Suprastomal granulation tissue and pediatric tracheotomy decannulation

Robert M. Merritt, John P. Bent, Richard J.H. Smith

Research output: Contribution to journalArticlepeer-review

37 Scopus citations


Although numerous decannulation techniques have been reported, often involving costly sleep studies, repetitive laser procedures, and tracheotomy tube 'downsizing,' no established standard of care exists. We advocate the following simple, minimally invasive decannulation protocol. After excluding concomitant airway lesions, suprastomal granulation is removed transtomally by an endoscopically guided rongeur. A tracheotomy tube is then fashioned with a fenestration centered in the tracheal lumen. Decannulation occurs if the patient maintains adequate ventilation over a 12- to 24-hour observation period with the fenestrated tracheotomy capped. Over 18 months we prospectively followed 10 consecutive children presenting as potential decannulation candidates. Using the aforementioned technique, nine of 10 patients were successfully decannulated (average follow-up, 11.5 months). The postoperative capped fenestrated tracheotomy trial provides a realistic assessment of preparedness for decannulation. We recommend this protocol as a rapid, efficient, and cost-effective means of achieving decannulation.

Original languageEnglish (US)
Pages (from-to)868-871
Number of pages4
Issue number7
StatePublished - Jul 1 1997
Externally publishedYes

ASJC Scopus subject areas

  • Otorhinolaryngology


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