TRACHEOSTOMAL STENOSIS AFTER LARYNGECTOMY - INCIDENCE AND PREDISPOSING FACTORS

Laryngectomy for carcinoma of the larynx has been performed since it w as first described in 1880. Since that time the complication of trache ostomal stenosis has plagued both surgeons and patients, The reported incidence of tracheostomal stenosis ranges from 4% to 42%. At West Vir ginia University Hospitals from 1976 to 1994, 106 patients undergoing laryngectomies on the head and neck oncology service were analyzed. Th e charts of patients treated before 1991 were reviewed retrospectively ; a prospective analysis was initiated in 1991. Only patients with a m inimum 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 trac heostomal 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 1998 a bevel or ci rcle technique was used, with stenosis rates of 33% and 75%, respectiv ely (p < 0.05). Infection at the site of the stoma, fistula, steroid u se, neck dissection, pectoralis major myocutaneous flap usage, primary tracheoesophageal puncture, and radiotherapy did not correlate with a n increased incidence of stenosis, The most important factor in preven tion of stomal stenosis after laryngectomy is attention to detail whil e forming the stoma, With good technique and a plastic-type closure to break up the suture line, a minimal rate of stenosis should be encoun tered.