Patients, after laryngectomy, sometimes have difficulty maintaining an adequate size of tracheal stoma. Various reasons for this are (1) a poorly constructed stoma, (2) postoperative infection at the skin mucosal line leading to a contracture ring, (3) spontaneous keloid formation, (4) poor healing in patients who have previously undergone irradiation for cancer of the larynx, and (5) refusal by the patient to undergo tracheal stomal revision.
Obviously, the best treatment for a constricting tracheal stoma is operative revision of the stoma. In most cases this is successful, if careful skin-to-mucosa approximation is achieved without postoperative infection. The handling of this problem is well discussed by Martin.1 The ideal tracheal stoma, of course, closely approximates the diameter of the trachea itself and requires no tubing.
However, for the reasons listed above, a few patients do not secure an adequate tracheal-skin opening. Unless they wear standard tracheostomy tubes, the stoma soon
Moore C. PLASTIC TRACHEOSTOMY BUTTON. JAMA. 1957;165(10):1276–1277. doi:10.1001/jama.1957.72980280003011a
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