A Clinical Experience of Laryngotracheal Separation After High-Incision Tracheotomy in a Neurologically Disabled Patient

Abstract

We encountered a 13-year-old boy with metachromatic leukodystrophy. He repeatedly suffered from aspiration-related pneumonia; therefore, high-incision tracheotomy was performed at the first and second tracheal cartilage levels at 11 years of age. However, he continued to suffer from aspiration-related pneumonia afterwards. He was found to be at impending risk of a tracheo-innominate artery fistula on computed tomography and bronchoscopy. He was scheduled to undergo laryngotracheal separation by Fukumoto’s procedure to improve the aspiration and prevent the tracheo-innominate artery fistula at 12 years of age. Fukumoto’s procedure can provide a wide tracheostomy orifice without changing the tracheal position. However, because the surgery was performed after high-incision tracheotomy, the cranial-side trachea had a membranous closure at the level of the thyroid cartilage. The postoperative progress has been good, and thus far, he has not aspirated, so we were able to remove his cannula temporarily. Even after the high-incision tracheotomy, Fukumoto’s procedure was useful for reducing the risk of a trachea-innominate artery fistula. We believe that this method may be necessary for addressing the closure of the cranial-side trachea in such patients.