Fractured metallic tracheostomy tube in a child: a case report and review of the literature

Piromchai P,?Lertchanaruengrit P,?Vatanasapt P,?Ratanaanekchai T,?Thanaviratananich S.


INTRODUCTION:?Tracheostomy is a common airway procedure for life support. The fracture of the tracheostomy tube is a rare complication. We report a case of a 14-year-old boy whose fractured stainless steel tracheostomy tube dislodged into the tracheobronchial tree. We include a literature review and proposed recommendations for tracheostomy care.

CASE PRESENTATION:?A 14-year-old Thai boy who had a stainless steel tracheostomy tube presented with a complaint of intermittent cough for 2 months. During tracheostomy tube cleaning, his parents found that the inner tube was missing. A chest X-ray revealed a metallic density foreign body in his right main bronchus. He underwent bronchoscopic removal of the inner tracheostomy tube and was discharged without further complications.

CONCLUSION:?A fractured tracheostomy tube is a rare complication. Appropriate cleaning and scheduled replacement of the tracheostomy tube may prevent this complication


Is the routine pressure dressing after thyroidectomy necessary? A prospective randomized controlled study.

BMC Ear Nose Throat Disord. 2008 Mar 20;8:1.

Piromchai P,?Vatanasapt P,?Reechaipichitkul W,?Phuttharak W,?Thanaviratananich S.

BACKGROUND: An acute complication of thyroidectomy is fatal hematoma, which can produce an upper airway obstruction needing immediate intubation or tracheostomy. After neck surgery, we usually apply a pressure dressing with a non-woven, adhesive fabric to reduce bleeding and fluid collection at the operative bed. We conducted a prospective, randomized, controlled study to evaluate a pressure vs. a non-pressure dressing after thyroid surgery by monitoring blood and serum in the operative bed. METHODS: We studied 108 patients who underwent 116 thyroid surgeries at Srinagarind Hospital, Khon Kaen University, between December 2006 and September 2007. The patients were randomized to either the pressure dressing or non-pressure dressing group. Ultrasound of the neck was performed 24 +/- 3 hours after surgery. The volume of fluid collection in the operative bed was calculated. All patients were observed for any post-operative respiratory distress, wound complications, tingling sensation or tetany. RESULTS: The distributions of age, sex, surgical indications and approaches were similar between the two groups. There was no statistically significant difference in the volume of fluid collection in the operative bed (p = 0.150) and the collected drained content (p = 0.798). The average time a drain was retained was 3 days. One patient in the pressure dressing group suffered cutaneous bruising while one patient in the non-pressure dressing group developed immediate hemorrhage after the skin sutures. CONCLUSION: Pressure dressing after thyroidectomy does not have any significant impact on decreasing fluid collection at the operative bed. The use of pressure dressing after thyroidectomy may not therefore be justified. TRIAL REGISTRATION: NCT00400465, ISRCTN52660978


House-Brackmann grading system

The House-Brackmann grading system is used to grade facial nerve paralysis as follows:

  • Grade I – Normal
  • Grade II – Mild dysfunction, slight weakness on close inspection, normal symmetry at rest
  • Grade III – Moderate dysfunction, obvious but not disfiguring difference between sides, eye can be completely closed with effort
  • Grade IV – Moderately severe, normal tone at rest, obvious weakness or asymmetry with movement, incomplete closure of eye
  • Grade V – Severe dysfunction, only barely perceptible motion, asymmetry at rest
  • Grade VI – No movement