Tracheal stenosis after percutaneous dilational tracheotomy.
OBJECTIVE
In many critical care units percutaneous dilational tracheotomy (PDT) has become an alternative to open tracheotomy. Although significant tracheal stenosis after PDT has been reported, the exact incidence is unknown. We report our findings on endoscopic laryngotracheoscopy for a group of patients who had undergone PDT more than 6 months before their examination.


METHODS
We did a retrospective review of 108 trauma patients who underwent PDT at least 6 months before enrollment in the study. Twenty-eight patients were either deceased or ineligible. Participation requests were mailed to the last recorded address of 80 patients. Thirty-four of those patients were contacted by phone, and 14 indicated their willingness to participate. Only 10 patients were able to make it to the clinic for examination. After transorally anesthetizing the hypopharynx and larynx with 4% lidocaine, each patient underwent flexible laryngotracheoscopy. Findings were categorized as normal or tracheal stenosis (<25%, 25% to 50%, or >50%).


RESULTS
The tracheotomy site was virtually undetectable in 5 patients. In 4 patients, a scar was visible at the tracheotomy site, but there was no decrease in cross-sectional area. In 1 patient there was a 25% to 50% stenosis. All patients were completely asymptomatic with regard to airway and voice quality.


CONCLUSIONS
One out of 10 patients in our series had a significant but asymptomatic stenosis after PDT. The risk of tracheal stenosis in PDT appears to be the same as that of open tracheotomy.
Bartels
Sande
S
Department of Otolaryngology-Head and Neck Surgery, Oregon Health and Science University, Portland 97201-3098, USA.
Mayberry
John C
JC
Goldman
Robert K
RK
Askew
Judah A
JA
Wax
Mark K
MK
D000328:Adult; D000368:Aged; D002404:Catheterization / Q000379:methods; D005260:Female; D006801:Humans; D007828:Laryngoscopy / Q000379:methods; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012720:Severity of Illness Index; D014135:Tracheal Stenosis / Q000601:surgery*; D014140:Tracheotomy / Q000379:methods*; D014833:Voice Quality