Plastic tracheostomal-widening procedure: the "petal" technique

Severe tracheostomal stenosis after total laryngectomy may require the permanent use of a tracheostomy tube which undoubtedly represents a personal and social handicap (cosmetic impairment, accumulation of sputum, noisy breathing, cough stimulation, tube management). In patients with voice prostheses, this is a major obstacle to phonation and device maintenance. Stenosis is so pronounced, in some cases, as to cause dyspnoea. The main causes of stenosis are perichondritis of the upper tracheal rings or, more frequently, a defect in the tracheostoma preparation. All such cases require surgical revision of the tracheostomal diameter, for which numerous procedures have been described in the literature. The "petal" technique, adopted by the Otorhinolaryngology O.U. in Vittorio Veneto, for four years, has been used in 59 patients. The technique is described and results of retrospective study, to assess outcome, are outlined. In 40 cases, outcome was immediately satisfactory, while recurrence of stenosis was observed in 19 patients, 9 of whom preferred to accept tube dependence while 10 were reoperated, with permanent successful results in 6 cases. In our opinion, since this is an easy surgical procedure to perform and, in the majority of cases, is carried out under local anaesthesia with good patient compliance, absence of complications and good long-term results, this should be considered the method of choice for surgical widening of permanent tracheostomas.