title: A Unique Surgical Technique for Tracheostomy in Heterotopic Ossification: A Case Report.
abstract: OBJECTIVE
  To describe a technique for tracheostomy in heterotopic ossification that has not yet been described in the literature.
  
  
  METHODS
  We report a case of difficult tracheostomy while using conventional techniques in a 68-year-old patient who underwent mitral valve replacement requiring warfarin therapy three months prior. Imaging revealed heterotopic ossification overlying the trachea. A literature review was performed to identify similar cases or techniques.
  
  
  RESULTS
  Extensive surgical planning was pursued after the initial attempted tracheostomy failed, and the airway was eventually accessed using a lighted intubation stylet for guidance and a drill. Heterotopic ossification has been described after orthopedic and abdominal surgeries. We identified one case report in the literature of tracheostomy performed in the setting of heterotopic ossification by an unspecified mechanism. There are few reported cases of tracheobronchial calcification in cardiac patients receiving warfarin therapy; however, these patients had characteristic imaging findings that were not consistent with those of our patient.
  
  
  CONCLUSIONS
  We illustrate a safe and effective technique for tracheostomy in heterotopic ossification that has not been reported. Coordination with the anesthesia service was paramount for a successful operation.
authors.affiliation: Department of Otolaryngology-Head & Neck Surgery, Loyola University Medical Center, Maywood, IL, USA Esther.Cheng@luhs.org.
authors.forename: Esther
authors.initials: E
authors.lastname: Cheng
authors.affiliation: Department of Otolaryngology-Head & Neck Surgery, Loyola University Medical Center, Maywood, IL, USA.
authors.forename: Eric
authors.initials: E
authors.lastname: Thorpe
mesh_terms: D000368:Aged; D000758:Anesthesia; D006801:Humans; D008297:Male; D009999:Ossification, Heterotopic / Q000000981:diagnostic imaging*; D014057:Tomography, X-Ray Computed; D014133:Tracheal Diseases / Q000000981:diagnostic imaging*; D014139:Tracheostomy / Q000379:methods*
keywords: airway management; airway remodeling; heterotopic ossification; tracheostomy