A novel permanent tracheostomy technique for prevention of stomal stenosis (triangular tracheostomy).
OBJECTIVE
Stenosis of a permanent tracheostoma after total laryngectomy lowers postoperative quality of life (QOL), and its prevention is clinically important.


METHODS
From April 2003 to March 2009, the authors performed 87 permanent tracheostomies. For the purpose of prevention of tracheostomal stenosis, we had applied new technique from October 2005.


RESULTS
The incidence of the tracheostomal stenosis was retrospectively reviewed. Until September 2005, conventional permanent tracheostomy was applied for 33 cases and tracheostomal stenosis developed in 6 cases (18.2%). On the other hand, stenosis did not develop in any of the 54 cases in which the new technique was used. The triangular method was significantly superior to the conventional method in preventing stenosis. Stomal recurrence did not develop in either technique.


CONCLUSIONS
The key point of the new technique is as follows: at the upper end of trachea, the posterior part of tracheal cartilage is preserved and the anterior edge of the tracheostoma is made much lower. The shape of the tracheostoma approximates a triangle, and the area is greater than with other methods. From our experience, this technique is safe and effective for the prevention of tracheostomal stenosis.
Suzuki
Masami
M
Department of Head & Neck Surgery, Gunma Prefectural Cancer Center, Japan.
Tsunoda
Atsunobu
A
Shirakura
Satoshi
S
Sumi
Takuro
T
Nishijima
Wataru
W
Kishimoto
Seiji
S
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D015994:Incidence; D007825:Laryngectomy / Q000379:methods; D007829:Laryngostenosis / Q000453:epidemiology* / Q000209:etiology / Q000517:prevention & control*; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D015995:Prevalence; D012307:Risk Factors; D054047:Surgical Stomas; D014139:Tracheostomy / Q000379:methods*