Tracheotomy revision in infants: to facilitate extubation and restore phonation.

The formation of tracheal 'granuloma' in the tracheostomized infant, as a cause of aphonia and an obstacle to decannulation has long been recognized. Endobronchial or transtomal removal has been recommended; however, a number of these lesions were resected in conjunction with complete tracheostomy revision and found to be very much larger than suspected endoscopically and consisting of dense mature scar tissue. It is, therefore, suggested that resection of these lesions endoscopically or transtomally may be quite inadequate and an open procedure preferred.