Medical Oncologist
CION Cancer Clinics
Planned tracheostomy before head and neck cancer surgery | CION Cancer Clinics
A tracheostomy is often planned during large operations on the tongue, jaw, floor of the mouth or throat. The tissues swell afterwards and can narrow the airway, so a tube in the neck keeps breathing safe until the swelling settles. It is usually done at the start of the same operation, while you are asleep, and for most people it comes out once healing allows. 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 is a tracheostomy planned before mouth or throat cancer surgery?
- What does the surgical team weigh before suggesting one?
- What happens from consent to the tube coming out?
- Which words might you see on the paperwork?
- What do families worry about, and what is true?
- How can you and your family prepare?
- Who may not need one, and what can this page not tell you?
- Common questions about a planned tracheostomy
The short answer
Why is a tracheostomy planned before mouth or throat cancer surgery?
After a large operation on the tongue, jaw, floor of the mouth or throat, the tissues swell and can narrow the airway for several days. A planned tracheostomy gives you a safe way to breathe below that swelling until it settles.
Why it is done during the same operation
It is usually done at the start of the cancer operation, while you are already asleep. Placing it calmly in theatre is much safer than trying to open an airway in a hurry later, on a ward, in someone whose mouth is swollen and freshly repaired. It also means the breathing tube used for anaesthesia can come out of the mouth, away from the area being operated on.
It is usually temporary
For most people who have one for this reason, the plan is to remove it once the swelling has gone down and you can breathe, cough and swallow safely. The opening then usually closes on its own. Your team will tell you if your situation is different.
Not every oral cancer operation needs a tracheostomy. Many smaller operations in the mouth do not.How the decision is made
What does the surgical team weigh before suggesting one?
No single factor decides it. The team looks at the whole picture of the operation and of you.
The size and place of the tumour
Cancers at the back of the tongue, the floor of the mouth or the throat sit closer to the airway. The larger the area removed, the more swelling is expected afterwards.
What the operation involves
Removing part of the jawbone, operating on the lymph nodes on both sides of the neck, or rebuilding the mouth with tissue from elsewhere all add to the swelling and bulk near the airway.
Words you may hear
- Mandibulectomy: removing part of the jaw
- Flap: tissue moved to rebuild the area
Earlier treatment
Tissue that has had radiotherapy heals more slowly and swells more readily. A repeat operation in the same area also raises the chance that a tube is advised.
Your breathing and general health
Chest problems, heavy snoring with pauses in breathing at night, a short thick neck or a mouth that does not open well all make the airway harder to manage without a tube.
Not sure whether this applies to you?
Ask an oncologistThe pathway
What happens from consent to the tube coming out?
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The consent conversation
The surgeon explains why a tracheostomy is being planned and what it will mean for speaking and eating. This is the time to bring the family member who will be caring for you at home.
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In theatre
Once you are asleep, the tracheostomy is done first, through a short cut low in the neck. The cancer operation then goes ahead.
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Waking up
You wake breathing through the tube, often in intensive care or a high dependency unit. You will not be able to speak at first, and you are usually fed through a thin tube in the nose while the mouth heals.
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The swelling settles
Nurses clear phlegm, keep the air moist and check the tube. Over the following days the cuff is let down and a speaking valve or cap is tried.
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The tube comes out
When capping is tolerated safely, the tube is removed on the ward and a firm dressing covers the opening. It usually closes on its own.
On the consent form
Which words might you see on the paperwork?
- Elective tracheostomy
- A tracheostomy that is planned in advance, as opposed to one done in an emergency.
- Composite resection
- An operation that removes the tumour together with nearby bone, usually part of the jaw, and often lymph nodes in the neck.
- Neck dissection
- Removal of lymph nodes, the small glands in the neck where cancer can spread first.
- Free flap
- Skin, muscle or bone moved from the arm, thigh or leg, with its blood vessels joined up in the neck, to rebuild the mouth.
- Ryles tube
- The thin feeding tube passed through the nose into the stomach, used while the mouth heals.
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Commonly believed
What do families worry about, and what is true?
"If they are planning a tube, the cancer must be very advanced."
The tube is planned because of the size of the operation and the expected swelling, not because of the stage alone. People with quite contained cancers sometimes need one after a large repair.
"We should ask them to skip it and keep watch after surgery."
You can ask what the alternatives are. For some people, staying on a breathing tube through the mouth overnight in intensive care is an option. For others the airway is too risky without a tracheostomy. Let the team explain their reasoning for your case.
"She will go home with the tube for life."
When it is planned for surgical swelling, most tubes come out before or soon after going home. Some stay longer, for example if radiotherapy follows closely. Ask what the plan is in your case.
"The tube is why he cannot eat."
The main reason for tube feeding is usually the repair in the mouth, which needs time to heal. The tracheostomy can make swallowing harder too, so eating starts only after a swallowing check.
Before admission
How can you and your family prepare?
- A notepad, a whiteboard or a phone ready for messages
- A few simple hand signals agreed with family
- Two family members free to learn tube care on the ward
- A list of every medicine you take, shown to the anaesthetist
- Stopping smoking, which helps healing and breathing
- Questions written down for the consent conversation
Being straight with you
Who may not need one, and what can this page not tell you?
This page cannot tell you whether your operation needs a tracheostomy. Two people with cancers that sound alike can have different plans because of the exact site, the repair needed and their breathing. Only the team who has examined you and seen your scans can say.
Who often does not need one
People having a smaller removal from the side of the tongue or cheek, without jaw surgery or a large repair, often do not. Some centres manage selected patients by leaving the breathing tube in overnight instead. That choice depends on the operation, the intensive care support available and the patient, so ask your own centre how they decide.
Questions to ask before you sign
Why do you think I need it? Is there an alternative in my case? How long do you expect it to stay? When will I be able to speak and eat? Will my family be trained before we go home, and what should they do if the tube blocks?
If you are unsure, it is reasonable to ask for time, or for a second opinion on the plan, before agreeing to surgery.Questions we are asked
Common questions about a planned tracheostomy
Will I be awake when the tracheostomy is done?
Usually not. A planned tracheostomy is done under the same general anaesthesia as the cancer operation, so you are asleep. An awake tracheostomy with the neck numbed is kept for situations where the tumour makes it unsafe to pass a breathing tube through the mouth.
How will I communicate after surgery?
At first you will not be able to speak, because the cuff is filled and the mouth is healing. Writing, a picture board, a phone or simple signals work well. Once the cuff is let down, a speaking valve often allows short words. The nurses will show you how.
Does the tracheostomy add to the pain?
The neck is sore, and suctioning can be uncomfortable, but most of the pain after these operations comes from the mouth and neck surgery itself. Pain relief is given regularly. Tell the nurses, by writing or a signal, if it is not enough.
Can I go home with the tube still in?
Sometimes. Many tubes come out before discharge, but if healing is slow or radiotherapy is due soon, you may go home with it. In that case your family will be trained in suctioning, cleaning and the emergency steps, and you will get supplies and a spare tube.
Will the tracheostomy delay radiotherapy?
It should not in itself. Radiotherapy after surgery is planned around how the mouth and neck are healing. The tube can stay in during treatment if needed, and your radiation team will know how to work around it.
Will there be two scars on my neck?
Often there is a separate small scar low on the neck where the tube was. If you are also having a neck dissection, that cut is longer and higher. The tracheostomy scar usually fades well, and it can be tidied later if it pulls or dips.
Do I need to stop any medicines before surgery?
Tell the surgeon and anaesthetist about every medicine, especially blood thinners such as aspirin, clopidogrel or warfarin, and diabetes medicines. They will tell you whether and when to pause anything. Never stop or change a medicine on your own.
Is the tracheostomy covered with the main operation?
Usually, when it is part of approved cancer surgery. Aarogyasri, CGHS, ECHS, EHS and most cashless insurers are accepted at CION. Home supplies, if you go home with the tube, may be charged separately. Call the helpline to check your own cover before admission.
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Sources
- NHS — Tracheostomy
- Cancer Research UK — Mouth cancer
- Macmillan Cancer Support — Head and neck 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
Tracheostomy: What It Is and Why It Is DoneThe basics of the tube in the neckDecannulation: Getting the Tube OutHow the team decides the tube can come outSpeaking With a Tracheostomy: The Speaking ValveGetting your voice back while the tube is inICU and the First Days After SurgeryWhat the first days after a big operation look likeTracheostomyEvery page in this guide
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