title: Upper airway obstruction by a fragmented tracheostomy tube: Case report and review of the literature.
abstract: BACKGROUND
  Many objects were described in the literature as causes of upper airway obstruction including seeds, nuts and household particles but fragmented tracheostomy tube is a rarely reported cause of airway obstruction. We report a case of foreign body aspiration in the tracheobronchial tree due to a fragmented and migrated tracheostomy tube.
  
  
  METHODS
  We report a 4.5 year old female patient who had upper airway obstruction due to a fragmented and migrated tracheostomy tube. She was diagnosed by chest X-ray and the tube was removed by rigid bronchoscopy.
  
  
  CONCLUSIONS
  Several factors contribute to fragmentation of the tracheostomy tube including repeated removal and reinsertion, cleaning, boiling or chemicals. Early breakage is most often due to manufacturing defects. The occurrence of a fractured tracheostomy tube in children is rare. Nevertheless, tracheobronchial foreign bodies in children can be life threatening and pose a dire emergency.
  
  
  CONCLUSIONS
  Based on our experience, the doctors and other staff should check for any manufacturing defects before the first use of a tracheostomy tube, which should reduce the occurrence of this rare, but life threatening.
authors.affiliation: Department of General Surgery, Division of Pediatric Surgery, University of Jordan, Faculty of Medicine, Amman, Jordan. Electronic address: hashemmomani@yahoo.com.
authors.forename: Hashem M
authors.initials: HM
authors.lastname: Al-Momani
authors.affiliation: Department of Anaesthesiology, University of Jordan, Faculty of Medicine, Amman, Jordan.
authors.forename: Khaled R
authors.initials: KR
authors.lastname: Alzaben
authors.affiliation: Department of General Surgery, Division of Endocrine Surgery, University of Jordan, Faculty of Medicine, Amman, Jordan.
authors.forename: Ayman
authors.initials: A
authors.lastname: Mismar
keywords: Airway obstruction; Fragmented tracheostomy tube