M.D. When your laryngectomy was done, part of the reconstruction was to create your stoma. This was done by suturing the cut end of your trachea to the skin of your lower neck. Under ideal circumstances we want the stoma to be at least as big as the diameter of your trachea, but actually hope that it might be slightly bigger. Several factors are at work. Any time we create a surgical wound, and the stoma is certainly a surgical wound, the body responds by laying down scar tissue as a natural part of the healing process.
Scar tissue is very dense and tough, much more so than surrounding normal tissue.
Usually that's not a problem for linear scars on the skin but when the contracting scar involves a round opening, then the possibilities become quite obvious. The opening will get smaller. There are several things that contribute to a small stoma. These include not removing enough skin from the lower neck during the surgery, compromising the blood supply to the cut end of the trachea, putting in too many sutures, too much tension on the trachea-skin suture line, poor nutrition, prior irradiation to the neck, and infection. Also, some folks just simply have a small trachea from the start so their stomas naturally will be smaller.