Surgical Dilatational Tracheostomy to Prevent Post-Tracheostomy Tracheal Stenosis: Preliminary Results in a Growing Animal Model

Chung, Young Jun; Kim, Sang Woo; Jeong, Han Sin; Baek, Chung Hwan

Abstract

BACKGROUND AND OBJECTIVES
Although pediatric tracheostomy is a useful procedure to secure airway, post-tracheostomy complications sometimes have significant detrimental effects on pediatric patients. Among the complications, post-tracheostomy tracheal stenosis is one of the major late sequelae, which may be preventable by adequate surgical technique. The objective of this study is to investigate the degree of post-tracheostomy tracheal stenosis after applying new modification of tracheostomy: surgical dilatational tracheostomy (SDT) in a growing animal model. SUBJECTS AND METHOD: Seven Newzealand White rabbits were divided into three groups: SDT (n=3), surgical conventional tracheostomy with vertical cartilage incision (SCT)(n=3), and control (n=1). Each rabbit underwent tracheostomy by assigned procedures on the first day. On day 8, they were decannulated. On day 15, their tracheas were harvested. We examined the gross findings and histologic changes of each tracheal segment at the level of stoma. We analyzed three parameters: the quotient of the stomal and non-stomal segment in sagittal diameter, coronal diameter, and cross sectional area. RESULTS: The frameworks of cartilages at the level of stoma were more distorted in the SCT group. Histologic examination also showed buckling of the anterior tracheal wall, loss of cartilage, infiltration of many polymorphonuclear neutrophils and marked in-growth of fibrous tissue in SCT group. Sagittal, coronal diameters and cross sectional areas were affected more severely after SCT than after SDT. CONCLUSION: We found no significant risk of post-tracheostomy tracheal stenosis for the SDT in a growing animal model. Therefore, SDT might be useful in the management of pediatric patients who require short-term tracheotomy. Further study of SDT should be investigated in children in a clinical setting.