Abstract
This report presents two cases of inspiratory dyspnea in whom urgent tracheotomy was performed with some difficulties because of unexpected tracheal stenosis. In the first case dyspnea had been caused by bilateral recurrent laryngeal nerve paralysis and intratracheal invasion of cervical esophagus carcinoma, and the latter had not been discovered until the trachea was opened. In the second case presophageal abscess which was enlarged towards the tracheal lumen was the cause of stenosis of the air way. This abscess could not been found before the operation.
In each case, surgical manipulations on the anterior wall of the trachea increased the grade of dyspnea markedly. The first case was cured by hurried opening of the trachea at the lower site than usual tracheotomy, however, the second case was suffocated and cardiac arrest followed. Though the patient was recovered from asphixia by heart massage and forced respiration, she died 28 hours after the operation without recovering consciousness.
It was the common cause of dyspnea of these cases that the trachea was almost obstructed at the site where usual tracheotomy was done. This obstruction is diffcult to be found preoperatively when urgent tracheotomy is recommended, because there is no time to examine the patient precisely in such a condition. Reflecting the cases reported, it was discussed how such a tracheal stenosis can be found as early as possible and how tracheotomy should be performed in such a case safely.
