%0 Journal Article
%T Customized Tracheostomy Cannula as a Therapeutic Adjunct in Tracheal Stenosis
%A Doh Young Lee
%A Jungirl Seok
%A Wonjae Cha
%A Won Yong Lee
%A J. Hun. Hah
%A Tack-Kyun Kwon
%A Kwang Hyun Kim
%A Myung-Whun Sung
%J Case Reports in Otolaryngology
%D 2013
%I Hindawi Publishing Corporation
%R 10.1155/2013/921365
%X Tracheotomy is often successfully used to manage tracheal stenosis, as a temporizing measure prior to definitive treatment or a long-term remedy. In some patients, where a sizeable portion trachea is stenotic, the fixed arm of an ordinary tracheotomy tube may not be of sufficient length to satisfactorily maintain the distal tracheal lumen, and commercially available adjustable tubes may not be at hand in certain clinical settings. Herein, we describe a simple method of constructing a temporary tracheotomy tube with an adjustable distal arm, allowing custom fit at the patient bedside. 1. Introduction Tracheal stenosis is a serious and potentially life-threatening condition of varied etiology [1, 2]. While tracheotomy usually maintains the airway prior to definitive treatment and may even serve as a long-term solution in some patients, the fixed distal arms of regular tracheotomy tubes simply do not provide the support needed to maintain tracheal lumen when the stenotic segment is lengthy. Furthermore, the tips of such relatively short tubes may be a source of mucosal irritation to exacerbate a patient¡¯s condition. For airway stenting of either temporary or long-term duration, the stent tip ideally should bypass the stenosis without sacrificing ventilation to either of the lungs. Severe stenosis of the distal trachea thus poses a distinct challenge to surgeons who render care. 2. Case Presentation A 17-year-old male was referred to our institution for airway stenosis. He had been injured while bicycling (traffic collision), undergoing intensive treatment elsewhere for subarachnoid hemorrhage, left mandibular fracture, a fractured clavicle, and bilateral pneumothoraces. Tracheotomy was subsequently performed to accommodate long-term mechanical ventilation. In a matter of two weeks, however, he developed inspiratory stridor and respiratory distress due to obstructive proliferation of granulation tissue at the cannula tip. An endotracheal tube with internal diameter of 6£¿mm was inserted for temporary relief, but the problem recurred at the tip of the endotracheal tube. At this point, the patient was referred to our facility. Computed tomography (CT) showed narrowing of the entire trachea (Figure 1), prompting evaluation by rigid bronchoscopy. Upon endotracheal tube removal, there was copious oozing of blood from eroded and inflamed tracheal mucosa (Figure 2(a)). Nevertheless, a short silicone T-tube 4.5£¿cm (the length of lower arm) kept the narrowed and severe inflamed lumen widely patent. Figure 1: Initial CT of airway in coronal view with narrowed tracheal
%U http://www.hindawi.com/journals/criot/2013/921365/