This narrative review examines airway risks after tracheostomy related to suture fixation, stoma care, and recurrent laryngeal nerve injury, with particular attention to their effects on cannula security, stoma-related complications, capping, and decannulation. Thirty-five publications addressing tracheostomy techniques, cannula fixation, stoma care, recurrent laryngeal nerve injury, special populations, and emerging digital care were synthesized and analyzed from three interrelated perspectives: suture fixation, stoma management, and upper airway neural function. The available literature indicates that appropriate suture fixation, particularly the use of stay sutures and selected stoma-maturation techniques, may reduce early accidental decannulation, false passage formation, and related mortality, while standardized stoma care can decrease infection, granulation tissue, airway stenosis, and tube obstruction. Recurrent laryngeal nerve injury may impair glottic mobility and swallowing function, thereby influencing the likelihood of successful capping and decannulation; although intraoperative nerve monitoring may reduce selected nerve injury risks, it cannot replace direct intraoperative nerve identification. Obese patients, children, patients with head and neck cancer, and patients with COVID-19 have distinct risk profiles and require individualized assessment. Overall, airway safety after tracheostomy should be managed through an integrated approach combining cannula fixation, stoma assessment, and upper airway evaluation, supported by standardized checklists, stoma care bundles, pre-decannulation upper airway assessment, and multidisciplinary workflows to reduce accidental decannulation, infection, stenosis, and decannulation failure.

Chi-Shing Kwok, Hang-Kai Cheung. Suture Fixation, Stoma Care, and Recurrent Laryngeal Nerve Injury-Related Airway Risks after Tracheostomy: A Narrative Review. Frontiers in Medical Science Research (2026), Vol. 8, Issue 3: 78-83. https://doi.org/10.25236/FMSR.2026.080311.

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