title: Iatrogenic tracheal flap mimicking tracheal stenosis with resultant stridor.
abstract: OBJECTIVE
  To illustrate a case of an iatrogenic mucosal tear in the trachea which caused a one-way valve effect, obstructing the airway and manifesting as post-extubation stridor.
  
  
  METHODS
  We report a case of iatrogenic tracheal mucosal tear secondary to violent movement during intubation. The patient presented with post-extubation stridor that worsened over three days. Initial evidence suggested tracheal stenosis. Computed tomography scans revealed a mucosal tear at the level of the seventh cervical to second thoracic vertebrae. The tear was caused by forceful inflow of air as breathing became more and more difficult, resulting in a false tract. A tracheostomy changed the direction of airflow, bypassing the tear. The inflated tracheostomy tube cuff acted as a stent to keep the flap in place as healing occurred.
  
  
  CONCLUSIONS
  Iatrogenic laryngotracheal injuries are common, especially when endotracheal intubation is performed under unfavourable emergency conditions. A tracheal mucosal tear is a rare entity which is almost always undiagnosed. However, a tracheal mucosal flap may be suspected when changes in patient position alter the nature and severity of the resultant stridor and/or respiratory distress. In such cases, an inflated tracheostomy tube cuff should be kept in place for an adequate period, to act as a stent and help keep the flap in place while healing occurs.
authors.affiliation: Department of Otorhinolaryngology, Universiti Malaya Medical Centre, Kuala Lumpur, Malaysia. kenglu@yahoo.com
authors.forename: K L
authors.initials: KL
authors.lastname: Tan
authors.forename: A W
authors.initials: AW
authors.lastname: Chong
authors.forename: M A
authors.initials: MA
authors.lastname: Amin
authors.forename: R
authors.initials: R
authors.lastname: Raman
mesh_terms: D000293:Adolescent; D000402:Airway Obstruction / Q000175:diagnosis* / Q000209:etiology / Q000601:surgery; D003937:Diagnosis, Differential; D005260:Female; D006801:Humans; D007049:Iatrogenic Disease; D007442:Intubation, Intratracheal / Q000009:adverse effects*; D020545:Respiratory Mucosa / Q000293:injuries; D012135:Respiratory Sounds / Q000175:diagnosis / Q000209:etiology*; D013226:Status Epilepticus / Q000150:complications / Q000628:therapy; D014132:Trachea / Q000293:injuries*; D014135:Tracheal Stenosis / Q000175:diagnosis*; D014139:Tracheostomy / Q000295:instrumentation