Totally obstructing tracheotomy-associated suprastomal granulation tissue

Although tracheotomy-associated suprastomal granulation tissue is quite com mon, suprastomal granulation tissue that totally obstructs the airway is re latively rare and can be associated with serious complications. In this rep ort the complications and management of six cases of totally obstructing su prastomal granulation tissue (TOSGT) are presented. Complications associate d with the presence or management of TOSGT included progression of subglott ic stenosis, development of posterior laryngeal stenosis, development of su praglottic stenosis following CO2 laser supraglottoplasty, and dislodgement of the TOSGT with distal tracheal obstruction resulting in anoxic brain in jury. It is recommended that the tracheotomy tube remains in position at al l times during attempted removal, and that if endoscopic removal is not pos sible, that open tracheoplasty is the safest method for removal. Measures t hat may decrease the chances of recurrence include diligent diagnosis and t reatment of gastroesophageal reflux disease (GERD) and bacterial infection. TOSGT may be a marker for some patients with abnormal wound healing. (C) 2 000 Elsevier Science Ireland Ltd. All rights reserved.