Tracheal stenosis after tracheostomy and after orotracheal cuffed intubation.

Tracheal stenosis occurred in 9 cases in a series of 812 tracheostomized patients, an incidence of 1.1%. Two additional stenoses had developed after orotracheal cuffed intubation. Two suprastomal, two stomal and seven infrastomal stenoses were confirmed. The stenosis was diagnosed within 10 weeks of extubation in 10 patients and 5 months after extubation in 1 case. The airway results were good after segmental resection and end to end anastomosis in 5 patients; satisfactory in 4 patients after various dilatation procedures and poor in 1 case after removal of granulation tissue. The mortality rate was 18%. One patient died on account of missed diagnosis and another of tracheo-innominate artery erosion with massive bleeding after tracheal resection. The present report indicates that the best airway results are achieved by segmental resection. Various dilatation procedures, however, produced satisfactory airway results and should be used as primary treatment when the stage of the stenosis makes resection inappropriate. When planning surgical treatment, X-ray examinations, tomography or tracheo-graphy are necessary for evaluation of the site and length of the stenosis. The stage of the stenosis can best be evaluated by tracheoscopy. The use of large, low-pressure thin-walled cuffs and avoidance of overinflation of the cuff are the most important measures for preventing the cuff-induced tracheal injury which may lead to tracheal stenosis.