Tracheostomal Stenosis following Total Laryngectomy

Abstract

Stenosis of the tracheostoma after laryngectomy is an infrequent but often distressing postoperative complication. Recognition of possible predisposing factors will allow appropriate preventive measures in preoperative planning, surgical technique and postoperative care. We describe a surgical technique which can be utilized to correct tracheostomal stenosis or can be used at the time of initial stomal construction. Our method emphasizes mobilization of the tracheal stump, extensive excision of subcutaneous fat, excision of redundant skin and creation of a posterior-superior skin flap which is interdigitated into a vertical posterior tracheal incision. Our method is compared to other techniques described in the literature.

Surgical Treatment of Tracheostomal Stenosis

“…The different techniques reported in literature propose again, albeit in different forms, two fundamental principles: breaking the circumference of the stoma with radial incisions 11,16 and interposing skin flaps along the tracheal circumference. 3,5,8,10,12,14,15,17,18 …”

“…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.…”

Management of Tracheostomal Stenosis

“…Many different techniques have been described for surgical repair of the tracheostomal stenosis. Advancement flaps, 3 single or double Z‐plasties, superiorly based flaps, 6 circular incision, swastika‐shaped incisions with rotation flaps, 15 and five‐flap techniques with Z‐plasties and V‐Y advancement flaps 15 . Most of these reports encompassed few patients with few long‐term results.…”

“…Most of these reports encompassed few patients with few long‐term results. What is more prevalent is the method by which the authors have described their primary technique of stomal reconstruction at the time of laryngectomy 5,6,12,14 . These techniques are applicable during the time of the tracheostomal revision.…”

“…Successful surgical revision allows for stent removal and vocal rehabilitation with a tracheoesophageal puncture 3 . Several stomal revision techniques have been described 4‐12 . Most reports deal with a single treatment modality by a single individual.…”