Before a child can have his tracheostomy tube removed (also called decannulation) they must have a microlaryngoscopy and bronchoscopy to evaluate how open the airway is. This evaluation sometimes reveals one of two common disorders resulting from a long-term tracheostomy tube.
The first is the presence of suprastomal granulation polyps above the site of the tube within the trachea. This is tissue that grows as a result of the foreign object in the airway (tracheostomy tube). These polyps must be removed prior to decannulation if large enough to partially block the airway. They are removed endoscopically, either through the mouth or through the existing stoma using a microdebrider, electrocautery or surgical instruments. The procedure usually takes 30 to 40 minutes.
The second common disorder is partial collapse of the trachea. The surgeon places an absorbable suture through the area of partial collapse, attaching it to surrounding tissue and providing additional support to the anterior (front) wall of the trachea. There is no incision involved in this 30- to 40-minute procedure.
Gray RF, Todd NW, Jacobs IN: Tracheostomy decannulation in children: approaches and techniques. Laryngoscope. 1998 Jan;108(1 Pt 1):8-12.