A Case of Urgent Laryngectomy for Tracheoinnominate Fistula

Tracheotomy is a commonly performed otolaryngologic procedure utilized to provide a secure airway. Tracheoinnominate fistula (TIF) is a feared complication of tracheotomy. Thorough preoperative physical examination and review of anatomic neck imaging include the assessment of the great vessels' relationship to the trachea. Intraoperative assessment is also critical. We outline a complex case of TIF development after performing tracheotomy for a locoregionally advanced-stage supraglottic malignancy. The patient presented with acute airway obstruction necessitating urgent tracheostomy, and her anatomy was later recognized as consistent with a bovine aortic arch anomaly. She ultimately underwent urgent total laryngectomy. A literature review highlights the anatomical variations of aortic great vessels and various challenges that aberrant vascular anatomy poses to tracheostomy. We also describe the intraoperative findings, inpatient clinical course, multidisciplinary emergency management, and different preventive and repair options. The goal of this case report is to highlight the critical need for surgeons to carefully evaluate for vascular anomalies involving the great vessels and to provide potentially effective methods to prevent devastating complications.