Other possible intraoperative complications include paratracheal insertion, injury of the anterior jugular vein, displacement of the tracheal tube, pneumothorax, desat­uration, posterior tracheal wall perforation, thyroid injury, and subcutaneous emphysema. Postoperative complications include bleeding, infection, pneumotho­rax, tracheostomy tube displacement and, rarely, trachea–innominate stula. This latter serious complication was found in 0.35% of cases from a total of 572 patients undergoing the procedure [27]. While the incidence rates of intraoperative and early surgical complications have been extensively described in the literature, late com­plications can be more difcult to identify and evaluate. Since most patients are critically ill, there is a high mortality rate and many patients are lost to follow-up. In their paper comparing rates of tracheal stenosis between percutaneous and standard tracheostomy, Koitschev etal. [28] found suprastomal stenosis greater than or equal to 50% in 23% of patients submitted to percutaneous tracheostomy and 7.3% of patients submitted to standard tracheostomy. There are a few mechanisms associ­ated with the development of tracheal stenosis. Fracture and displacement of tra­cheal rings during the dilation of the anterior tracheal wall, dynamic collapse of the lateral tracheal wall [29], and bacterial infection leading to local inammation can contribute to the development of this complication. There is also evidence that the tracheal stenosis caused by percutaneous tracheostomy occurs earlier and is signi­cantly closer to the vocal cords (subglottic) than stenosis caused by standard open tracheostomy [30].