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During long-term intubation and tracheotomy in childhood there is risk of stenosis in 3 regions: 1. in the area of the cricoid (ring) cartilage, 2. in the area of the tracheostomy, 3. in the area of the inflated cuff of the tube. To prevent this it is recommended to take an endoscopic look at the mucous membranes when changing the intubation tube or the tracheal cannula; to use for long-term intubation the naso-tracheal approach, combined with a tube with the smallest possible diameter; to use the "open-type tracheotomy" with a mucous membrane-epidermis suture and without the removal of cartilage. Careful inflation of the cuff and rhythmical changing of the position of the cuff in the cervical segment of the trachea lower the risk of pressure-induced damage. If there is an infection or a metabolic disease the mucous membranes are extremely sensitive to pressure. Serious stenoses frequently make laryngical and tracheal plastic surgery in several sessions necessary. The curvature and stiffening of the ventral wall of the trachea can be achieved by implantation of arched cartilage from the cartilage bank. more...

During chronic intubation or tracheostomy in children, there is a risk of stenosis at three sites: the cricoid ring, the tracheostomy and the area of tube cuff inflation. The following measures are recommended to prevent this occurrence: endoscopic examination of the mucous membranes when changing the intubation tube or the tracheal cannula: nasotracheal intubation with the smallest possible diameter tubes when chronic intubation is required; use of the "open-type" tracheostomy utilizing mucosaskin retraction sutures but with out removal of tracheal cartilage. Careful inflation of the cuff and regular changing of the position of the cuff in ther cervican trachea also lower the risk of pressure-induced injury. Infection or co-existing metabolic disease increases mucosal sensitivity to pressure. Several stenosis of the laryngotracheal regions frequently requires staged laryngeal and tracheal plastic reconstruction. The curvature and stiffening of the ventral wall of the trachea can be achieved by the implantation of arched homograft cactilage taken from a tissue bank. more...