Global Advanced Research Journal of Medicine and Medical Sciences (ISSN: 2315-5159)
October 2016, Vol. 5(10) pp. 256-263
Copyright © 2016 Global Advanced Research Journals

Case Report 

Mediastinal Tracheostomy: Indications, Outcomes and Case Discussion

Paulo José de Cavalcanti Siebra³, Terence Pires de Farias¹*, Fernando Luiz Dias², Juliana Fernandes de Oliveira³, Juliana Maria de Almeida Vital³, Arli Regina Lopes Moraes³ and José Gabriel Miranda da Paixão³

¹Researcher of the Brazilian National Cancer Institute – INCA, Rio de Janeiro/RJ. PhD in Oncology at the Brazilian National Cancer Institute – INCA Rio de Janeiro/RJ. Assistant Professor of Postgraduate Course in Head and Neck Surgery of the Pontifical Catholic University of Rio de Janeiro - PUC / RJ.
²Department of Head and Neck Surgery, Brazilian Cancer Institute, Rio de Janeiro, RJ, Brazil. Titular Professor of Postgraduate Course in Head and Neck Surgery of the Pontifical Catholic University of Rio de Janeiro - PUC / RJ. Titular of Brazilian Surgeons College.
³Medical residence in Head and Neck Surgery at the National Cancer Institute - INCA, Rio de Janeiro-RJ.

*Corresponding Author E-mail: terencefarias@yahoo.com.br; Phone: 05521988967868; Fax: 0552125792090,

Accepted 27 October, 2016

Abstract

A mediastinal tracheostomy is a highly complex procedure. Despite presenting great morbidity and mortality, it is not proscribed and could be indicated for selected cases. Maneuvers such as transposition of the trachea under the innominate artery and pectoralis major flap rotation have been developed to reduce the risk of complications. In some cases, it is necessary to reconstruct the alimentary tract with several options depending on the extent and the co-morbidities of the patient. Relevant articles were identified from a literature search using the Pubmed database and Google Academic site using the keywords: Mediastinal tracheostomy, cervical exenteration and pharyngeal reconstruction. There were no restriction on publication data. A 52-year-old male patient with squamous cell carcinoma of the hypopharynx submitted to total laryngopharyngoesophagectomy with colon transposition. A colon-pharyngeal fistula and dehiscence of the tracheostoma with tracheal retraction into the mediastinum were presented as complications. In reoperation, a mediastinal tracheostomy was confectioned for better access to the airway and to perform a fistula repair. Patient had no new complications and is in outpatient control with no recurrence of cancer and only one episode of pneumonia after hospital discharge. The principal articles with the largest series found about mediastinal tracheostomy are presented with discussion about the indications, complications, digestive reconstruction and results. We present a case in which the mediastinal tracheostomy presented an unusual indication and was conducted in a successful manner. Thus, according to the discussion, it is a feasible procedure in well-selected cases.

Keywords: Mediastinal tracheostomy, Colon transposition, Tracheostomy