Factors Associated with Fracture and Migration of Tracheostomy Tube into Trachea in Children: A Case Series

Introduction Tracheostomy is done to bypass the obstructed upper airway. Rare complication of this procedure is the fracture of the tube. Early identification and management of this condition is a great challenge to an otolaryngologist. To study the factors associated with the fracture and migration of tracheostomy tube into tracheobronchial tree in paediatric age group. Materials and Methods: This study is a case series study conducted on children with a diagnosis of fractured tracheostomy tube presenting as a foreign body airway over five years duration. Data regarding the possible patient and tube factors responsible for the condition were collected and analysed. Results: Total 11 patients (males-5 and females-6, average age-10.18 years, range 1-15 years) wearing tracheostomy tube for an average period of 2 years (range 3 months-8 years) were included in the study. Aspirated tubes were Jackson’s metallic inner tube, Romson polyvinyl chloride plastic tube and Fuller’s outer tube flange in 5 (45.5%), 4 (36.4%) and 2 (18.1%) patients respectively. The most common fracture site was at the junction between tube and neck plate (90.9%). The most common causes for fracture tube were prolonged use in 10 cases (90.9%), stomal narrowing in 9 cases (81.8%), and infection with peri-stomal granulation tissue in 9 cases (81.8%). Conclusion: A fractured tracheostomy tube is a rare but preventable late complication of tracheostomy. Appropriate training about proper tracheostomy care, timely check-up of tracheostomy tube for signs of wear and tear, scheduled replacement, regular follow up and awareness may prevention this complication.