Detection and management of tracheal stenosis following cuffed tube tracheostomy

This report describes the experience with 60 instances of symptomatic posttracheostomy stricture seen at Toronto General Hospital between 1963 and 1970. Interpretation of symptoms was frequently incorrect, and diagnosis was delayed for years in some patients. Between 1967 and 1969 a prospective study of tracheal injury was undertaken. This study clarified symptomatology and revealed stricture in 32 of 153 patients, a 20% incidence of stenosis, in patients who survived treatment.Methods of treatment included endoscopic dilatation, segmental tracheal resection, staged plastic reconstruction, and permanent tracheostomy. Of 37 lesions managed by resection and end-to-end anastomosis there were 33 good results (the patient was asymptomatic), although a second resection for restenosis was necessary in 6 of these patients. There were 2 operative deaths.Operative techniques and general principles of surgical management are outlined. A laryngeal release procedure was used for mobilization in 5 patients, and our experience supports the usefulness of the maneuver. Although some mild strictures may be satisfactorily managed by endoscopic dilatation, the majority are best treated by segmental resection. Segmental defects up to 5 cm. in length can be resected and successfully reconstituted by end-to-end anastomosis.