Difficult Tracheostomy in Calcified Tracheal Rings - Surgical Case Series

Abstract

Background: Surgical airway management in an acute setting of road traffic accident can be difficult, even in the context of an anatomically normal airway. Tracheostomy, as a surgery is dependent on the exposure and removal of upper tracheal rings. When these rings are found calcified, it leads to further difficulties or complications in management, at times even resulting in surgical emphysema. Methods: A series of 6 adults, all males, aged between 32-45 years, presented to us individually between Nov 2021 to Nov 2022, with history of road traffic accidents causing poly trauma and requiring immediate airway stabilization. Results: None of them had prior history of neck trauma or endotracheal intubation or chronic cough. Chest x ray was normal in all of these individuals. Elective tracheostomy under general anesthesia was performed on day 5 of endotracheal intubation. During the procedure of conventional tracheostomy, after retracting the thyroid isthmus upwards, and prior to making a tracheal window, tracheal rings 3 and 4 were found to be calcified, which prolonged the time taken to remove a piece of cartilage. Conclusion: A junior surgeon needs to be well versed with the surgical anatomy of the region, the surgical procedure and management of possible complications with confidence and ease. A lack of knowledge amongst junior medical staff coupled with unskilled assistance when managing such cases lead to increased operative times and hence complications. Keywords: Tracheostomy, Calcified tracheal rings, adult, surgical