Tracheal suspension with autogenous rib cartilage in a patient with severe tracheomalacia
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(2019) 14:21
CASE REPORT
Open Access
Tracheal suspension with autogenous rib cartilage in a patient with severe tracheomalacia Shuonan Xu1,2,3†, Jianfei Zhu1,2†, Guolong Zhao1,2,4* and Shudong Li1,2*
Abstract Background: Tracheomalacia (TM), caused by anterior mediastinal tumorectomy, most likely to deteriorate condition of patient life. Case presentation: A 63-year-old patient felt serious dyspnea diagnosis as TM caused by the recurrent cervical schwannoma. The narrowest diameter of the TM was only 0.446 cm and the length of malacic segment was 7.47 cm. Here we designed a novel tracheal suspension technique by using autogenous rib cartilage graft to treat severe TM. The obvious effect was observed that the inner diameter increased from 0.446 cm to 1.390 cm,and the airway symptom was alleviated. Conclusion: The autogenous rib cartilage graft used for suspending the malacic trachea was safe and effective. Keywords: Tracheomalacia, Tracheal suspension, Rib cartilage
Background Tracheomalacia (TM) is characterized by pathologically collapsed segment of cartilaginous rings and membranous wall of trachea-bronchi, which results in life-threatening symptoms [1]. TM is mainly associated with congenital malformation, surgery-based trauma and tumor compression [2]. The common surgical approach for treating TM was aortopexy over the past decades. Recently many scholars sought to stablize malacial trachea by using endotracheal stent placement and paratracheal biomaterial scaffold [3, 4], but there is no consensus with regard to radiographic assessment and standard therapeutic method for TM [2]. Here we introduced a novel tracheal suspension technique to treat a patient with TM. Case presentation A 63-year-old male patient with large anterior mediastinal mass was referred to our hospital for treatment. The patient was pathologically diagnosed as cervical * Correspondence: [email protected]; [email protected] † Shuonan Xu and Jianfei Zhu contributed equally to this work. 1 Department of Thoracic Surgery, Shaanxi Provincial People’s Hospital, Xi’an 710068, China Full list of author information is available at the end of the article
schwannoma and underwent surgical resection twelve years ago. He had re-operation because of the recurrent neck tumor four years ago. No specific neural, cardiovascular and respiratory disfunction and neoplasms his history contained as well as his family history. The patient suffered from chest oppression and shortness of breath for four months, and these symptoms gradually became worse. The Preoperative CT confirmed that the patient was diagnosed as TM and large anterior mediastinal mass (Fig. 1) Due to occasion of severe airway overreaction during the process of his endoscopy, fiber bronchoscopy was not finished. Consideration of potential risk from serious TM, the patient was intubated with guidance of fibreoptic bronchoscopy in the supine position, then underwent median sternotomy and tumor resection followed by tracheal suspension. The prime procedures of this surgery were briefly dep
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