Emergency mediastinal tracheostomy is life saving  in patients with unresectable cervical tumors, in whom the  site of the tracheostomy  lies in the upper mediastinum  in  the tumor free area. Radiotherapy increases the risk due to substernal adhesion and presence of vascular structure make the procedure complex in this area. Careful nibbling of manubrium and left sternoclavicular joint with lateral traction of proximal 1-2cm of innominate artery after their origin from aorta gives a good exposure of substernal segment of trachea.

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4. Yasumichi Yamamoto, Toshiya Toyazaki, Shinji Kosaka Simple Palliative Mediastinal Tracheostomy (Ann Thorac Surg 2013;95:2185–7).

Dr Ajit Kumar Padhy

Asst. Prof., CTVS, Dept of Cardiothoracic Surgery, VMMC, and Safderjung Hospital New Delhi 110049