Tracheostomal Stenosis After Immediate Tracheoesophageal Puncture

Tracheostomal stenosis revision with simultaneous tracheoesophageal puncture

“…Conversely, the lack of reports of tracheostomal stenosis following secondary puncture is probably related to the selection criteria of patients who have a well‐formed and well‐healed stoma. Although our numbers are low, we suspect that the tracheostomal stenosis rate in patients who have their stomas revised and have a tracheoesophageal puncture should lie between the series of Ho et al 10 and the 0% reported by the majority of authors. Our technique of inserting a V‐Y advancement flap into the inferior trachea to break up the concentric scarring has contributed to a negligible tracheostomal stenosis rate in patients undergoing primary laryngectomy 17 .…”

“…Other reports do not mention stenosis at all. The most comprehensive report by Ho et al 10 concerns 71 patients who underwent primary tracheoesophageal puncture; 19% of these patients developed tracheostomal stenosis, five of whom underwent revision and eight of whom wore a tube. It is difficult to compare our patient population with those having primary puncture with laryngectomy, because there are many factors that would predispose to stenosis that are not present when a secondary revision is undertaken.…”

Surgical Treatment of Tracheostomal Stenosis

“…Literature reports an incidence of this complication ranging from 4% to 42%, 1–10 attributable to different criteria being applied when defining stenosis. Wax et al 8 defined as having tracheal stenosis a patient who either requires a stent for longer than 3 months after surgery or requires tracheostoma revision for any reason.…”

“…Many etiological factors have been indicated as contributing to the onset of stenosis: type of skin incision, diameter of the trachea, type of tracheal dissection performed, devascularization of the trachea, level of the stoma, excess skin and peristomal fat, flap reconstruction, incorrect mucosal-cutaneous suturing, excessively large thyroid gland, infection after surgery, hypertrophic scarring and formation of keloids, presurgical and postsurgical radiotherapy, use of corticosteroids, and tracheoesophageal puncture. 1,[3][4][5]8,[11][12][13] As many authors 3,5,7,8,[13][14][15] have already highlighted, the most important factor in prevention of stenosis is correct execution of the tracheostoma when total laryngectomy is carried out.…”

A Surgical Technique to Prevent Tracheostomal Stenosis After Laryngectomy

“…Regarding stomal stenosis after laryngectomy, prevention is better than cure. Historical causes of stenosis range from excessive peristomal fat, postoperative infection, and a pharyngocutaneous fistula to poor operative technique, an enlarged thyroid, bulky sternocleidomastoid muscle heads, defective or absent tracheal rings, steroid therapy, irradiation, and the creation of a primary tracheoesophageal fistula 1‐4 . Recently, however, it has been found that wound infection, a fistula, steroid use, neck dissection, primary tracheoesophageal puncture, and radiotherapy do not correlate with an increased incidence of stenosis 5,6 .…”