Cricothyroidotomy vs. sternal tracheotomy for challenging airway anatomy

Although tracheotomies are the standard procedure for elective surgical airways, some patients present with challenging anatomy. In circumstances of abnormal skeletal deformities, such as kyphoscoliosis, the airway is also often tortuous and access to the trachea may be difficult. In the situation of severely distorted tracheal anatomy, where access to the trachea may require a mediansternotomy, a cricothyroidotomy may be the safer option. This article details the technique involved in approaching a substernal larynx and stomatizing a cricothyroidotomy for a patient who required a long-term surgical airway secondary to severe kyphoscoliosis from Proteus syndrome and failure to extubate.