Tracheostomy — Indications and Complications

A 58-year-old man with a 40-pack-year smoking history presents with progressive dyspnea and stridor over 3 weeks. Flexible laryngoscopy reveals a large exophytic mass involving the anterior two-thirds of the vocal cords, with significant subglottic extension. Biopsy confirms squamous cell carcinoma. CT chest shows no distant metastases. The patient is scheduled for total laryngectomy with adjuvant radiotherapy. Before surgery, the anaesthetist expresses concern about securing the airway intraoperatively due to the mass location. What is the most appropriate immediate management?

A 62-year-old woman undergoes elective tracheostomy for severe bilateral vocal cord paralysis secondary to thyroid cancer surgery performed 8 weeks ago. The procedure is completed uneventfully under local anesthesia. On postoperative day 2, the patient develops sudden onset of subcutaneous emphysema over the anterior neck and upper chest, with mild dyspnea. Chest X-ray shows air tracking into the mediastinum. The tracheostomy tube is in situ and patent, with good air entry bilaterally. What is the most likely complication and the most appropriate next step?

During a routine tracheostomy procedure in a 55-year-old male with laryngeal papillomatosis, the surgeon must select the site of the stoma. Which is the most common and recommended site for tracheostomy?

A 52-year-old man with motor neuron disease underwent tracheostomy 6 months ago. He now presents with recurrent lower respiratory tract infections and foul-smelling secretions. Which finding best distinguishes tracheal stenosis from tracheomalacia in this clinical scenario?

A 52-year-old male with laryngeal stenosis secondary to prolonged intubation presents with progressive dyspnea and stridor. He is a candidate for tracheostomy. Which investigation is most appropriate to assess the degree of stenosis and guide surgical planning?