Right Clavicle Resection and Stent Placement for Stenosis of Trachea due to Tracheomalacia

Abstract

Case. A 28-year-old woman with cerebral palsy was admitted with failure of ventilation due to obstruction of sputum. As hypoxemia, hypercapnia and apnea prevented her from leaving the respirator, tracheostomy was performed. She was discharged once, but returned to our hospital on suspicion of tracheal stenosis. Bronchoscopy revealed growth of granulation tissue on the tip of the cannula and collapse of bronchial lumen in the expiratory phase. CT scan revealed the trachea was shifted to the right because of scoliosis and oppression by the brachiocephalic trunk, right clavicle and a vertebral body on the tip of the cannula. To keep patent the trachea, the spiral cannula whose depth could be adjusted was inserted to just above the carina by bronchoscopy. Though bronchoscopic ablation was repeated to excise granulation, she suffered from recurrent suffocation by airway obstraction. Surgical intervention of partial resection of the right clavicle and covering the trachea by anterior cervival muscle away from the brachiocephalic trunk was performed to prevent tracheal compression and tracheoarterial fistula. Clinical features improved after surgery, but collapse of the tracheal lumen in the expiratory phase still remained. To manage the situation an I-shaped Dumon stent was inserted, and the clinical course has been satisfactory after this procedure. The spiral cannula was changed to a T-tube, and she could leave the respirator at last.