Abstract
We experienced a case with severe motor and intellectual disabilities (SMID) who improved by long-term response, while experiencing difficulty in management of intratracheal granulation and tracheomalacia. The patient is a 27 year old man with SMID due to near drowning when 15 year old, and became under tracheotomy management at an early stage. At the age of 20, intratracheal granulation was detected, the size, insert length, and type of cannula was changed, and the application and inhalation of dexamethasone, and suppression of muscle stress by internal remedy were carried out. 14 months later, coexisting tracheomalacia was confirmed, and cyanotic attacks gradually increased. From the age of 22, high positive end-expiratory pressure (high PEEP) management by continuous positive airway pressure (CPAP) was introduced. Furthermore, sedative strengthening by large amounts of phenobarbital (PB) was initiated and local injections of triamcinolone acetonide (TA) to the granulation were carried out, and cyanotic attacks then gradually decreased. At the age of 24, laryngotracheal separation surgery was performed. As a result, the cannula was no longer needed and lower respiratory tract infection significantly decreased. Currently, the patient is not experiencing cyanotic attacks and is able to go out with his family. Local injection of TA was considered effective for intratracheal granulation, and the laryngotracheal separation surgery could prevent aggravation of lower respiratory tract disease, and enough suppression by PB was deemed effective for the tracheomalacia.
