Progressive tracheal obstruction.

Eighteen cases of progressive tracheal obstruction seen at the Santa Clara County Medical Center, San Jose, over the last 8 years are described and analyzed. In 15 of the cases the obstruction was related to tracheal stenosis secondary to the trauma of tracheostomy or endotracheal intubation. The other three cases were the result of carcinoma. The literature on etiology, diagnosis, and operative approach is briefly reviewed. The importance of expeditious action is stressed, as is the need to be prepared for serious complications at all stages. A case is made for tracheal resection rather than dilation or debridement. In discussing the etiology of the cases, it is suggested that some patients have a hyperirritable tracheal mucosa and that the toxins of Staphylococcus or Pseudomonas may directly stimulate the proliferation of granulation tissue.