Anwarul Haq, Syed Muhammad, Asad Shabbir Bukhari, Aasim Umar.
A unique management of tracheal stenosis.
J Ayub Med Coll Abottabad Jan ;18(2):93-4.

A 17 years old boy met an accident while driving the hike. He was brought from the accident site within half an hour having multiple injuries head, neck and difficulty in breathing. He was immediately shifted to Main Operation Theatre, Combined Military Hospital Kharian. Initial assessment revealed a young boy, stuprous, having abrasions scalp, fore-head and limbs. There was massive swelling over the neck, subcutaneous emphysema and mucosal tear oral cavity. He was resuscitatd and endotracheal intubation was done. In spite of endotracheal intubation patient was having low oxygen saturation with Glasgow coma scale 3/15. Urgent exploration of neck through horizontal incision was done. Exploration revealed complete transaction of tracheal rings 3t(1 and 4th along with shattered thyroid isthmus. Tracheostomy was done by passing tube, into distal segment of trachea. Post operatively patient improved and his Glasgow coma scale became 15/15. To prevent tracheal stenosis in future, tracheoplasty with tracheal ste nt was planned 07 days after initial injury. A 3cm straight piece of Montgomery T- Tube was used as a silicon tracheal stent. After horizontal incision at tracheostomy site, the transected tracheal ends were located. A new tracheostomy at lower neck was performed. The damaged part of tracheal ends was resected and both ends of trachea were sutured in layers. A silicon stent was placed at the anastomotic site and was sutured with skin by using non- absorbable sutures. Tracheostome was closed on 5th post operative day. Patient showed smooth recovery and satisfactory wound healing on periodic 1 monthly examinations. He was advised regular follow-ups and will be assessed endoscopically for removal of stent, 06 months after the tacheoplasty.

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