Anatomic landmarks for skin incision. The leading landmarks are the laryngeal prominence of the thyroid cartilage and the jugular notch. The incision is made halfway between the laryngeal prominence and the caudal border of the jugular notch.Incision of skin, subcutaneous fatty tissue down to the sternothyroid muscle.Midline division and undermining of the sternothyroid muscle.Thyroid gland with overlying vein becomes visible.Thyroid gland is retracted in cranial direction, trachea becomes visible.Transverse incision of the trachea between the second and third tracheal rings.Vertical lateral incisions of the trachea in caudal direction.The inversely U-shaped tracheal plate is fixed with two 2–0 Vicryl sutures (Ethicon, Somerville, NJ) to the subcutaneous tissue.The nasopharyngeal tube is pulled out.Insertion of the tracheal tube and lateral fixation of the tracheal tube to the skin.
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