A Case of Excessive Dynamic Airway Collapse Caused by Deep Neck Abscess and Tracheostomy

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  • Miyamoto Daisuke
    Department of Otorhinolaryngology, Municipal Tsuruga Hospital Department of Otorhinolaryngology, Head & Neck Surgery, Faculty of Medical Sciences, University of Fukui
  • Imoto Yoshimasa
    Department of Otorhinolaryngology, Head & Neck Surgery, Faculty of Medical Sciences, University of Fukui
  • Kanno Masafumi
    Department of Otorhinolaryngology, Head & Neck Surgery, Faculty of Medical Sciences, University of Fukui
  • Fujieda Shigeharu
    Department of Otorhinolaryngology, Head & Neck Surgery, Faculty of Medical Sciences, University of Fukui

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  • 深頸部膿瘍，気管切開術を契機にExcessive dynamic airway collapseを発症した1症例
  • シンケイブ ノウヨウ,キカン セッカイジュツ オ ケイキ ニ Excessive dynamic airway collapse オ ハッショウ シタ 1 ショウレイ

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Abstract

<p>Excessive dynamic airway collapse (EDAC) is a condition in which chronic inflammation or irritation of the trachea or main bronchi leads to increased vulnerability of the posterior membrane, causing tracheal stenosis by protrusion of the posterior membrane into the tracheal lumen during expiration. In this report, we describe a case of EDAC caused by deep neck abscess and tracheostomy. An emergency tracheostomy was performed for upper airway obstruction due to a right deep neck abscess. The patient was treated conservatively with systemic antibacterial therapy for deep neck abscess and initially showed a tendency toward improvement, but on the 4th day of treatment, a rapid deterioration of respiratory condition was observed. Fiberscopy and CT scan of the cervicothoracic region revealed protrusion of the posterior membrane of the trachea into the tracheal lumen during expiration, which led to the diagnosis of EDAC. The respiratory condition was stabilized by CPAP therapy with noninvasive positive pressure ventilation, and the patient was weaned from the ventilator on the 9th day of treatment, and the tracheal cannula was removed on the 14th day. In this case, chronic irritation of the trachea and bronchi due to long-term smoking was the underlying cause, and EDAC was most likely induced by acute inflammation due to a cervical abscess, tracheostomy, and tracheal cannula. We believe that the presence of EDAC should be kept in mind when treating dyspnea in adults.</p>

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