PMC5660825_01
Bronchoscopy showed a stenosed airway. This view was obtained by insertion of the bronchoscope through the nasal cavity.
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We performed a bronchoscopic examination through the nasal cavity in the operating room under general anesthesia with the tracheal tube in place because of the risk of suffocation (Figure 1).
Image of the patient's airway. His larynx was extremely stenotic due to lysosomal storage disease. His trachea was stenosed by granulation tissue secondary to a previous tracheostomy and tracheomalacia. Therefore, peripheral observation was poor.
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An image of the patient's airway is shown in Figure 2.
Intraoperative view of the mediastinal tracheostoma. (a) View of the tracheal lumen after tracheal resection. (b) An electric scalpel was not used to create the tracheostoma. (c) View from the back of the U-shaped flap after creation of the tracheostoma. (d) After skin closure following construction of the mediastinal tracheostoma.
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After we confirmed that no granuloma was present in the tracheal lumen on the peripheral side (Figure 3(a)), we intubated the trachea on the surgical field side. To maintain blood flow, the skin incision for the mediastinal tracheal hole was cut using a sharp scalpel and Metzenbaum scissors, without an electrotome (Figures 3(b) and 3(c)). Mediastinal tracheostomy was performed with an inlay thymus graft between the innominate vein and trachea (Figure 3(d)).
Bronchoscopy findings 6 months after the operation.
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Although he was referred to another institution for respiratory failure associated with his primary disease 6 months postoperatively, his airway management was successful for 1.5 years postoperatively (Figure 4).