To the Editor: Tracheostomy is a well-established procedure in patients with respiratory insufficiency who need mechanical ventilation. When patients recover sufficiently from respiratory failure, and mechanical ventilation is no longer required, predicting which patients will tolerate abrupt airway decannulation is difficult (1). In such patients, we use a tracheal button to keep the stoma open for immediate access. A 63-year-old man underwent open prostatectomy under epidural anesthesia. After two episodes of severe respiratory insufficiency in the 2 wk after surgery, a percutaneous tracheostomy was performed. Eleven days after the tracheostomy, the patient was weaned from mechanical ventilation, tracheally extubated, and a 10 mm diameter, 40 mm length tracheal button was inserted to maintain a patent tracheostomy lumen. He could breathe easily and cough adequately. Two days later he was discharged from the hospital. Seventy-five days after the button insertion, the patient returned for a prostate follow-up examination. He was breathing well, speaking well, and we elected to remove the tracheal button. To our dismay, it was stuck. Flexible bronchoscopy under topical anesthesia revealed a 3 × 6 mm white hemorrhagic tumor arising from the right anterior part of the trachea (Fig. 1a).Figure 1.: Fiberoptic bronchoscopic view of the tracheal lumen before (a) and after (b) laser therapy.The tumor was irradiated with a high-power laser (Argon 1000 COAG, Hamburg, Germany). Specimens were obtained with forceps and sent for histology. The tumor was destroyed, and all its remnants were removed (Fig 1b). The button was then easily removed. The tumor histology showed respiratory mucosa. The patient was subsequently seen monthly, and presented with granulomata arising at the same site in the trachea 3, 4, and 8 mo after tumor destruction, which were again removed using a laser (Figs. 2a and b).Figure 2.: A granuloma of the trachea found 3 mo after the initial therapy with a laser (a) and removed with the same technique (b).It is difficult to teach patients and their care-givers proper tracheal button care. Buttons should, therefore, be removed as soon as possible. This report does not preclude using a tracheal button to keep the tracheostomy stoma patent during weaning from tracheostomy. It is a useful and safe technique. However, one must remove buttons once they are no longer useful to minimize foreign body reactions in the airway. Nicolaos G. Balamoutsos, MD Suzana L. Anissoglou, MD Symela P. Antoniadou, MD Georgios S. Sarikos, MD Intensive Care Unit and Pain Clinic Department of Pneumonology Theagenion Anticancer Hospital Thessaloniki, Greece [email protected]