Pediatric Suprastomal Granuloma: Management and Treatment

Abstract

OBJECTIVE: Suprastomal granulomas (SSG) are a common complication of pediatric tracheotomy. Occasionally excision is indicated for obstructive granulomas. We report on our experience on the management of SSG requiring excision. STUDY DESIGN AND SETTING: A retrospective chart review of 68 patients who underwent SSG excision at a tertiary referral pediatric hospital between July 1997 and November 2002. The medical charts were reviewed for excision techniques and outcomes. RESULTS: A total of 106 excisions of SSG were performed on 68 patients. Of the patients, 25 (36.8%) required multiple excisions. Removal techniques included sphenoid punch (34.9%), optical forceps (34.0%), open excision (22.6%), electrocautery (4.7%), and hook and eversion (3.8%). CONCLUSION: The majority of SSG do not require removal. If excision is indicated, we recommend using optical forceps for soft and friable lesions and the sphenoid punch for fibrous and firm granulomas. For granulomas that have a broad base, are very large, or where endoscopic instrumentation is not possible, we recommend open excision.