The platysma muscle together with the subcutaneous tissue comprises the superficial fascia of the head and neck. The deep fascia forms more distinct layers: superficial, pretracheal/middle, prevertebral/ deep, and carotid sheaths. Both the pretracheal and retrovisceral spaces descend into the superior mediastinum acting as important potential conduits of head and neck infections. The thyroid cartilage forms most of the anterior and lateral walls of the larynx. Anterior to the trachea in the neck is the isthmus of the thyroid gland at about the level of the second to fourth tracheal cartilages; below this the inferior thyroid veins, lymph nodes, and sometimes a thyroid ima artery. Lateral to the trachea in the neck are the lobes of the thyroid gland, great vessels, and recurrent laryngeal nerves. A thorough knowledge of anatomy and anatomical variations of the head and neck is essential to avoid or assess complications arising from tracheotomies.

Defective or incomplete separation by the tracheoesophageal septum is one of the most frequent congenital anomalies producing tracheoesophageal fistula (TEF). Anatomic variations that can influence the planning and success of a tracheotomy may be broadly grouped into extrinsic and intrinsic causes. The etiology of the nasal obstruction may include an anterior congenital nasal pyriform aperture stenosis (which is rare), a tumor, or choanal atresia. The most common congenital malformation of the esophagus is esophageal atresia, with or without TEF. Congenital tracheal stenosis may be associated with congenital heart disease, TEF, and skeletal abnormalities. Treatments include tracheoplasty, resection with reanastomosis and stenting. Direct trauma can result in cartilaginous damage and occlusion of the airway lumen by hemorrhage, edema, granulation tissue, scarring, or structural collapse. Congenital tracheal webs are rare presenting with stridor, wheezing, and recurrent respiratory infections. The most common pediatric tracheobronchial tumors include hemangioma, bronchial carcinoid, and papillomatosis.