External Fixation of Subglottic Tracheal Stents: Case Reports

External Fixation of Subglottic Tracheal Stents: Case ReportsA 68-year-old woman with a history of chronic obstructive pulmonary disease and left upper lobe resection for tuberculosis was referred for increasing dyspnea. Medical history included endotracheal intubation, mechanical ventilation, and permanent tracheotomy after abdominal surgery. The FFB revealed abundant granulation tissue along the anterior tracheal wall in the immediate subglottic region, prompting RB and laser resection. Severe malacia was apparent at the site of the tracheotomy. Recurrent dyspnea prompted repeat rigid bronchoscopic examination; tracheomalacia was noted and granulation tissue was again removed from the subglottic region. A 12 mm/40 mm straight silicone stent was inserted, but was loose fitting. A 14 mm/50 mm stent was inserted, but would not expand entirely despite preliminary tracheal dilatation to 12 mm. The 12/40 stent was, therefore, reinserted and sutured into place. Canadian neighbor pharmacy More info Six months later, the tracheotomy stoma had fully healed and there was no evidence of inflammation around the button. The stent was removed by rigid bronchoscopy and the trachea appeared normal. Shortly thereafter, however, dyspnea recurred, and another stent was inserted and sutured into place. The patient did well for 11 months when rigid bronchoscopy was again required to remove granulation tissue that had grown along the anterior tracheal wall proximal to the stent. The patient is asymptomatic more than 2 years since initial stent placement.
A 47-year-old man with steroid-dependent asthma and a history of tracheotomy, prolonged mechanical ventilation, and placement of a 12 mm/16 mm Montgomery T-tube was referred because of recurrent stomal infections. The T-tube was placed 3 years previously to support a long segment of malacic trachea. Malacia began in the subglottis and extended to within 2 cm of the main carina. Persistent leakage around the external sidearm of the T-tube caused multiple infections. With the patient under general anesthesia, the T-tube was removed via the tracheotomy site, and a 16 mm/100 mm silicone stent was inserted endoscopically. Because of malacia and a very large tracheal lumen, the stent was sutured into place and fixed, this time, to a subcutaneous button. Two days later, however, cough and dyspnea prompted FOB, which revealed granulation tissue and a large blood clot partially occluding the stent. Removal resulted in moderate improvement. The patient had difficulty clearing secretions despite inhaled bronchodilators and saline aerosol treatments.

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