How to manage tracheostomal recurrence Book Section

  


Author: Kraus, D. H.
Editor: Cernea, C. R.
Article/Chapter Title: How to manage tracheostomal recurrence
Abstract: Tracheostomal recurrence after laryngectomy is an extremely challenging problem. The vast majority of these patients will have undergone chemoradiation and salvage laryngectomy. Tracheostomal disease typically represents recurrence of nodal disease in the tracheoesophageal groove. Surgical management is feasible in the minority of patients and the ability to cure is relatively remote. Patients who are considered for surgical management should suffer limited medical comorbidities. Utilizing the Sisson staging system, stage I (suprastomal disease without pharyngeal involvement) or stage II (suprastomal disease with involvement of the pharynx) is far preferable to stage III (infrastomal disease without great vessel involvement) or stage IV (infrastomal disease with great vessel involvement) disease. Patients require complete resection of the tracheostomal disease, a portion of the trachea, pharyngeal resection, and all involved cervical skin. Reconstruction focuses on reestablishment of the pharynx, reconstruction of the cervical skin, and reconstruction of the stoma. Postoperative complications can be life-threatening. Wound breakdown can lead to fistula formation and the risk of rupture of the carotid and/or innominate artery. Patients undergoing successful management may be considered for re-irradiation, possibly with chemotherapy. Even with aggressive treatment, approximately 25-30% patients are cured of their disease. Distant metastases remain a significant risk.
Keywords: Head surgery; Neck surgery; head and neck neoplasms surgery
Book Title: Pearls and Pitfalls in Head and Neck Surgery: Practical Tips to Minimize Complications. 1st ed
ISBN: 978-3-8055-8425-8
Publisher: S. Karger AG  
Publication Place: Basel, Switzerland
Date Published: 2008-01-01
Start Page: 86
End Page: 87
Language: English
PROVIDER: manual
Notes: Book Chapter: 4.8
MSK Authors
  1. Dennis Kraus
    268 Kraus
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