This patient was able to speak, in spite of the fact that she had an uncapped tracheostomy tube. A suction catheter could not be introduced more than a few inches before meeting resistance.
The picture above is a sagittal reformatting of a neck CT scan that shows the tracheotomy cannula in a false tract, outside the trachea. The axial CT scan picture below shows the same tracheostomy cannula anterior to the trachea. This can be avoided by creating an inferiorly-based anterior tracheal wall trapdoor flap.