PRIOR TO World War II, most tracheostomies were performed for mechanical obstruction of the airway due to tumors, foreign bodies, and infections. Since that time, the value of tracheostomy in patients with excessive tracheobronchial secretions has been recognized. This has accounted for a great increase of tracheostomies being performed today. For the past ten years, tracheostomies done for secretions have outnumbered two to one those done for obstruction. From this experience a classification evolved which divided all tracheostomies into two groups: mechanical ventilatory obstruction and secretional ventilatory obstruction.1 In reevaluating our experience with 187 tracheostomies, we divided the patients into two groups: mechanical and secretional obstruction. It became apparent that most of the patients in the mechanical obstruction group primarily had difficulty in swallowing and coughing and did not have life-endangering impairment of the airway. A typical example was the patient with a tumor of the posterior tongue or