Further clinical experience with the silicone tracheal cannula in obstructive sleep apnea

We report on the perioperative and postoperative course of 47 patients with severe obstructive sleep apnea, who underwent tracheostomy by use of a silicone tracheal cannula developed by Dr. William Montgomery. Our initial experience with the first 20 of these patients (presented in 1982) was quite favorable because of the ease of insertion and care, a high degree of patient acceptance, and infrequent complications. With our current sample, larger experience, and more prolonged follow-up, we noted that symptomatic granulation tissue formation, with or without wound infection, occurred more frequently than was initially appreciated. In 21% (10 of 47) of the cases, the only way to resolve this problem was to remove this device and replace it permanently with a metal (or other type) tracheostomy tube. Other complications included tracheal narrowing and cannula malpositioning and fragmentation. This full report lists in detail the incidence of complications associated with our use of this cannula and modifications which may lessen these.