Tracheostomal stenosis after laryngectomy: incidence and predisposing factors

Laryngectomy for carcinoma of the larynx has been performed since it was first described in 1880. Since that time the complication of tracheostomal stenosis has plagued both surgeons and patients. The reported incidence of tracheostomal stenosis ranges from 4% to 42%. At West Virginia University Hospitals from 1976 to 1994, 106 patients undergoing laryngectomies on the head and neck oncology service were analyzed. The charts of patients treated before 1991 were reviewed retrospectively; a prospective analysis was initiated in 1991. Only patients with a minimum of 6 months of follow-up were included in this study. The male-to-female ratio was 3:1, with an age range of 28 to 86 years (mean, 58 years). The overall rate of stenosis was 28.4%. The incidence of tracheostomal stenosis was higher in women (46.4%) than in men (21.6%) (p < 0.05). Since 1991 a plastic type of closure was used in 25 patients. The stenosis rate was 0% in these patients. Before 1991 a bevel or circle technique was used, with stenosis rates of 33% and 75%, respectively (p < 0.05). Infection at the site of the stoma, fistula, steroid use, neck dissection, pectoralis major myocutaneous flap usage, primary tracheoesophageal puncture, and radiotherapy did not correlate with an increased incidence of stenosis. The most important factor in prevention of stomal stenosis after laryngectomy is attention to detail while forming the stoma. With good technique and a plastic-type closure to break up the suture line, a minimal rate of stenosis should be encountered.