With the Seldinger percutaneous technique, a flexible guidewire is
introduced under bronchoscopic visualization, and dilators
of increasing diameter are passed over the wire to create the
tracheostoma. In this technique, the tracheal rings can be
down-fractured and invaginated into the airway leaving an
anteriorly based stenosis.
One possible mechanism of anterior subglottic stenosis is infracture of the tracheal rings during initial percutaneous tracheal wall
dilation with subsequent inflammation and fibrosis. (A) Normal tracheal ring on cross-section. (B) In-fracture of anterior tracheal cartilage
possible by percutaneous tracheotomy dilator. (C) Anterior-based scarring as the result of injury in B.