Widening techniques for stomal stenosis: Y-V advancement vs. two circular incisions technique

Abstract

Background: Tracheostomal stenosis following total laryngectomy for carcinoma of larynx is a challenging condition for an otolaryngologist, especially when the patient requires post-operative radiotherapy. Critical narrowing of the stoma needs surgical widening. Though there are few surgical techniques described for the same, re-stenosis has been observed in many. We conducted a comparative study of two widening techniques: Y-V advancement and two circular incisions technique. Methods: A prospective study was conducted, to assess the outcome of 2 surgical techniques: Y-V advancement and two circular incisions technique in patients with tracheostomal stenosis following total laryngectomy. Initially three patients were subjected to Y-V advancement technique for stomal dilatation. But all three patients presented with re-stenosis in a mean period of 8 months and were then subjected to stomal widening by the double circular incisions technique. The next five patients who presented with stomal stenosis underwent widening by two circular incisions technique. All 8 patients were followed up for one year postoperatively. Results: Among the 8 patients, 3 patients who presented initially underwent stomal widening by the Y-V advancement technique. All 3 patients presented with re-stenosis in a mean period of 8 months post-operatively. Stomal widening using the two circular incisions technique was adopted for these three patients and another 5 patients who presented with stomal stenosis. All 8 patients were found to be maintaining an adequate stoma on one year post-operative follow up. Conclusions: In our experience, stomal widening by the two circular incisions technique has found to be effective in maintaining an adequate stoma with no features of re-stenosis on a one year postoperative follow up. However a larger study is desirable to conclusion of the same.