The classical indication for tracheostomy is obstruction of the upper airway. Tracheotomy is one of the oldest surgical procedures, described by ancient Egyptians and supposedly performed by Alexander the Great on an unfortunate soldier.

Whilst head and neck surgeons still create tracheostomies to manage upper airway obstruction, indications have evolved so that the majority of procedures are carried out by a different speciality, in different circumstances.

Question: Which patient group is most likely to require tracheostomy?

Answer: Since the development of Intensive Care Medicine as a speciality and the recognition of the role tracheostomy can play in invasive ventilation, critically ill patients are the group most likely to require tracheostomy in Western medicine.

Between 12 000 and 15 000 tracheostomies are performed in the critically ill annually in the UK. The majority of these are performed at the bedside by intensivists, but some are performed by surgeons.

Around 5,000 head and neck surgical tracheostomies are performed annually in the UK, either as primary procedures or as part of more complex surgery.

Between 600 and 1,000 laryngectomies are performed annually, typically for surgical management of laryngeal cancer.