INTRODUCTION

Tracheotomy is the ultimate surgical treatment for obstructive sleep apnea (OSA). It has the highest success rate for all therapies for OSA and is considered an important adjunct in treating severe life-threatening disease. Tracheotomy was once the only treatment for OSA and has been replaced by more conservative site-specific surgical stiffening and dilation of the upper airway. In addition, nasal continuous positive airway pressure (CPAP) and other nonsurgical therapies have proven highly effective in treating mild, moderate, and some severe forms of OSA. Tracheotomy is generally reserved for temporary airways, severe OSA failing CPAP, and life-threatening cardiac disease resulting from OSA. Tracheotomy and tracheostomy are used synonymously in the medical literature. Trache(o)—referring to the trachea, from Greek tracheia arteria [Gr. meaning rough artery] and tomy [Gr. tome a cutting] to cut the trachea, or stomy [Gr. stomoun to furnish with an opening] referring to the opening in the trachea. The procedure is probably the oldest surgical procedure in recorded history dating back 5600 years. Egyptian tablets circa 3600BC depict images of what appears to be a knife-wielder surgeon performing a throat incision. Tracheotomy was first described in the sacred book of Hindu medicine, the Rig Veda and later in Western medical text in the eight century BC when Homer described the opening of the trachea for the relief of a choking patient. In the first century BC, Asclepiades first described it in an elective setting. The Dark Ages saw little use for the tracheotomy, which at the time was considered both dangerous and useless. Robert Hook (1667) described the ability to sustain a dog’s life by ventilating the dog with a bellows placed in the severed trachea. Heister (1739) was the first to use the term ‘‘tracheotomy’’ to describe placement of a straight tube into the trachea using a straight trocar.