Abstract
We report a 24-year-old man who had tracheostomy with mental retardation. He had a brain contusion caused by a traffic accident in November 1994. After surgery for brain contusion, he needed respiratory care with mechanical ventilation for two months via tracheostomy. After 12 months of hospitalization, simple closure of the tracheostomy was performed and he was discharged. However, since he soon complained of dyspnea again, tracheostomy was performed again. Afterward, closure of the tracheostoma was attempted several times during several years, all surgical procedures were unsuccessful because dyspnea reoccurred after surgery. Anotherattempt using a rotation skin also failed. He was referred to our hospital in August 1999. His condition was stable, but neurological examination revealed paraplegia(Th1 and below). CT, 3D-CT and fiberoptic bronchoscopy showed a defect of tracheal cartilage at the site of tracheostomy and fibrotic stricture of the membranous portion. The 3D-reconstructed images revealed that the airway stenosis was due to elevation of the membranous portion. Therefore we thought that both resection of the stenotic portion and end-to-end tracheal anastomosis were necessary. Because of mental retardation and a past history of convulsion attacks, difficulties were foreseen in the postoperative course. To overcome poor conditions, we constructed a gastrostomy before operation. We also planned continuous sedation and mechanical ventilation after surgery to keep his wound stabilized. Tracheoplasty was performed on November 15, 1999. Through a collar incision, a 3.5 cm-segment of trachea, including the stoma and the stenotic portion was resected. After mobilization of the thoracic trachea, end-to-end anastomosis with 4-0 PDS II knotted suture was done. Laryngeal release was not performed. He was maintained on mechanical ventilation(CPAP, PEEP 5 cm H_2O)for one week and chin flexion was maintained. His postoperative course was uneventful and he was discharged on January 16, 2000.
