Anticipated Difficult Tracheostomy: Should CT Scan Be a Pre-Requisite

Tracheotomy is a surgical procedure which consists of making an incision on the anterior aspect of the neck and opening a direct airway through an incision in the trachea. In our case, surgical tracheostomy was planned because of anticipated difficulty neck anatomy. Literature suggests that although tracheotomy is a commonly performed procedure; however, with anatomical deformities, it can be associated with a high morbidity and mortality, partially due to accidental decannulation potential difficulties exist with both surgical tracheostomies performed on obese patients with short/thick necks and prolonged intubation. This report shows that clinical examination and CXR imaging can be misguiding. CT scan is not routinely required for short, thick neck but if any problem is being faced during ventilation or for likely difficult tracheostomies, especially with some obvious unfavourable neck anatomy like anterior neck swellings, CT neck can be a useful guide. We want to emphasize that we should have a low threshold for CT scan before tracheostomy to avoid unanticipated complications