A fenestrated tracheostomy tube contains openings that allow air to pass through the area of the throat that leads to the mouth and nose.

In a tracheostomy, a surgeon creates an opening in the front of the neck and inserts a tracheostomy tube into the windpipe to help a person breathe.

As well as the main tracheostomy opening, fenestrated tracheostomy tubes have additional openings that allow air to pass to the area of the throat leading to the mouth and nose.

This article provides an overview of a fenestrated cannula, including its uses, how it works, and when a person may need one.

A surgeon inserting a fenestrated tracheostomy tube -2.Share on Pinterest
skaman306/Getty Images

Doctors perform a tracheostomy to help a person breathe.

A person may need one if:

  • they are receiving treatment with a ventilator for a prolonged period
  • their upper airway is blocked
  • doctors have removed their upper airway due to an illness such as cancer


Most adult tracheostomy tubes consist of three main parts:

  • the outer cannula
  • the inner cannula
  • the tracheostomy tie

The outer cannula is a hollow tube that remains in place and keeps the tracheostomy from closing.

The inner cannula is another tube that fits inside the outer cannula. It is the tube a person breathes through. The tie goes around the neck and holds the outer cannula in place.

In a fenestrated tracheostomy tube, there are openings in the inner and outer cannulas. The movement of air through these openings allows a person to speak and can help them cough more effectively when necessary.

A tracheostomy can alter the structure of the airway and disrupt the connection between the lower respiratory tract and the voice box. This can cause a person to lose vocal function and affect their ability to cough.

In some cases, a person may be able to use a speaking valve, which a healthcare professional can insert at the opening of the tracheostomy. The valve restores airway airflow and allows the person to speak.

However, some people cannot use a speaking valve. In that case, they may only be able to speak with the use of a fenestrated tracheostomy tube.

A 2019 article notes that a doctor may opt to use a fenestrated tracheostomy tube in the following circumstances:

A person cannot tolerate a speaking valve

A person may not be a viable candidate for a speaking valve for various reasons. This can include a severe obstruction in their trachea or the use of an inflated tracheostomy tube cuff.

A fenestrated tracheostomy tube can help a person make sounds and speak, as it allows air to flow through the vocal cords and to the tracheostomy opening.

For mechanical ventilation without cuff deflation

Mechanical ventilation is when a machine entirely takes over breathing for a person who cannot breathe on their own.

A person who requires mechanical ventilation may have a cuffed tracheostomy tube with a soft inflated balloon around part of the tube that seals the airway. The cuff helps maintain proper air pressure during ventilation and helps prevent aspiration, where someone accidentally inhales an object or fluid into their airways.

Doctors typically deflate the cuff when possible to begin rehabilitation, reduce the risk of damage, and restore speech.

If the person requires the cuff to remain inflated to breathe, doctors may opt for a fenestrated tracheostomy tube instead.

To wean a person off a ventilator

A fenestrated tube may help a person start breathing without a ventilator by decreasing the effort involved.

A tracheostomy tube’s inner and outer cannulas carry air in and out of the tracheal opening. The outer cannula remains in place in the opening. A person can remove the inner cannula to clean or replace it.

In a fenestrated tube, the inner cannula has small holes that line up with an opening in the outer cannula.

As a person breathes, air passes through the tube and exits through the tracheal opening, but some air also passes upward, out through the holes, toward the upper airway.

This allows air to pass through a person’s vocal cords so that they can speak.

To insert a tracheostomy tube, doctors will usually do the following:

  1. Administer a general anesthetic.
  2. Create an incision in the throat with a needle or scalpel.
  3. Insert the tube into the opening.
  4. Use stitches or ties to secure the tube in place.
  5. Place a dressing around the tracheostomy.

A non-fenestrated tracheostomy tube does not have openings in the inner or outer cannulas, except for the openings on either end of the tube.

This allows air to pass through the trachea and the surgical opening. A non-fenestrated tube does not direct airflow toward the nose and mouth.

Doctors use non-fenestrated tubes in most cases of tracheostomy. They use fenestrated tubes rarely, in unique or specific situations.

Fenestrated tracheostomies carry a risk of complications.


A 2018 systematic review notes that short-term complications can include:

  • anxiety
  • shortness of breath
  • subcutaneous emphysema, which involves air becoming trapped in the layer of fat and connective tissue beneath the skin
  • tracheomalacia, a condition in which the cartilage in the trachea becomes soft, and the trachea weakens and collapses, affecting a person’s ability to breathe
  • bleeding, which can be serious and may be life threatening
  • tube displacement
  • pneumothorax, the medical term for a collapsed lung


Long-term complications can include:

  • infection
  • tube displacement or occlusion
  • stenosis, which refers to narrowing of the trachea that can cause difficulty breathing

A fenestrated tracheostomy may also irritate the trachea, which can lead to the growth of granulation tissue. This can cause obstruction and bleeding and can make it difficult for doctors to remove the tracheostomy tube.

A person will need to suction their tracheostomy to clear it of mucus and secretions. This involves using a suction catheter attached to a suction machine.

With a fenestrated tracheostomy tube, people need to ensure they replace their inner cannula with one that does not contain holes or openings before they suction their tracheostomy.

Learn about how to suction a tracheostomy.

Below are the answers to some common questions about fenestrated tracheotomy tubes.

What is a cuffed fenestrated tracheostomy tube?

A cuffed tracheostomy tube has a soft inflated balloon around part of the tube that seals the airway. This helps maintain proper air pressure during ventilation and helps prevent pulmonary aspiration.

What is a Shiley 6 cuffless fenestrated tracheostomy tube?

Shiley is a popular manufacturer of tracheostomy tubes. The Shiley 6 fenestrated cuffless tracheostomy tube is a fenestrated tracheostomy tube in a specific size that does not have a cuff.

What is a capped fenestrated tracheostomy tube?

With a doctor’s approval, a person may put a cap over their inner cannula to block the tracheostomy and allow them to breathe through their nose and mouth before a doctor removes their tracheostomy tube.

A person should not place a cap on a tracheostomy tube with an inflated cuff.

A fenestrated tracheostomy tube contains an opening in the outer cannula and small holes in the inner cannula. These openings direct some air toward the nose and mouth instead of just through the tracheostomy opening in the neck. This allows a person to make noise and speak.

In most cases, a person will receive a non-fenestrated tracheostomy with a speaking valve attached to allow them to speak.

Doctors do not usually opt to insert fenestrated tubes, as they increase the risk of complications such as granulation tissue formation and tracheal stenosis.

A person may receive a fenestrated tube if they cannot tolerate a speaking valve or in other specific circumstances.