SUBMANDIBULAR TISSUE OBSTRUCTION OF TRACHEOSTOMY TUBE - REVERSAL WITHCHIN SLING

We report on a 55-year-old woman with a tracheostomy who had unexplain ed respiratory failure from acute nocturnal shortness of breath. Durin g the second day of admission, the patient noticed that her ''second c hin'' folded over the tracheostomy on neck flexion, occluding her arti ficial airway. The patient jury-rigged a strap to retain the submental tissue from occluding the opening of the tracheostomy tube. She was s ubsequently free from obstructive symptoms with good oxygen saturation even with neck flexion. She was consequently discharged with a presum ptive diagnosis of acute upper airway obstruction. We believe that thi s unusual complication of the tracheostomy tube may be more common tha n appreciated. Accordingly, patients with a tracheostomy should be eva luated through a full range of body and neck positions. Increases in b ody fat and tissue relaxation should be suspected as possible causes o f occult occlusion of tracheostomy tubes. The application of a ''chin sling'' can reverse this unusual upper airway obstruction until defini tive correction by surgical lipectomy is performed.