Pediatric tracheostomy. II. Radiographic features of difficult decannulations

A difficult decannulation was the principal complication in 12 of 30 consecutive infants and children with tracheostomies. Simple radiographic studies permitted accurate diagnoses which correlated with bronchoscopy. In eight patients an endotracheal lesion was caused directly by the tracheostomy, a risk of complication higher than expected. These obstructions were usually granulomas at the superior margin of the stoma; resectable and nonresectable granulomas could not be differentiated radiographically. Four patients had a primary tracheal or laryngeal obstruction which preceded the tracheostomy and complicated decannulation; these included adhesions of the vocal cords and subglottic trachea and posed difficulties in radiographic diagnosis. In no case was dependency on tracheostomy entirely due to emotional causes.