Permanent tracheostomy and tube tracheostomy are both important for patients' supportive care; neither procedure cures any particular disease. Permanent tracheostomy is indicated to by-pass upper airway obstructions in the ambulatory patient needing an alternate airflow route for a long period. Temporary or tube tracheostomy is indicated to facilitate anesthetic management during head and neck surgery, long-term mechanical ventilation, and emergency patient care. Perioperative problems are expected with both procedures. Obstruction of the tube or stoma is the most common life-threatening problem. Most problems can be circumvented with careful and diligent patient management.