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Ventilation failure with elective tracheostomy during oral cancer surgery: a case of tracheal diverticulum
  1. Sandipta Mitra,
  2. Anup Singh,
  3. Saurabh Vig and
  4. Sanjay Kumar Meena
  1. Otorhinolaryngology and Head Neck Surgery, All India Institute of Medical Sciences, New Delhi, Delhi, India
  1. Correspondence to Dr Anup Singh; anoop.aiims1{at}


Tracheal diverticulum is usually detected incidentally. Rarely, it may lead to difficulty in securing the airway intraoperatively. Our patient underwent oncological resection under general anaesthesia for advanced oral cancer. Elective tracheostomy was performed at the end of the surgery, and a cuffed tracheostomy tube (T-tube) of 7.5 mm size was inserted through the tracheostoma. Despite repeated attempts at T-tube insertion, ventilation could not be established. However, on advancing the endotracheal tube beyond tracheostoma, ventilation was restored. The T-tube was inserted into the trachea under fibreoptic guidance achieving successful ventilation. A fibreoptic bronchoscopy through the tracheostoma performed after decannulation revealed a mucosalised diverticulum extending behind the posterior wall of the trachea. The bottom of the diverticulum showed mucosa-lined cartilaginous ridge with differentiation into smaller bronchiole-like structures. Tracheal diverticulum should be considered as a possible differential in case of failed ventilation following an otherwise uneventful tracheostomy.

  • Cancer intervention
  • Ear, nose and throat/otolaryngology
  • Head and neck cancer
  • Head and neck surgery

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  • Contributors Planning—SM, AS, SV and SKM. Conduct—SM and AS. Reporting—SM, AS, SV and SKM. Conception and design—SM, AS, SV and SKM. Acquisition of data—SM, AS, SV and SKM. Analysis and interpretation of data—SM, AS, SV and SKM.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Case reports provide a valuable learning resource for the scientific community and can indicate areas of interest for future research. They should not be used in isolation to guide treatment choices or public health policy.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.