The treatment for thick neck, obese, bull neck and trauma patients have become easier with Bivona Tracheostomy Tubes. In case of anatomy or pathology, the device is made to help and it can be adjusted horizontally and vertically. These patients can have secure airway without any endotracheal tubes. The stomal insertion is possible by its tight-to-shaft cuff. There is an Adult TTS Adjustable Neck Flange Hyperflex Tracheostomy Tube for temporary use which is incorporated with a obturator/introducer device and tracheostomy tie. The device cannot be used at home. The silicon used here gives comfort to trachea. There is a guidewire which can be changed by the clip in obturator which has a hollow tip. The long wire helps to adjust the length of silicon shaft even in unusual cases.