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 The cuff of the endotracheal tube was deflated and the tube withdrawn for inspection of the trachea and mainstem bronchi.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.