Adjuvant chemotherapy, advanced age, smoking, cardiopathies, diabetes, local infections, impaired immunocompetence, and malnutrition are potential cofactors in the genesis of aberrant wound healing and may thus play an important role in the genesis of tracheostomal stenosis. The aim of the study is to analyse the influence of the above-mentioned local and systemic risk factors in determining tracheostomal stenosis in patients who have undergone total laryngectomy and adjuvant radiotherapy. In 79 % of the cases, tracheostomal stenosis occurred within 12 months of surgery. Diabetes mellitus and local infection were the only factors that showed a statistically significant difference according to univariate and multivariate analysis. Diabetes mellitus and the related tracheostomal infection may be considered as risk factors for TS in patients who have undergone total laryngectomy and adjuvant radiotherapy.