Management of Difficulty in Decannulation for Patients with Long-Term Tracheostomy Tubes Following Brain Diseases

Abstract

Objective: To investigate the etiology of difficult decannulation in patients with long-term tracheostomy following brain-related diseases, and to explore the preoperative examination and assessment, selection of surgical indications, surgical and postoperative management methods. This aims to provide a scientific basis for facilitating successful decannulation, improving patients' quality of life, and guiding clinical practitioners in the management of such cases.
Methods: A retrospective analysis was conducted on 27 patients who were hospitalized in our department from May to December 2025 and had experienced failed decannulation after long-term tracheostomy. Preoperative examination and assessment included electronic laryngoscopy and laryngotracheal CT three-dimensional reconstruction. Electronic laryngoscopy was simultaneously used to assess swallowing function, including the Penetration-Aspiration Scale score, Murray Secretion Scale score, vallecula and pyriform sinus residue grading, and swallowing disability grading and classification. The surgical procedure involved endoscopic-assisted resection of laryngeal and tracheal granulation tissue via a supporting laryngoscope under general anesthesia.
Results: The primary cause of laryngotracheal stenosis leading to decannulation failure in patients with long-term tracheostomy due to brain diseases was obstruction from granulation tissue hyperplasia within the larynx and trachea, followed by restricted bilateral vocal cord abduction. Based on detailed preoperative examinations and assessments, all 27 patients in this group were deemed suitable candidates for surgery. They successfully underwent endoscopic-assisted resection of laryngeal and tracheal granulation tissue via a supporting laryngoscope under general anesthesia without any complications. Decannulation was successfully achieved in all patients within 7 to 10 days postoperatively.
Conclusions: 1) Electronic fiberoptic laryngoscopy and laryngotracheal CT three-dimensional reconstruction are effective methods for preoperative examination and evaluation. 2) Appropriate surgical candidates can be selected based on these two examinations. 3) Endoscopic-assisted resection of laryngotracheal granulation lesions via a supporting laryngoscope under general anesthesia is a safe and effective method to resolve decannulation difficulties in such patients.