Tracheal Stenosis Complicating Tracheostomy with Cuffed Tubes

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

“…In this animal defects up to a centimetre in diameter caused minimal narrowing. The defects healed by a thin layer of fibrous tissue lined by normal respiratory epithelium, but no cartilage regeneration occurred, either macroscopically or microscopically (Watts, 1963 ;Pearson, Goldberg, and da Silva, 1968). As Dukes (1970) pointed out, any type of permanent defect left by merely extubating a tracheostomy will almost always lead to narrowing at the level of the stoma, which is probably most severe after a flap operation if the flap is not replaced.…”

“…This destruction will be enhanced by movement of the tube and by local infection, which inevitably occurs (Fennell, 1962;Jackson, 1963;Stiles, 1965a;Deverall, 1967;Pearson, 1969;Gregory, 1970). Infection arises because of the presence of a foreign body in an open wound, and because infected secretions pool in the region above the cuff from where they are not usually aspirated (Pearson, 1969).…”

“…Severe narrowing occurs from before backwards, but little from side to side (Fig. 5) (Reading, 1958;Venables, 1959;Jackson, 1963;Deverall, 1967;Pearson et al, 1968;Grillo, 1969a;Cooper and Grillo, 1969). Sometimes this is accompanied by the development of a granuloma at the upper margin of the stoma (Smythe and Bull, 1959;Pearce and Walsh, 1961).…”

“…9) in consequence of pressure, movement, infection, and perhaps also chemical irritation and other factors such as systemic hypotension (Stiles, 1965a);Little, 1956;Pearson et al, 1968) or steroid administration (Stiles, 1965a;Pearson et al, 1968). Pressure by the inflated cuff is obviously a vital factor in their production (Watts, 1963;Bradley, Spencer, and Semple, 1964;Yanagisawa and Kirchner, 1964;Fraser and Bell, 1967;Gibson, 1967;Byrn et al, 1967;Campbell, 1968;Jewsbury, 1969;Griulo, 1 969a;Cooper and Grillo, 1969;James, Macmillan, Eaton, and Grillo, 1970).…”

Pathogenesis of tracheal stenosis following tracheostomy with a cuffed tube: An experimental study in dogs

“…Since that time, even with refined operative techniques and better postoperative care and management, tracheal stenosis following tracheotomy with cuffed or uncuffed tubes is still a hazardous complication reaching reported incidences of 1 to 20% (Falbe-Hansen, 1955;Aboulker, Lissac, and Saint-Paul, 1960;Paloschi and Lynn, 1965;Deverall, 1967;Johnston, Wright, and Hercus, 1967;Kucher, Lechner, Pokieser, and Steinbereithner, 1967;Pearson, Goldberg, and Da Silva, 1968a and b;Pearson and Fairley, 1970; Andrews and Pearson, 1971). Four types of post-tracheotomy tracheal stenosis have been identified, each presumably caused by similar as well as different factors-subglottic stenosis, stenosis at the level lSupported by grants from the Medical Research Council of Canada and from the Ontario Cancer Treatment and Research Foundation, Toronto, Ontario 2Present address: The London Chest Hospital, London E.2, England of the tracheostome, stenosis at the level of the cuff, and stenosis at the tip of the tube.…”