Case Report:
A 53-year-old male underwent surgical tracheostomy during
hospitalization for a cerebrovascular accident in April of 2021. During
the operation, three Prolene stay sutures were placed (one superior on a
trapdoor incision of the trachea, and one left, and one right). On
postoperative day 7, the tracheostomy tube was changed to a smaller
size. The stay sutures remained in place. Approximately three weeks
after surgery, the patient was ultimately discharged from the hospital
to a rehabilitation facility with the tracheostomy tube in place. He was
decannulated at the facility about six weeks after tracheostomy tube
placement without complication, although it is unclear if it was an
intentional or accidental decannulation. He was stable without the
tracheostomy and the facility opted not replace the tube, allowing the
stoma to close. He reported subjective hoarseness, but denied any other
issues after decannulation. A few weeks later, during fiberoptic
endoscopic evaluation of swallowing (FEES) with the Speech and Language
Pathology team at the rehabilitation facility, there was a string-like
object noted in his airway on exam, and the patient was sent to the
emergency department for further evaluation. At the hospital, the
Otolaryngology team performed flexible laryngoscopy in the emergency
department, which confirmed the presence of what appeared to be a
Prolene suture in the glottis. The patient’s stoma had closed with
minimal granulation and no evidence of suture in the neck. The patient
was urgently taken to the operating room for direct laryngoscopy and
removal of the foreign body.
The patient was orotracheally intubated uneventfully. Upon inspection of
the glottis, a Prolene suture was seen sitting lodged between the
endotracheal tube cuff and the glottic airway (Figure 1) . Using
a 0-degree rigid telescope and grasping forceps, the suture was grasped
and easily removed. The cuff of the endotracheal tube was deflated and
the tube withdrawn for inspection of the trachea and mainstem bronchi.
Minimal inflammation was noted at the level of the first and second
tracheal ring. No further foreign body was identified. The patient
uneventfully recovered with no complication.