the wound and the girl recovered, thereby proving that an incision in the larynx could heal. circa ad 1020, avicenna (980–1037) described tracheal intubation in the canon of medicine in order to facilitate breathing. the first correct description of the tracheotomy operation for treatment of asphyxiation was described by ibn zuhr (1091–1161) in the 12th century. according to mostafa shehata, ibn zuhr (also known as avenzoar) successfully practiced the tracheotomy procedure on a goat, justifying galen's approval of the operation. 16th–18th centuries hieronymus fabricius (1533–1619) was the first to introduce the idea of a tracheostomy tube the european renaissance brought with it significant advances in all scientific fields, particularly surgery. increased knowledge of anatomy was a major factor in these developments. surgeons became increasingly open to experimental surgery on the trachea. during this period, many surgeons attempted to perform tracheotomies, for various reasons and with various methods. many suggestions were put forward, but little actual progress was made toward making the procedure more successful. the tracheotomy remained a dangerous operation with a very low success rate, and many surgeons still considered the tracheotomy to be a useless and dangerous procedure. the high mortality rate for this operation, which had not improved, supported their position. from the period 1500 to 1832 there are only 28 known reports of tracheotomy. in 1543, andreas vesalius (1514–1564) wrote that tracheal intubation and subsequent artificial respiration could be life-saving. antonio musa brassavola (1490–1554) of ferrara treated a patient with peritonsillar abscess by tracheotomy after the patient had been refused by barber surgeons. the patient apparently made a complete recovery, and brassavola published his account in 1546. this operation has been identified as the first recorded successful tracheostomy, despite many ancient references to the trachea and possibly to its opening. ambroise paré (1510–1590) described suture of tracheal lacerations in the mid-16th century. one patient survived despite a concomitant injury to the internal jugular vein. another sustained wounds to the trachea and esophagus and died. towards the end of the 16th century, anatomist and surgeon hieronymus fabricius (1533–1619) described a useful technique for tracheotomy in his writings, although he had never actually performed the operation himself. he advised using a vertical incision and was the first to introduce the idea of a tracheostomy tube. this was a straight, short cannula that incorporated wings to prevent the tube from advancing too far into the trachea. he recommended the operation only as a last resort, to be used in cases of airway obstruction by foreign bodies or secretions. fabricius' description of the tracheotomy procedure is similar to that used today. julius casserius (1561–1616) succeeded fabricius as professor of anatomy at the university of padua and published his own writings regarding technique and equipment for tracheotomy. casserius recommended using a curved silver tube with several holes in it. marco aurelio severino (1580–1656), a skillful surgeon and anatomist, performed multiple successful tracheotomies during a diphtheria epidemic in naples in 1610, using the vertical incision technique recommended by fabricius. he also developed his own version of a trocar. in 1620 the french surgeon nicholas habicot (1550–1624), surgeon of the duke of nemours and anatomist, published a report of four successful "bronchotomies" which he had performed. one of these is the first recorded case of a tracheotomy for the removal of a foreign body, in this instance a blood clot in the larynx of a stabbing victim. he also described the first tracheotomy to be performed on a pediatric patient. a 14-year-old boy swallowed a bag containing 9 gold coins in an attempt to prevent its theft by a highwayman. the object became lodged in his esophagus, obstructing his trachea. habicot suggested that the operation might also be effective for patients with inflammation of the larynx. he developed equipment for this surgical procedure which displayed similarities to modern designs (except for his use of a single-tube cannula). sanctorius (1561–1636) is believed to be the first to use a trocar in the operation, and he recommended leaving the cannula in place for a few days following the operation. early tracheostomy devices are illustrated in habicot's question chirurgicale and julius casserius' posthumous tabulae anatomicae in 1627. thomas fienus (1567–1631), professor of medicine at the university of louvain, was the first to use the word "tracheotomy" in 1649, but this term was not commonly used until a century later. georg detharding (1671–1747), professor of anatomy at the university of rostock, treated a drowning victim with tracheostomy in 1714. 19th century in the 1820s, the tracheotomy began to be recognized as a legitimate means of treating severe airway obstruction. in 1832, french physician pierre bretonneau employed it as a last resort to treat a case of diphtheria. in 1852, bretonneau's student armand trousseau reported a series of 169 tracheotomies (158 of which were for croup, and 11 for "chronic maladies of the larynx") in 1858, john snow was the first to report tracheotomy and cannulation of the trachea for the administration of chloroform anesthesia in an animal model. in 1871, the german surgeon friedrich trendelenburg (1844–1924) published a paper describing the first successful elective human tracheotomy to be performed for the purpose of administration of general anesthesia. in 1880, the scottish surgeon william macewen (1848–1924) reported on his use of orotracheal intubation as an alternative to tracheotomy to allow a patient with glottic edema to breathe, as well as in the setting of general anesthesia with chloroform. at last, in 1880 morell mackenzie's book discussed the symptoms indicating a tracheotomy and when the operation is absolutely necessary. 20th century laryngeal structures, trachea (1 - 4) and invasive procedures (a - b) (1) thyroid cartilage (2) cricothyroid ligament (3) cricoid cartilage (4) trachea (a) cricothyrotomy (b) tracheotomy in the early 20th century, physicians began to use the tracheotomy in the treatment of patients affected by paralytic poliomyelitis who required mechanical ventilation. however, surgeons continued to debate various aspects of the tracheotomy well into the 20th century. many techniques were described and employed, along with many different surgical instruments and tracheal tubes. surgeons could not seem to reach a consensus on where or how the tracheal incision should be made, arguing whether the "high tracheotomy" or the "low tracheotomy" was more beneficial. the currently used surgical tracheotomy technique was described in 1909 by chevalier jackson of pittsburgh, pennsylvania. jackson emphasised the importance of postoperative care, which dramatically reduced the death rate. by 1965, the surgical anatomy was thoroughly and widely understood, antibiotics were widely available and useful for treating postoperative infections, and other major complications had also become more manageable. society and culture notable individuals who have or have had a tracheotomy include mika häkkinen, stephen hawking, connie culp, christopher reeve, roy horn, william rehnquist, gabby giffords, george michael, val kilmer, and many others. across movies and tv shows, there are many situations where an emergency procedure is done on an individual's neck to re-establish an airway. an example is in the 2008 horror, saw v, in which a character being drowned from the neck up performs a manual tracheotomy, stabbing his neck with a pen to create an airway to breathe through. the most common procedure is a cricothyrotomy (or "crike"), which is an incision through the skin and cricothyroid membrane. this is often confused or misnamed as a tracheotomy (or "trach") and vice versa. however, they are quite different based on location of the opening and length of time the alternate airway is needed.