Keywords: Tracheostomy, tracheotomy, laryngotracheal stenosi

Abstract: There is no agreement in the literatura about the better technic for entering in the trachea in a tracheostomy. In order to compare two of the most common used technics and their relation with laryngotracheal stenosis, a randomized prospective study was dope comparing the removal of a window of cartilage from the anterior tracheal wall and a longitudinal incision. A hundread nine tracheostomies were done in patients with previous orotracheal intubation and mecanical ventilation, between november 1992 and apri1 1995. The patients were studied about age, sex period of orotracheal intubation and the presence of laryngotracheal stenosis. Before decanulation all patients underwent a flexible laryntracheoscopy under local anestesia to search for stenosis. Fifty one patients underwent longitudinal incision and 58 window removal, 48 were male and 61 female. The period of orotracheal intubation varied from 1 to 27 days.Fifty four died in the ICU, 41 were decanulated, 11 presented laryngotracheal stenosis and 3 were lost. Of the 11 with laryngotracheal stenosis 8 underwent window removal and 3 longitudinal incision, 9 were female and 2 male. Although the high mortality rate in our study group makes difficult any conclusions, our results suggest that in female patients with ventilatory assistence, the longitudinal incision for tracheal entering would be highly recomende.