Fractured and migrated tracheostomy tube in the tracheobronchial tree.

OBJECTIVE

To study the clinical presentation and management of fractured tracheostomy tube (FTT) presenting as tracheobronchial foreign body (FB) in children.

METHODS

A retrospective chart review of children with a diagnosis of FTT, FB in tracheobronchial tree was carried out. Data regarding the patients' demographic details, diagnosis, clinical presentation and management were noted and analyzed.

RESULTS

Total 8 cases (males 3 and females 5, average age 8.8 years, range 1-15 years) wearing tracheostomy tube for an average period of 2 years (range 3 months-4 years) were found. Indications for tracheostomy were bilateral abductor palsy, subglottic stenosis and congenital subglottic hemangioma in 4 (50%), 3 (37.5%) and 1 (12.5%) cases, respectively. Classical triad of FB aspiration (coughing/choking, wheezing and reduced breath sounds) was present in 6 (75%) patients. Aspirated FTTs were Jackson's metallic inner tube, Romson's polyvinyl chloride plastic tube and Fuller's outer tube flange in 4 (50%), 3 (37.5%) and 1 (12.5%) respectively. The most common fracture site was at the junction between tube and neck plates {in 7 (87.5%) children}. Sites of lodgment of FTT were right bronchus, trachea and both trachea and left bronchus in 5 (62.5%), 2 (25%) and 1 (12.5%) cases, respectively. FTTs were retrieved by transtracheostomal rigid bronchoscopy and exploring the tracheostomal wound in 7 cases and 1 case, respectively.

CONCLUSION

Though FTT presenting as pediatric tracheobronchial FB is rare, it should be considered in differential diagnosis in a tracheostomised child with respiratory distress. When diagnosed, FTT removal is best done using a rigid bronchoscope through the tracheal stoma.