(D) Laryngeal cancer[?]High tracheostomy is done above the level of thyroid isthmus (isthmus lies against II, III and IV tracheal rings). It violates the 1st ring of trachea. Tracheostomy at this site can cause perichondritis of the cricoid cartilage and subglottic stenosis and is always avoided. Only indication for high tracheostomy is carcinoma of larynx because in such cases, total larynx anyway would ultimately be removed and a fresh tracheostoma made in a clean area lower down.[?]Low tracheostomy is done below the level of isthmus. Trachea is deep at this level and close to several large vessels; also there are difficulties with tracheostomy tube which impinges on suprasternal notch.Indications of tracheostomy:1. Upper respiratory tract obstruction; Laryngeal, supralaryngeal, and tracheal causes. (Causes of stridor)2. Lower respiratory tract obstruction: (Secretory obstruction, Wet lung syndrome).Only indication for high tracheostomy is carcinoma of larynx because in such cases total larynx airway would ultimately be removed and a fresh tracheostoma made in a clean area. TRACHEOTOMY INDICATIONSCauseExamplesCongenitalSubglottic or upper tracheal stenosis, laryngeal web, laryngeal & vallecular cysts, tracheoesophageal anomalies or haemangioma of the larynxTRACHEOTOMY INDICATIONSCauseExamplesCongenitalSubglottic or upper tracheal stenosis, laryngeal web, laryngeal & vallecular cysts, tracheoesophageal anomalies or haemangioma of the larynxInfectiveAcute epiglottitis, laryngotracheobronchitis, diaphtheria or Ludwig's angina.MalignancyAdvanced tumours of larynx, pharynx or upper trachea presenting with stridorTraumaGunshot and knife wounds to the neck, inhalation of steam or smoke, swallowing of corrosive fluidVocal cord paralysisPost operative complication of thyroidectomy, cardiac or oesophageal surgery, bulbar palsy.Foreign bodySwallowed or inhaled object lodged in upper airway causing stridor.Other Options[?]Vocal Cord Palsy:Vocal fold paralysis (VFP) refers to neurological causes of reduced or absent movement of one or both vocal folds.Bilateral VFP (BVFP) is characterized by inspiratory dyspnea due to narrowing of the airway at the glottic level with both vocal folds assuming a paramedian position.The primary objective of intervention for BVFP is to relieve patients' dyspnea.Common clinical options for management include tracheostomy, arytenoidectomy and cordotomy.[?]Tracheomalacia:Indications for tracheostomy in Tracheomalacia are severe symptoms, failure of conservative therapy, and proximal or diffuse tracheomalacia.Indications for aortopexy are dying spells or reflex apnea, recurrent pneumonia, intermittent respiratory obstruction, and inability to extubate airway in an infant who is intubated..[?]Foreign Body:Occasionally, open surgical intervention in the form of tracheostomy, thoracotomy and bronchotomy and/or pulmonary resection is needed for removal of foreign bodies.[?]General indications for Tracheostomy:Include the following: Congenital anomaly (E.g, laryngeal hypoplasia, vascular web) Upper airway foreign body that cannot be dislodged with Heimlich and basic cardiac life support maneuvers. Supraglottic or glottic pathologic condition (E.g, infection, neoplasm, bilateral vocal cord paralysis).