Tracheal stenosis after tracheostomy

Tracheal stenosis is a late and usually non-life-threatening complication of surgical and percutaneous tracheostomies (PDT) as well as delayed endotracheal extubation. We undertook a retrospective review of all patients who had a surgical tracheostomy over a 10-year period. Patients were included if they had computed tomography (CT) or magnetic resonance imaging (MRI) of the tracheostomy site both preoperatively and six or more weeks postoperatively. Patients whose imaging was not available were excluded (n=3), as were those who still had a tracheostomy in situ (n=8). In total 91 patients were included. In the same period 1170 surgical tracheostomies were performed by the maxillofacial surgeons. The images were analysed by a radiologist and the degree of stenosis reported. All 91 patients underwent a tracheostomy with a window and 83 did not show any stenosis. Looking at the remaining eight with stenosis, it was less than 25% in six, between 25% and 50% in one, and more than 50% in one. Both patients with stenosis of more than 25% had more than one surgical tracheostomy. We have shown that the risk of stenosis is 8.8%, which is lower than that often quoted in the literature, and when it occurs it is likely to be symptomatic only in severe cases. In our group the main risk was repeat surgical tracheostomies, and this also seemed to be linked to a greater degree of stenosis. (C) 2020 The British Association of Oral and Maxillofacial Surgeons. Published by Elsevier Ltd. All rights reserved.