Bedside Techniques: Horseshoe Cartilage Ring-Preserving Tracheostomy for Preventing Stomal Site Stenosis

Introduction Post-tracheostomy cuff site stenosis (CSS) can be resolved using a soft cuff cannula [1], but there is no established treatment for stomal site stenosis (SSS), including subglottic stenosis (SGS), which can arise as a complication of tracheostomy [2,3]. To prevent SSS, we commonly use a tracheostomy procedure in which the framework of the horseshoe cartilage rings is preserved, as the trachea is opened transversely at the inter-cartilage ligament. This procedure is quite simple and involves a cannula being smoothly inserted using a percutaneous tracheostomy kit (PCT kit). As the number of tracheostomy procedures required has increased due to COVID19-related pneumonia, a standard tracheostomy procedure should be re-established.