Decannulation

DECANNULATION, the freeing of a patient from wearing a tracheotomy tube, can be performed in the event that, upon restoration of the patency of the larynx and trachea, the need for maintaining the tracheotomy opening disappears. The conditions for removing the tube can be quite varied. In acute cases of diseases of the trachea and larynx (edema, inflammation of the mucosa, diphtheria, subchordal laryngitis, etc.), the need for the tube often disappears after a few days or even hours, while in other cases (in chronic laryngitis with thickening of the mucosa and infiltrates, especially after perichondritis on the basis of syphilis, various forms of typhus, and other infectious diseases), persistent changes develop in the larynx, leading to tissue overgrowth (infiltrates) and to cicatricial degeneration, such that wearing the tube may be necessary for months, years, or even a lifetime. Sometimes the removal of the tube is hindered by causes lying outside the lumen of the larynx and trachea, such as diseases of neighboring organs (tumors). In accordance with the variety of causes hindering decannulation, one must resort to various surgical techniques. It is often possible to restore breathing through the mouth after removing granulations and thickenings that have grown around the tracheotomy tube due to prolonged irritation by this foreign body: such formations often occur in cases where, during the tracheotomy operation, the opening was made too high on the cricoid or thyroid cartilages. After wearing the tube for a short time, the opening usually heals by itself, but if its edges have scarred and become covered with epidermis, a plastic surgery operation is required (sometimes with skin and cartilage grafting), or the goal is achieved by freshening the edges and suturing. In chronic stenoses, freeing the patient from the tube usually presents great difficulties; decannulation is preceded by very prolonged treatment of the larynx by bougienage with Schrotter dilators; it is more expedient to resort to surgical interventions, which have been well developed in the USSR in recent times by A. F. Ivanov on a large amount of material (mainly typhus-related). But even with this method, treatment continues for months and years, because the thickenings of the mucosa have an increased tendency to grow back, especially in young subjects. The essence of the operation consists of dissecting the larynx, excising scars and infiltrates, and inserting rubber tubes into the lumen of the larynx for its dilation. See also Tracheotomy.