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New Delhi, June 04, 2022:
Sir Ganga Ram Hospital department of Thoracic Surgery and department of ENT received a 13 year old male Srikanth (name changed) from Rajasthan in last week of April 2022. The patient had Tracheostomy tube inserted in his breathing wind pipe for more than 10 years. Due to long period of Tracheostomy and a portion of missing wind pipe, there was no airway for him to breathe normally. The child had neither spoken nor eaten normally for last 7 years.
According to Dr. Manish Munjal, Senior Consultant, Department of ENT, Sir Ganga Ram Hospital, “When I first saw the patient, I felt, it was going to be a very complicated airway and voice box surgery which in my last 15 years of practice had not seen. This child had a complete 100% stenosis (blockage) of the Cricoid and Tracheal complex (air pipe). Due to this huge complication a single re-anastamosis (re-surgery) was going to be very difficult and challenging.
Seeing the complexities and rarity of this kind of surgery Sir Ganga Ram Hospital decided to form a panel of doctors taken from department of Thoracic Surgery, department of ENT, department of Pediatric Intensive Care and Department of Anesthesia.
Speaking on the issue Dr. Sabyasachi Bal, Chairperson, Department of Thoracic Surgery, Sir Ganga Ram Hospital said, “We decided to attempt complete ‘Crico-tracheal resection’ of the affected disease airway segment. This is a complicated and challenging surgery with high risk of failure which may lead sometimes to mortality (death). But the child did not have any other option and the same was explained to the family.”
On 23 April 2022, the child was wheeled inside the Operation Theatre. The teams from department of Thoracic Surgery, ENT and Anesthesia worked together for six and half hours.
Dr. Manish Munjal further added, “Since 4 cms of airway pipe near the voice box was completely destroyed and non-recoverable, our first challenge was to reduce this gap by bringing the upper and lower segments of airway as close as possible. For this ‘Laryngeal Drop’ procedure was performed to bring down the Voice Box from its normal position.”
Dr. Sabyasachi Bal added, “Simultaneously when the voice box was being brought down, we released the lower part of wind pipe from its surrounding attachment in the chest and pulled the wind pipe towards the voice box.”
Dr. Manish Munjal added, “Finally, the most important and difficult part was to operate on badly stenosed (blocked) Cricoid bone. This is a horse shoe shaped bone below the voice box which contains the minute voice nerves on both the sides and is mainly responsible for voice and airway protection.
We used a system of drills to widen the severely stenosed portion of Cricoids bone. We had to be extra careful to preserve the very minute laryngeal nerves (voice nerves). If these were damaged the voice would have never come back. Finally re-fashioned segments of both upper and lower sides of airway were brought together and joined back.”
The surgery was totally successful, but the challenges were still there. The post surgery management was very important.
According to Dr. Anil Sachdev, Director Paediatrics Intensive Care, Department of Paediatrics, Sir Ganga Ram Hospital, “The child had a very high risk of airway leak into the chest wall, which could have been catastrophic. Therefore the child was kept in neck flexion (chin locked down towards the chest position) for 3 days. Also, he was kept on low pressure oxygen support so that he did not develop any traumatic air leak. He was also kept in ICU for 3 days and the recovery was uneventful.”
The child has now been discharged and is in stable condition.
According to Mr. Amit Kumar (father of the child), “We are now very happy that our child who was neither speaking nor eating, missing school and his normal life, is now back to school. He has spoken for the first time after 7 years and most importantly taken his own breath without any outside help. He is also eating normally without tube. We are very grateful to all the staff of Sir Ganga Ram Hospital for their miraculous surgery.”
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