Elevation of the cutaneous and subplatysmal flaps and identification of the strap muscles.

The strap muscles are divided in the midline by the linea alba.

The stitches are positioned in order to facilitate exposure of the laryngeal framework, the thyroid gland, and the anterior tracheal wall.

Below the cricoid cartilage, the surgeon can identify and palpate the first tracheal ring.

Look and study the trachea and identify and palpate any pathologic deformity (Fig. 6.2).

Do an intraoperative fibroscopy and identify the exact location of the stenosis.

With the endoscopic light, you can mark with dermographic pen the pathologic tracheal stenosis on anterior tracheal wall (Fig. 6.3).

The tracheal dissection is performed by anterolateral direction. The main goals are to mobilize distally the trachea, preserve all the structures located laterally to the trachea, and identify and preserve esophagus. Pay attention to tracheal dissection and remember that all the vascular supply coming bilaterally from the tracheal esophageal groove should be preserved (Fig. 6.4).