A Case of Subglottal Stenosis Treated by Insertion of a T-tube

Abstract

We report a case of subglottal stenosis successfully treated by insertion of a T-tube. A 55-year-old male was referred to our hospital with complaints of dyspnea and aphonia after emergency tracheal intubation.
The patient had an attack of myocardial infarction, and emergency tracheal intubation was performed for resuscitation. The tube was kept in place for 4 days and then removed. Two months after removal of the tube, the patient developed dyspnea. Although tracheal intubation was again attempted, the insertion failed because of an apparent stenosis at the subglottic level, and tracheotomy was performed. The patient was eventually referred to our hospital after coronary bypass surgery. Laryngeal examinations revealed a granulomatous mass at the subglottal space and the mass was removed under laryngomicroscopy. His postoperative course was uneventful and the tracheal tube was removed 2 weeks postoperatively. However, the patient developed dyspnea again approximately 3 weeks after the closure of the tracheostoma, and was readmitted for another tracheotomy. Fiberscopic examinations at this point revealed recurrence of granulomatous subgottal stenosis. The granulation was subsequently completely removed by laryngotracheal fissure approach and a T-tube was inserted. The T-tube was kept in place for 5 months and removed without any further problems, and the tracheostoma was closed successfully. We speculated that the subgottal stenosis developed due to intubation injury associated with his poor general condition, resulting in local ischemia. The insertion of a T-tube should have been performed in the first stage of removal of granulation mass in this case.