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 1-2 cm of innominate artery after their origin from aorta gives a good exposure of substernal segment of trachea.
