Management of suprastomal tracheal obstruction following : a case report

To demonstrate the importance of proper pre operative assessment of laryngotracheal stenosis especially if it acquired one. It also demonstrates the fact that the available treatment modalities for laryngotracheal obstruction can be easily modified as per the clinical presentation for better post operative results. Here we present a case of tracheal stenosis following percutaneous tracheostomy where there was suprastomal tracheal obstruction which was managed in an interesting way to give good post operative results. The obstruction was due to impaction of the first tracheal ring in the stoma which was fused to the posterior tracheal wall. The obstructing tissue was excised and tracheal lumen was established. New tracheostomy was made lower down and the previous stoma was closed. By proper pre operative evaluation and assessment of the unique pathomechanism of stenosis in this case we could operate the above case by simply excicing the obstructing tissue and establishing a lumen instead of resorting to other demanding operations for stenosis of larynx that often lead to complications.