Management of tracheostomal stenosis

Background: Tracheostomal stenosis following laryngectomy is a distressing complication with major effects on patient rehabilitation. Management ranges from stenting with a prosthetic device to surgical revision. The goal is a widely patent stoma that is amenable to tracheoesophageal puncture. Objective: Review the long-term results of different methods of tracheostomal revision. Methods: Review of 43 patients with symptomatic tracheostomal stenosis. End point was ability to function with no artificial stenting of their stoma. Results: Forty-three patients underwent 55 revisions. The male-to-female ratio was 1.3:1.0. The age range was from 38 to 81 years (mean age, 59.5 y). Median time to revision was 11 months following the initial surgical procedure (range, 1-150 mo). Thirty- three patients underwent one revision; eight patients, two revisions; and two patients, three revisions. In 40 of 43 patients (93%) revision was successful. Of the last 21 patients who underwent revision, 18 had tracheoesophageal punctures placed, Fifteen developed excellent tracheoesophageal speech. The initial rates of success for these procedures were as follows: advancement flaps, 8 of 9; Z-plasty, 13 of 15; V-Y inset, 8 of 8; other procedures, 2 of 4; and dilation, 2 of 7 (P < .05 for dilation rs. all others). The ultimate success rates for these procedures were as follows: advancement flaps, 8 of 11; Z-plasty, 15 of 18; V-Y inset, 12 of 13; other procedures, 3 of 6; and dilation, 2 of 7. Other procedures and dilation were inferior (P < .05) compared with advancement flap, Z-plasty, and V-Y insets. Conclusion: Tracheostomal stenosis can be successfully managed in a multitude of ways.