Tracheal Granulation: A Complication of Pediatric Tracheotomy

Abstract

Tracheotomy has long been utilized as a rapid and safe method of providing unobstructed airway. In the pediatric population the tracheotomy itself is occasionally a problem, e.g., delayed decannulation. The problems creating delayed decannulation may result in death. In recent years our attention at St. Christopher's Hospital for Children, in Philadelphia, has been focused on several patients with partial tracheal obstruction due to posttracheotomy granulation tissue. These cases serve as the basis of this report. We were asked to treat two children who developed severe breathing difficulty weeks after decannulation due to tracheal granulation tissue. In both cases prompt evaluation and treatment would have averted emergency situations. Our principles in evaluating children following decannulation are discussed. Also presented is a patient who required a tracheotomy in the early months of life and who subsequently died. The postmortem examination of her trachea revealed a mass arising from the tracheal stoma. Anatomic lessons learned from this case were applied successfully in treating another child with a similar problem. Our treatment protocol is reviewed and emphasis placed on early diagnosis to determine the cause of difficulties encountered in decannulating children.