube to clear mucus. It makes you cough and is uncomfortable for a few seconds. Needed often at first, less as you recover.
- Humidification
- Warm, moist air given over the tube, because air through the neck misses the nose that normally warms and wets it.
- Speaking valve
- A one-way cap that lets air in through the tube and out past the voice box, so you can talk with the tube still in.
- Decannulation
- Taking the tube out for good.
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One thing that cannot wait
If you go home with the tube, or the opening has not yet closed, any sudden difficulty breathing, a tube that will not clear with suction, or bleeding from the opening is an emergency. Call an ambulance or go to the nearest emergency department at once. Do not wait to reach the centre where the operation was done.
Commonly believed
Four things families say about the tube, and what is true
"A hole in the throat means it is very
serious."
A tracheostomy in tongue surgery is a planned safety step, not a sign that something has gone wrong. It says nothing about how advanced the cancer was. It is about swelling, not about the disease.
"He will never speak normally with a hole in his
neck."
The tube bypasses the voice box for a few days but does not damage it. Once it is out and the opening has closed, the voice is unaffected. Speech changes after tongue surgery come from the tongue, not from the tracheostomy.
"The tube will be there for life."
After tongue surgery it is nearly always temporary and removed before or soon after discharge. Long-term tracheostomies are used for other conditions. If your surgeon expects yours to stay longer, they will tell you why.
"She cannot eat or drink while the tube is
in."
Eating by mouth is usually held back in the early days because of the tongue surgery itself, and a feeding tube covers it. Once the swallow is checked, some people do start swallowing with the tracheostomy still in place, with the cuff down.
Being straight with you
What this page cannot tell you
This page cannot tell you whether your operation will include a tracheostomy, or how many days yours would stay in. That depends on how much is removed, whether a flap is used, whether the jaw or neck is operated on, and how your centre manages the airway. Ask your surgeon directly, and ask the anaesthetist too.
What it feels like
Breathing through the tube is easy and most people are surprised by that. The hard parts are not being able to speak for a few days, the suction, and a dry, tickly cough. The first breaths after the tube comes out feel strange, because air is passing through the nose again and the dressing lifts slightly with each breath. That settles quickly.
What to ask before the operation
Ask whether a tracheostomy is planned, possible or unlikely. Ask how you will communicate while you cannot speak. Ask what the family should expect to see in intensive care, so the tube is not a shock.
A pad and pen, or a phone with large text, on the bedside table from day one makes the silent days far less frightening.Questions we are asked
Common questions about tracheostomy in tongue surgery
How long does the tube stay in?
Usually days rather than weeks, and most people have it removed before going home. It comes out once the swelling has settled and you breathe comfortably with the tube capped. After a very large operation with a flap it can be longer.
Does it hurt?
The opening is made under anaesthetic and is sore for a few days, much like a small cut. Suction is uncomfortable for a few seconds and makes you cough. Breathing through the tube itself does not hurt. Pain relief covers the rest, and you should say if it is not enough.
Will I be able to talk?
Not at first, because air leaves through the tube below the voice box. Once the cuff is down, a speaking valve or a finger over the tube lets air pass upward and you can speak. Until then, writing and gestures work, and the nurses are used to it.
Will I go home with it?
Usually not. Most tubes are removed while you are still in hospital. If yours needs to stay longer, you and a family member will be taught how to clean and suction it before discharge, and given a clear plan for its removal.
What will the scar look like?
A small mark low on the front of the neck that fades over months. Because it sits where a collar or the fold of a dupatta falls, most people find it hard to notice once healed.
Can I refuse the tracheostomy?
You can ask why it is planned and whether there is an alternative for your operation. For some large operations, going without one is not safe, and the surgeon will say so plainly. This is a conversation to have before the day, with the person who will be making decisions with you.
How does the family help in intensive care?
Bring a pad and pen or a phone with large text. Speak normally and give time for a written answer. Do not touch the tube or the dressing. Ask the nurse to show you what the suction is for, so it is not frightening when it happens.
Is the tube covered by Aarogyasri or insurance?
It is part of the operation, not a separate procedure, so where the surgery is covered the tracheostomy usually is too. Aarogyasri, CGHS, ECHS, EHS and most cashless insurers are accepted at CION. Call the helpline and we will check your cover.
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Sources
- NHS — Tracheostomy
- Cancer Research UK — Mouth and oropharyngeal cancer
- Macmillan Cancer Support — Mouth cancer
- National Cancer Institute — Head and neck cancers
This page is general information, not a prescription. Do not change or stop any treatment based on what you read here. If anything is worrying you, contact your own treating team — or call our helpline and we will help you reach the right specialist.
Keep reading
Related pages
Glossectomy: What the Operation InvolvesThe operation the tracheostomy is part ofICU and the First Days After SurgeryWhat intensive care is like after a big operationDrains, Tubes, Lines and CathetersThe other tubes you will wake up withAnaesthesia for Cancer SurgeryThe anaesthetist shares the airway decisionFeeding Tube After GlossectomyHow you are fed while the mouth heals
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