Factors Associated with Fracture and Migration of Tracheostomy Tube into Trachea in Children: A Case Series

Document Type : Original


1 Department of ENT and Head Neck Surgery, AIIMS Bhubaneswar, Odisha-751019, India.

2 Department of ENT, JIPMER, Pondicherry- 06.


Tracheostomy is done to bypass the obstructed upper airway. Rare complication of this procedure is the fracture of the tube. Early identification and management of this condition is a great challenge to an otolaryngologist. To study the factors associated with the fracture and migration of tracheostomy tube into tracheobronchial tree in paediatric age group.
Materials and Methods:
This study is a case series study conducted on children with a diagnosis of fractured tracheostomy tube presenting as a foreign body airway over five years duration. Data regarding the possible patient and tube factors responsible for the condition were collected and analysed.
Total 11 patients (males-5 and females-6, average age-10.18 years, range 1-15 years) wearing tracheostomy tube for an average period of 2 years (range 3 months-8 years) were included in the study. Aspirated tubes were Jackson’s metallic inner tube, Romson polyvinyl chloride plastic tube and Fuller’s outer tube flange in 5 (45.5%), 4 (36.4%) and 2 (18.1%) patients respectively. The most common fracture site was at the junction between tube and neck plate (90.9%). The most common causes for fracture tube were prolonged use in 10 cases (90.9%), stomal narrowing in 9 cases (81.8%), and infection with peri-stomal granulation tissue in 9 cases (81.8%). 
A fractured tracheostomy tube is a rare but preventable late complication of tracheostomy. Appropriate training about proper tracheostomy care, timely check-up of tracheostomy tube for signs of wear and tear, scheduled replacement, regular follow up and awareness may prevention this complication.


Main Subjects

  1. Okafor BC. Fracture of tracheostomy tubes. Pathogenesis and prevention. J Laryngol Otol. 1983; 97(8):771-774.
  2. Piromchai P, Lertchanaruengrit P, Vatanasapt P, Ratanaanekchai T, Thanaviratananich S.  Fractured


metallic tracheostomy tube in a child: a case report and review of the literature. J Med Case Rep. 2010; 4:234.

  1. Majid AA. Fractured silver tracheostomy tube: a case report and literature review. Singapore Med J. 1989;30(6):602-604.
  2. Gana PN, Takwoingi YM. Fractured tracheostomy tubes in the tracheobronchial tree of a child.Int J Pediatr Otorhinolaryngol.2000;53(1):45-8.
  3. Parida PK, Kalaiarasi R, Gopalakrishnan S, Saxena SK. Fractured and migrated tracheostomy tube in the tracheobronchial tree. Int J Pediatr Otorhinolaryngol. 2014;78(9):1472-1475.
  4. Krempl GA, Otto RA. Fracture at fenestration of synthetic tracheostomy tube resulting in a tracheobronchial airway foreign body. South Med J. 1999; 92(5):526-528.
  5. Kakar PK, Saharia PS. An unusual foreign body in the tracheo-bronchial tree. J Laryngol Otol. 1972; 86(11):1155-1157.
  6. Kemper BI, Rosica N, Myers EN, Sparkman T. Inner migration of the inner cannula: an unusual foreign body. Eye Ear Nose Throat Mon. 1972; 51(7):257-258.
  7. Gupta SL, Swaminathan S, Ramya R, Parida S. Fractured tracheostomy tube presenting as a foreign body in a paediatric patient. BMJ Case Rep. 2016; 8:2016.
  8. So-Ngern A, Boonsarngsuk V. Fractured metallic tracheostomy tube: A rare complication of tracheostomy. Respir Med Case Rep. 2016;19:46–8.
  9. Otto RA, Davis W. Tracheostomy tube fracture: an unusual etiology of upper respiratory airway obstruction. Laryngoscope. 1985;95(8):980-981.
  10. Chaturvedi VN, Gupta NB. Study of size and manufacturing defects of various tracheostomy tubes. Indian J Otolaryngol Head Neck Surg. 1995; 47(3): 221-225.
  11. Bhargava MS, Bhat MS. Broken tracheostomy introducer-an unusual tracheobronchial foreign body. J Laryngol Otol. 1993;107(5):463-464.
  12. Alvi A, Zahtz GD. Fracture of a synthetic fenestrated tracheostomy tube: case report and review of the literature. Am J Otolaryngol. 1994; 15(1): 63-67.
  13. Lynrah ZA, Goyal S, Goyal A. et al. Fractured tracheostomy tube as foreign body bronchus: Our experience with three cases. Int J Pediatr Otorhinolaryngol. 2012;76:1691-1695.
  14. Sherman JM, Davis S, Albamonte-Petrick S et al. Care of the child with a chronic tracheostomy. Am J Respir Crit Care Med. 2000;161(1):297-308.
  15. Fiske E. Effective strategies to prepare infants and families for home tracheotomy care. Adv Neonatal Care. 2004;4(1):42-53.