頸椎骨折と咽頭後間隙血腫に対し，輪状軟骨開窓術による気道確保が有用であった強直性脊椎炎例

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  • A Case of Ankylosing Spondylitis with Cervical Spine Fracture and a Retropharyngeal Hematoma Requiring Cricoid Fenestration
  • ケイツイ コッセツ ト イントウ ゴ カンゲキ ケッシュ ニ タイシ,リンジョウ ナンコツ カイソウジュツ ニ ヨル キドウ カクホ ガ ユウヨウ デ アッタ ゴウチョクセイ セキツイエンレイ

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<p>Retropharyngeal hematoma can induce dyspnea by causing upper airway obstruction. Therefore, early diagnosis and prompt securing of the airway, either by tracheal intubation or tracheostomy, are of importance. Tracheostomy is usually carried out between the 2nd and 4th tracheal ring. However, it is difficult to perform standard tracheostomy in patients with abnormalities of the cervical region, such as obesity, low-set larynx, neck stiffness, thyroid tumor, brachiocephalic meandering, or an unstable cervical spine. In 2007, Kano et al. reported “a newly developed surgical airway-opening technique (cricoid fenestration) using partial resection of the cricoid cartilage to form a stoma.”</p><p>The patient reported herein was a 70-year-old man with ankylosing spondylitis who presented with an unstable cervical spine fracture and a retropharyngeal hematoma. The patient sustained a fall after binge drinking and presented with breathlessness; he was diagnosed as having a cervical spine fracture and a retropharyngeal hematoma. An anesthesiologist performed tracheal intubation, however, laryngopharyngeal edema presented until 2 weeks later. Therefore, we performed cricoid fenestration as we could not perform a standard tracheostomy because of the difficulty in neck extension. The patient showed a good clinical course following this procedure.</p><p>Cricoid fenestration is a useful and safe technique for casess where standard tracheostomy is expected to be difficult. However, we have observed this patient for only less than one year after closure of the tracheal stoma, and must continue to observe the patient for any late complications.</p>

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