Subglottic stenosis carries devastating consequences. Its pathogenesis, and therefore prevention, have thus far eluded precise definition. The following data suggest that tracheostomy results in a contaminated wound, secondarily infecting a larynx which may have been injured by prior intubation, fracture, or surgery. The interpretation of these data is based upon the tested assumption that infection prolongs healing of injured tissue and predisposes to scar and stricture formation. Therefore, the ability of control stomal contamination by the judicious use of topical or systemic antibiotics may play an important role in the prevention of complications in an organ functionally by-passed by the tracheostomy cannula.