Post intubation tracheal stenosis is a severe clinical condition with an increasing prevalence due to the advances of critical care medicine. This is a retrospective study including 12 cases of post-intubation tracheal stenosis managed by TRA in our head and neck surgery department between the years 2013 and 2019. All patients underwent preoperative clinical evaluation based on neck CT scan and endoscopy under general anaesthesia. Traffic road accidents and trauma were the main causes of prolonged intubation. Ten (10) patients required tracheostomy. According to the Cotton Meyer grading, 4 patients had grade II, 2 had grade III and 4 had grade IV. The mean length of stenosis was 16.2±5.6 millimeters. T-tube was inserted intraoperatively in 5 patients. 4 were successfully decannulated in a mean delay of 9.2 months. Early postoperative complications were subcutaneous emphysema, laryngeal edema, aspiration pneumonia, intra-tracheal migration of the T-tube, and vocal cord paralysis each complication occurred in 1 case. Late postoperative complications were granulation tissue formation observed in 5 cases and restenosis in 3 cases. The initial success rate of the TRA was 91.7%. Management of Post intubation tracheal stenosis requires a skillful multidisciplinary team. TRA guided by a meticulous preoperative evaluation is the gold standard. Keywords: tracheal resection, anastomosis, tracheal resection with end-to-end anastomosis, cervical computed tomography
Objectives: port catheter fracture and migration could be an iatrogenic life-threatening complication. We aimed to sensitize head and neck surgeons to this complication. Observation: a 61-years old man was referred to our surgery department for management of T3N0M0 laryngeal cancer after failure of preservative treatment. The patient had received 2 cycles of chemotherapy and was judged a bad responder. A total laryngectomy with bilateral neck dissection was indicated. The port catheter was kept in place for possible further chemotherapy treatment. During neck dissection the catheter fractured and migrated. Post operative CT scan showed the distal part of the catheter bulging in the right cardiac chambers. The patient was transferred to an interventional cardiology unit where the foreign body was successfully retrieved using femoral venous access. Conclusion: port catheters are a real potential danger because of the risk of fracture and migration of the distal part. Removal of these devices should be performed in collaboration with medical care oncologists before every neck intervention.
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