Tracheal stomal stenosis after laryngectomy.

Stenosis of the postlaryngectomy tracheal stoma remains a persistent problem. A retrospective study of 89 patients determined on overall incidence of 22 percent. The use of postoperative radiotherapy was associated with a higher incidence (36 percent) than preoperative radiotherapy (19 percent) and combined preoperative and postoperative radiotherapy (17 percent). Retention of the tracheal cannula for longer than 1 week was associated with a slightly increased incidence (25 percent) of stenosis. The technique of stomal construction was an important determinant of stoma stenosis. A simple circle of straight transection of the trachea had the highest incidence (29 percent) of stenosis, which could be reduced with a beveled technique (15 percent). The lowest incidence was seen with a primary plastic or flap construction technique (8 percent). The authors recommend the construction of a patulous stoma by a technique of beveling transection of the tracheal stump in combination with the use of interdigitation skin flaps.