Airway foreign body retrieval in a tracheostomy-dependent patient with severe laryngeal stenosis

Objective: When an airway foreign body (FB) cannot be retrieved through the glottis via direct laryngoscopy, it poses a special clinical challenge. We herein describe retrieval of an aspirated FB in a tracheostomy-dependent patient with severe laryngeal stenosis which precluded transglottic FB removal. Methods: A 34-year-old man with a history of tracheostomy-dependence presented to the emergency department with chest pain and shortness of breath. He reported aspirating a Montgomery cannula. Computed Tomography (CT) scan imaging demonstrated an aspirated Montgomery cannula (AMC) in the distal tracheobronchial airway with extension into the right bronchus. Results: After the patient was placed under general anesthesia, micro-direct laryngoscopy with dilation of posterior glottic and subglottic stenosis was performed. Even after laryngeal dilation, the severity of the stenosis made it unfeasible to pass the AMC through the laryngeal inlet. Passing instrumentation through the stoma would occlude the patient's only airway and he was already in respiratory distress. Therefore, a thin bronchoscope and balloon dilator were passed through the larynx and used in a manner that kept the AMC lumen patent while drawing it back to the level of the stoma where it could be retrieved with a hemostat. There was no damage to the airway at the conclusion of the operation and the patient was discharged without complication. Conclusion: In the setting of severe laryngeal stenosis in tracheostomy patients, certain FBs may be retrieved using the method described in this case report.