Current utilization of tracheotomy as a therapeutic measure: A Review of the Literature and an Analysis of 526 Cases

Laryngotracheal obstruction complicating tracheostomy or endotracheal intubation with assisted respiration. A critical review.

“…(usually attached to upper margin of stoma) PATHOGENESIS Stomal stenosis may arise because a granulomatous polyp develops at the stoma (Holinger, Novak, and Johnston, 1950;Pearce and Walsh, 1961 ;Atkins, 1964;Binns, 1964;Johnston et al, 1967;Cooper and Grillo, 1969;Grillo, 1969a). Such polyps usually develop at the superior margin of the stoma (Pearce and Walsh, 1961;Johnston et al, 1967), as illustrated in Fig.…”

“…6, but Calvet, Coll, Fournie, and Son Qui (1962) described one at tube-tip level caused by trauma from the end of the tracheostomy tube. These granulomata may follow the use of either cuffed or non-cuffed tubes and were reported many times before the introduction of cuffed tubes (Atkins, 1964). They are more common, and also more likely to cause obstruction, in children than in adults, and in children they may give rise to difficulty following extubation.…”

“…Dilatations, usually with a bronchoscope (a) Peroral (b) Perstomal 3. Tracheostomy (a) Distal (below stenosis), with or without dilatation or stenting, or stenting and grafting, of the stenosis: (i) Temporary Bronchoscopic or tracheoscopic excision This is a very useful method of treating granulomatous polyps arising from the upper margin of the stoma (Pearce and Walsh, 1961 ;Atkins, 1964;Johnston et al, 1967). Most workers advise doing this by the usual technique of peroral bronchoscopy, but Johnston et al (1967), because of the danger of haemorrhage, advised excision through a tracheostomy incision and the tracheostome, with an endotracheal tube in place.…”

“…Permanent tracheostomy may also be performed above (proximal tracheostomy) a cuff stenosis (Atkins, 1964;Johnston et al, 1967;Pearson et al, 1968) or a tube-tip stenosis (Mollaret et al, 1962;Johnston et al, 1967) in patients who are unsuitable for resection in view of their general condition. In such cases the tracheostomy tube must be passed through the stricture after it has been dilated.…”

The Role of Cricothyrotomy, Tracheostomy, and Percutaneous Tracheostomy in Airway Management

“…Performance of open ST is a time-honored procedure 55 involving incision and dissection of the soft tissue overlying the anterior trachea followed by either removal of the anterior segment of a tracheal ring or creation of a tracheal flap, after which a tracheostomy tube is placed into the trachea and fixed in place. Historically used in the treatment of upper airway obstruction, ST has become predominantly used in the treatment of those patients unable to wean from mechanical ventilation who are deemed to be poor candidates for PDT, or following resection of head and neck cancer.…”