2019 Volume 31 Issue 02 Pages 176-181
Percutaneous dilatational tracheostomy (PDT) is considered a relatively safe and simple procedure and is widely performed worldwide. However, PDT carries a risk of mispuncture in cases with anatomic mutations and postoperative complications, such as structural disruption and tracheal stenosis. A 78-year-old male was admitted to the previous hospital due to exacerbating heart failure. For intensive respiratory care, endotracheal intubation and subsequent PDT were performed. Thereafter, tracheal stenosis occurred. He was admitted to our department for a further evaluation and treatment. On an examination, the trachea was completely obstructed below the first tracheal ring. Computed tomography showed complete obstruction of the trachea with destruction of the tracheal anterior wall. Furthermore, remarkable thoracic spine deformity and tracheal deviation were noted. To remove the obstruction and better manage the airway, an operation was performed via the transoral and transcervical approaches, and a polyglycolic acid sheet and gauze with tetracycline hydrochloride ointment were placed to maintain the intratracheal lumen and prevent tracheal re-stenosis. The anatomical structures of chest and neck should be carefully evaluated before the type of tracheostomy is decided, and PDT should be avoided when there is an evident cervical or thoracic anatomical abnormality.
