About Author: Dr Nishikanta Tripathy, MBBS, MS (PGI, Chandigarh), DNB, FHNS Author is a head and neck surgeon, and co-founder of ANVI ENT & HEAD NECK HOSPITAL
Though surgery may appear to be a painful process to most common people, surgeon’s dedicated execution of the procedure brings back the smile to countless patients and their families. Below is a story of a young man who had not only lost his voice but also his hope to recover from a rare condition called tracheal stenosis (narrowing of windpipe). And as surgeons we feel content in bringing back those lost smiles and lost hopes.
Tracheal stenosis is a medical condition in which breathing pipe (trachea) gets narrowed which hampers breathing. There are different treatment modalities and primary aim of all modalities is to restore tracheal lumen so that patient can breathe.
We faced unique challenge in one of our patients where tracheal lumen was completely obliterated. This 23year young patient had road traffic accident and was in ventilator for some days in ICU. After some days of discharge from hospital he developed breathing difficulty. As his breathing problem worsened, he had to undergo tracheostomy (a procedure where a breathing tube inserted to trachea to facilitate breathing, bypassing nose and voice box). With this tracheostomy he was unable to speak. For 1.5 year he was roaming different hospitals in search of getting rid of this tracheostomy, before he comes to us at ANVI ENT & HEAD NECK HOSPITAL.
We evaluated him with different diagnostic tests like bronchoscopy, CT scan of neck & chest and what we found was very unique. He had complete obliteration of trachea starting from just below voice box up to 2.5cm length and there was tracheostomy tube below it. As there was no other way to open the lumen of obliterated trachea our team decided to undertake a very major surgical intervention. The plan was to remove the portion of the blocked wind pipe and to rejoin the residual wind pipe. And the challenge was the length of trachea being removed to make a tension free wind pipe closure. This surgical intervention is very complex as there are critical nerves and food pipe around it and airway need to be manipulated. Our surgical, anaesthesia and supportive care team discussed about the plan of action before the day of surgery. We carried out the surgery as planned successfully. In post-operative period major challenge was to maintain the neck in partially forward bending position to avoid traction on wind pipe suture junction. Our supportive care team were very active in counselling the patient to get his co-operation and helping him as well. Patient was very happy as he got rid of bothering tracheostomy tube.
After 3 weeks of surgery when we he started speaking, it was the most emotional moment for him and his family, as this young man had not uttered a single word since last one and half year. This was also an emotional moment for our team as we were able to bring back the smile and the hope of a family.
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