Z-Plasty of Tracheal Stoma at Laryngectomy

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Abstract
ONE OF the most distressing complications of laryngectomy is stenosis of the tracheostoma. This complication, which may occur at any time in the postoperative period, is most often seen months or years following surgery, although one sees constriction begin and progress rapidly in the first several postlaryngectomy weeks, particularly in patients who have had heavy preoperative doses of irradiation. It rarely presents as an emergency airway problem, but the progressive obstructive feature of this condition with its resultant compromised respiratory exchange can be a frightening experience for the patient. In addition, the patient who has a small stoma is usually required to wear some form of foriegn body in the stoma, generally a laryngectomy tube or "stomal button." Patients do not complain of a stoma being too large. In reviewing the literature, it is apparent that much more emphasis has been placed on the reconstruction of the microstomia than on

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