In today's world, tracheostomy is a time-honored procedure, used for managing the airway in acute settings, such as maxillofacial and laryngeal trauma, and establishing a secure airway to manage head and neck infections. Tracheostomy is routinely performed in the intensive care unit for patients on prolonged mechanical ventilation and in the management of head and neck oncological surgeries and reconstruction. The oral and maxillofacial surgeon is routinely involved with surgical procedures requiring a secure airway, acutely, or in the setting of long-term management of the airway.