Surgical options in suprastomal collapse-induced severe airway obstruction

Abstract

Purpose A single institutions experience with various surgical options in the treatment of severe suprastomal collapse (SSC). Methods The study included 18 tracheostomized children with SSC treated between January 2012 and December 2018. Data included: patient demography, initial airway lesions, comorbidities, indication and age at tracheostomy, prior airway surgery, stomal demography, type of surgery, postoperative management, complications and treatment outcomes. Results Four techniques were used to correct SSC. The surgical choice was dependent on stoma demography and associated airway lesions. Excision was done in eight patients and rib cartilage augmentation in five. Three patients had single stage tracheal resection and anastomosis. Two patients received stomal rigidification and temporary placement of Montgomery T tube. Three patients with anterior rib graft augmentation required additional lateral tracheal wall rigidification. Three patients (two with cartilage augmentation, and one with stomal rigidification) developed minimal granulation tissue in the postoperative period. Complete SSC resolution was seen in all except two patients who had a partial response to the treatment. All patients were successful decannulated and are currently asymptomatic. Conclusion Decannulation failures may be due to severe suprastomal collapse that could be either unique or associated with obstructing laryngotracheal lesions. Therefore, it is essential to select the most appropriate surgical treatment to obtain overall favorable outcomes.

Tracheal A‐frame deformity and suprastomal collapse after pediatric tracheostomy

“…For example, fractured or weakened anterior tracheal cartilage can result in lateral collapse known as an “A‐frame” deformity 5 . Additionally, some patients will develop suprastomal collapse where the anterior tracheal wall will collapse inward towards the posterior trachea 6,7 . Chronic inflammation associated with prolonged tracheostomy tube dependence can also result in the formation of granulomas that may also cause airway obstruction 8 …”

“…5 Additionally, some patients will develop suprastomal collapse where the anterior tracheal wall will collapse inward towards the posterior trachea. 6,7 Chronic inflammation associated with prolonged tracheostomy tube dependence can also result in the formation of granulomas that may also cause airway obstruction. 8 To date, the incidence of structural abnormalities resulting from pediatric tracheostomy placement is understudied.…”