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Clinical Note |

Tracheal Obstruction Due to Heterotopic Ossification in a Tracheostomy Scar

Ophir Ilan, MD, PhD; Diana Prus, MD; Boris Zamsky, MD; Esther-Lee Marcus, MD
Arch Otolaryngol Head Neck Surg. 2012;138(1):76-78. doi:10.1001/archoto.2011.213.
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Long-term tracheostomy has been associated with various complications, including obstruction of the distal end of the tube by granulation tissue in the trachea, stenosis of the stoma, dilatation of the stoma, tracheomalacia, tracheal stenosis, tracheoinnominate artery fistula, and tracheoesophageal fistula.1,2 We report a rare and, to our knowledge, previously undescribed life-threatening complication resulting from tracheal obstruction due to heterotopic ossification in a tracheostomy scar in a mechanically ventilated patient. The ossification prevented intubation or the insertion of a larger tracheostomy tube. Unlike heterotopic ossification in abdominal scars, which is benign, ossification in a tracheostomy scar may be life-threatening during a routine change of a tracheostomy tube. With the increasing number of tracheostomies performed in long-term ventilated patients, physicians may encounter this complication and should be aware of its presentation, management, and possible prevention.

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Figure. Hematoxylin-eosin–stained specimens. A, Specimen showing ulcerated skin with acute and chronic inflammation, granulation tissue, and heterotopic ossification (arrows) (original magnification ×40). B, Magnification of the area of heterotopic ossification showing fragments of trabecular bone within abundant well-vascularized fibrous stroma (original magnification ×200).




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