A case of 8-year regression of intratracheal granulation due to tracheostomy cannula after local injection of triamcinolone acetonide

Abstract

Background

Granulations may form in the trachea during tracheostomy cannula placement, resulting in airway narrowing. Managing stenosis is difficult when the cannula cannot be removed. Herein, we report a case of long-term regression and maintenance of intratracheal granulation following local injection of triamcinolone acetonide (TA).

Case

A 14-year-old boy presented to our pediatric department with epilepsy and psychomotor retardation. He was born at 24 weeks and 4 days of gestation and weighed 705 g at birth. He underwent a tracheostomy for tracheomalacia at 1 year of age. At the age of 12 years, granulation formed at the tip of the tracheostomy cannula, resulting in severe tracheal stenosis, which was repeatedly managed using ventilator management and replacement cannulas. As bronchoscopic cauterization and removal of the granulation tissue did not improve the condition, triamcinolone acetonide solution was injected into the granulation tissue three times, which resulted in regression of the granulation. Thereafter, no restenosis has been observed for more than 8 years.

Conclusion

We encountered a case in which the local injection of triamcinolone acetonide into the intratracheal granulation caused by a tracheostomy cannula was very effective, and no regrowth of the granulation was observed for a long period of time, even though the cannula remained in place.