Three Cases of Dysphagia Due to Inappropriate Tracheostomy

─Importance of Appropriate Tracheostomy

Abstract

Once the patient's respiratory and general conditions improve after a tracheostomy, we must work to restore the patient's oral intake and speech function. However, these functions may not be restored if the tracheostomy is performed in an inappropriate site and postoperative management is inadequate. Case 1 (83-year-old male) had a tracheostomy tube placed in the cricothyrotomy ligament and was followed up, resulting in failure to elevate the larynx and subglottic stenosis. Case 2 (86-year-old male) had a tracheostomy performed from the right lateral side of the trachea, which resulted in inability to elevate the larynx and paralysis of the right vocal cord. Case 3 (78-year-old female) had a high tracheostomy that injured the cricoid cartilage, resulting in failure of laryngeal elevation and subglottic stenosis. For these three cases we reoperated with the tracheal foramen in the appropriate position. In Case 1, laryngeal elevation and subglottic stenosis were improved and the tracheal foramen was closed. In Case 2, laryngeal elevation and paralysis of the right vocal cord were improved and the tracheal foramen was closed. In Case 3, the anterior surface of the cricoid cartilage was resected and a long vertical tracheal foramen was formed. Although the tracheal foramen was difficult to close, a tracheostomy tube was no longer necessary. In all three cases, oral intake was possible after reoperation to properly position the tracheal foramen. Appropriate tracheostomy is important to improve postoperative swallowing and speech function.