Should Granulomas Be Excised in Children With Long-term Tracheotomy?

Pediatric Suprastomal Granuloma: Management and Treatment

“…Initially, the granuloma is soft, friable and compressive, but over time it becomes fibrous and firm, and may cause airway obstruction when the tube is removed. In our study, the mean time to first excision of the granuloma was 14.0 months, which is consistent with the literature 1,3 …”

A single-center 6-year experience with two types of pediatric tracheostomy

“…Whereas granulation tissue at the stoma showed only a mild trend to appear more often in the Flap group (4/12; 33%) than in the Vertical group (1/7; 14%), the occurrence of tracheal stenosis was similar in both groups. In agreement with other reports on pediatric tracheostomy, we believe that the formation of granulation tissue is not a serious complication of tracheostomy since this is often found postoperatively without association to difficult cannula handling or concomitant wound healing problems [10,12,14,26]. However, suprastomal granulation tissue can delay the decannulation process [26,27].…”

“…After creation of an inferiorly based tracheal flap, tracheal stenosis was found in 5% (1/20 [3]), 3.7% (1/27 [14]), and 4% (5/ 126 [15]). No sufficient information on the occurrence of tracheal stenosis was available in both reports on vertical tracheal incision [1,12], reports on inferior base tracheal flaps [10], and reports when both techniques were performed [2,4]. Compared to these results, tracheal stenosis was observed more often in both patient groups in our study (Vertical group, 2/7 = 28%; Flap group, 3/ 12 = 25%).…”

Practice Patterns After Tracheotomy in Infants Younger Than 2 Years

“…In addition, in a tertiary referral center such as ours, many patients are either lost to follow-up or choose to follow up closer to home. Our data corroborate the findings of Rosenfeld and Stool, 1 who showed that removal of asymptomatic granulation does not change the natural course of the phenomenon. However, we are unable to make any definitive statements regarding the utility of surveillance endoscopy based on our data.…”

“…It is interesting to note, however, in the nonintervention group, only a third of the patients had SSG at subsequent evaluation. This supports the findings of Rosenfeld and Stool, 1 who determined in a prospective study of 50 patients that management of granuloma by either excision or observation did not alter the probability of detecting a new or persistent granuloma at subsequent bronchoscopy.…”