Three Cases of Tracheostomal Hypergranulation Causing Difficulty in Tracheostomy Tube Changing

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  • Ito Keiko
    Department of Otorhinolaryngology, Nishinihon Hospital
  • Yumoto Eiji
    Department of Otorhinolaryngology, School of Medicine, Kumamoto University
  • Samejima Yasuhiro
    Department of Otorhinolaryngology, School of Medicine, Kumamoto University

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Other Title
  • 気管孔に肉芽を形成し，カニューレ交換に支障をきたした3症例の検討
  • キカンコウ ニ ニクガ オ ケイセイ シ,カニューレ コウカン ニ シショウ オ キタシタ 3 ショウレイ ノ ケントウ

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We experienced three cases of tracheostomal granulation that induced difficulty in changing of the tracheostomy tube after percutaneous tracheal dilation or surgical tracheostomy at an acute care hospital. Case 1 was a male in his fifties. Percutaneous tracheal dilation was performed for traumatic subarachnoid hemorrhage. After transfer to our hospital, he experienced difficulty extracting his tracheostomy tube. Fiberscopic examination showed protrusion of granulation from the anterior wall of the trachea through the side hole of the tracheostomy tube. The granulation was surgically removed under local anesthesia. Later, after decannulation, the tracheostoma was closed. Case 2 was a male in his twenties. Tracheostomy was performed for traumatic cerebral contusion. After transfer to our hospital, he had difficulty extracting his tracheostomy tube. Under local anesthesia, the granulation was surgically removed and the tracheostoma was closed at the same time. Case 3 was a female in her eighties. Tracheostomy was performed for pneumonia. After transfer to our hospital, she demonstrated difficulty inserting her tracheostomy tube. Under general anesthesia, tracheal fenestration was performed and the tracheostoma was sutured to the margin of the skin incision. In all cases, sagittal CT images showed thickness of the anterior wall of the trachea just above the tracheostoma. CT was useful to evaluate hypergranulation of a tracheostoma and the position of a tracheostomy tube. Tracheal fenestration should be performed when long-term airway management with a tracheostoma is necessary.

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