title: Fractured and migrated tracheostomy tube in the tracheobronchial tree.
abstract: OBJECTIVE
  To study the clinical presentation and management of fractured tracheostomy tube (FTT) presenting as tracheobronchial foreign body (FB) in children.
  
  
  METHODS
  A retrospective chart review of children with a diagnosis of FTT, FB in tracheobronchial tree was carried out. Data regarding the patients' demographic details, diagnosis, clinical presentation and management were noted and analyzed.
  
  
  RESULTS
  Total 8 cases (males 3 and females 5, average age 8.8 years, range 1-15 years) wearing tracheostomy tube for an average period of 2 years (range 3 months-4 years) were found. Indications for tracheostomy were bilateral abductor palsy, subglottic stenosis and congenital subglottic hemangioma in 4 (50%), 3 (37.5%) and 1 (12.5%) cases, respectively. Classical triad of FB aspiration (coughing/choking, wheezing and reduced breath sounds) was present in 6 (75%) patients. Aspirated FTTs were Jackson's metallic inner tube, Romson's polyvinyl chloride plastic tube and Fuller's outer tube flange in 4 (50%), 3 (37.5%) and 1 (12.5%) respectively. The most common fracture site was at the junction between tube and neck plates {in 7 (87.5%) children}. Sites of lodgment of FTT were right bronchus, trachea and both trachea and left bronchus in 5 (62.5%), 2 (25%) and 1 (12.5%) cases, respectively. FTTs were retrieved by transtracheostomal rigid bronchoscopy and exploring the tracheostomal wound in 7 cases and 1 case, respectively.
  
  
  CONCLUSIONS
  Though FTT presenting as pediatric tracheobronchial FB is rare, it should be considered in differential diagnosis in a tracheostomised child with respiratory distress. When diagnosed, FTT removal is best done using a rigid bronchoscope through the tracheal stoma.
authors.affiliation: Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry, India. Electronic address: drpradipta04@gmail.com.
authors.forename: Pradipta Kumar
authors.initials: PK
authors.lastname: Parida
authors.affiliation: Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry, India.
authors.forename: Raja
authors.initials: R
authors.lastname: Kalaiarasi
authors.affiliation: Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry, India.
authors.forename: Surianarayanan
authors.initials: S
authors.lastname: Gopalakrishnan
authors.affiliation: Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry, India.
authors.forename: Sunil Kumar
authors.initials: SK
authors.lastname: Saxena
mesh_terms: D000293:Adolescent; D001980:Bronchi; D001999:Bronchoscopy; D002648:Child; D002675:Child, Preschool; D020878:Device Removal; D004868:Equipment Failure; D005260:Female; D005548:Foreign-Body Migration / Q000175:diagnosis* / Q000601:surgery; D006801:Humans; D007223:Infant; D008297:Male; D012189:Retrospective Studies; D014132:Trachea; D014135:Tracheal Stenosis / Q000628:therapy; D014139:Tracheostomy / Q000295:instrumentation*
keywords: Foreign body; Rigid bronchoscopy; Tracheobronchial tree; Tracheostomy tube