One hundred sixty-four consecutive
tracheotomies are reviewed over the 10-year period 1972-1981. Early in the series acute inflammatory
airway obstruction was the major indication for
tracheotomy, being 60% of cases in the first 3 years. In the last 3 years this fell to approximately 15%. After 1975 nasotracheal intubation replaced
tracheotomy for acute epiglottis. More recently it has become the treatment of choice for acute laryngotracheobronchitis.
Tracheotomy prior to reconstructive surgery for major
craniofacial abnormalities is becoming more frequent.
Acquired subglottic stenosis is not a problem in our hospital despite the use of long-term nasotracheal intubation in premature infants, and no
tracheotomies were performed for this indication. There were few major complications. Decannulation difficulties were due to obstruction by stomal granulation tissue or displaced flap of anterior tracheal wall. There was no case of
hemorrhage, no posttracheotomy
stenosis, and no death was attributable to
tracheotomy. These results demonstrate that in a major pediatric hospital
tracheotomy is a relatively safe and effective procedure with minimal morbidity.