MEDIASTINAL TRACHEOSTOMY IN TEHRAN IMAM KHOMEINI’S HOSPITAL FROM JANUARY 1991 TILL DECEMBER 2000

Abstract

Mediastinal tracheostomy is a complex surgical procedure for the management of airway reconstruction in patients whose distal trachea is not sufficiently long to be reconstructed as cervical tracheostomy after tracheal resection for malignant diseases. In this article (study), we present our 10 year experience of this uncommon procedure in thoracic surgery ward of Imam Khomeini's Hospital, Tehran. Sixteen patients (87.5% male, 12.5% female, 58.4±1.4 y/o) underwent this procedure because of thyroid cancer (31.3%), SCC of cervical trachea (12.5%), postcricoid esophageal cancer (12.5%), and laryngeal cancer (43.8%). The procedure was associated with cervical exenteration in 12.5% and total laryngectomy (44%), thyroidectomy (6.2%), laryngopharyngoesophagectomy (12.5%), resection of neck mass (18.5%) and repair of cervical esophageal fistula with myocutaneous flap (6.2%).They had history of total thyroidectomy (25%), total laryngectomy (25%), cervical tracheostomy (13%), and hemi-laryngectomy (6%). Six percent of patients died because of uncontrolled intraoperative hemorrhage, and 94% were complicated with postoperative hypocalcemia (31%), osteomyelitis (13%), fistula (13%) and necrosis of the flap (13%).