Tracheostomy uses skin puncture and dilators to insert the tracheostomy tube. Sometimes endotracheal intubation or tracheostomy may be indicated to overcome upper respiratory obstruction. In more advanced cases endotracheal intubation or tracheostomy may be required. The provision of the opening via a tracheotomy is called a "tracheostomy". It soon replaced tracheostomy as the emergency diphtheric intubation method. Other early products included endotracheal and tracheostomy products. Surgical methods for airway management include cricothyrotomy and tracheostomy. Another surgical airway method is called tracheostomy. People generally require tracheostomy and lifetime mechanical ventilation on a ventilator in order to survive. Severe cases may require permanent ventilation or tracheostomy. Emergency treatments include protecting the airway, which might involve a tracheostomy. Percutaneous tracheostomy is typically avoided in pediatric patients. If prolonged ventilation is required, tracheostomy is usually considered. Knowledge of occurrence of the artery is especially important during tracheostomy and thyroidectomy. If the whole larynx has been removed, the person is left with a permanent tracheostomy.