Tracheostomy Decannulation: Suprastomal Granulation Tissue in Perspective

Abstract

Background: Suprastomal granulation tissue is a complication of tracheostomy which may make decannulation difficult and presents a therapeutic challenge to the Otorhinolaryngologists. The aims of this study therefore were to evaluate tracheostomy in black African population, determine the prevalence of suprastomal granulation tissue and provide updated information on it that will enable the otorhinolaryngologists to better understand and manage the lesion.

Methods: We reviewed case files of patients who had tracheostomy between 1993 and 2007 at University College Hospital, Ibadan, Nigeria for essential clinical data.

Results: Of the 256 patients who had tracheostomy, 133(51.95%) had prior orotracheal intubation for 10 – 21days. Suprastomal granulation tissue complicated 16 (6.25%) cases, this accounted for 88.89% of cases of failed decannulation. Indications for tracheostomy in these patients included severe head injury in 12 (75%), tetanus in 3 (18.75%)] and intubation granuloma in 1(6.25%) of these cases. Sixteen (4.3%) cases had stomal infection.

Conclusion: This study showed that the prevalence of suprastomal granulation is high among our patients. There is a need for good surgical tracheostomy technique to prevent this complication and stomal infection should be promptly treated while cuffed orotracheal intubation for more than two weeks in unconscious and tetanus patients should be avoided.