External Fixation of Subglottic Tracheal Stents: Analysis

Purulent drainage was noted at the site of the subcutaneous button. Granulation tissue was again removed and significant tracheomalacia was discovered beyond the distal extremity of the stent. Cultures of bronchial secretions were positive for methicillin-resistant Staphylococcus aureus, but cultures of the cutaneous drainage revealed no organisms. Antibiotics were administered and the patient returned to his home in another state: coughing, but without other symptoms more canadian family pharmacy. One week later, the patient was unable to clear secretions effectively and had skin breakdown at the site of the subcutaneous button, which prompted hospitalization. The stent was removed, and an 18-mm diameter Montgomery T-tube was inserted. The patient has been well for 9 months, although still struggling with abundant tracheobronchial secretions.
A 53-year-old woman with a 6-year history of malignant melanoma was referred for increasing dyspnea secondary to a large mediastinal mass compressing the posterior cervical trachea. Open biopsy confirmed metastatic disease. The RB was performed to dilate the upper third of the trachea, to exclude intraluminal invasion, and to insert a 14 mm/50 mm straight silicone stent that was sutured into place 2 cm below the vocal cords. Symptoms improved substantially, although two tumor-debulk-ing procedures were required for pain relief. Surveillance bronchoscopies revealed few secretions and no formation of granulation tissue. The stent remained in place until the patient’s death 6 months later from cerebral metastases.
A 56-year-old man was referred for laser debulking of an oropharyngeal cancer with subglottic tracheal invasion requiring emergent tracheotomy. Seven months earlier, tracheotomy for acute airway obstruction had been necessary, but external beam radiation therapy effectively decreased tumor size and permitted decannulation. The RB revealed a large, exophytic mass in the subglottis. After laser resection, a 14 mm/50 mm straight silicone stent was inserted but migrated into the right main bronchus 3 days later. It was removed emergently. During the next 3 months, four rigid bronchoscopies were performed to remove large amounts of necrotic tumor from the anterior wall of the upper third of the trachea. One month after the last procedure, recurrent dyspnea required intubation. Bronchoscopy revealed recurrent tumor and substantial loss of the cartilaginous support of the anterior tracheal wall. A 14 mm/50 mm stent was inserted and sutured into place. Tumor debulking was necessary on two occasions before the patient’s death 3 months later.

This entry was posted in Subglottic Tracheal Stents and tagged bronchoscope, granulation tissue, rigid bronchoscopies, subglottic stenosis, tracheal stenosis.