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PREOPERATIVE DIAGNOSIS: Tracheal stenosis and metal stent complications.

POSTOPERATIVE DIAGNOSIS: Tracheal stenosis and metal stent complications.

ANESTHESIA: General endotracheal.

ENDOSCOPIC FINDINGS:
1. Normal true vocal cords.
2. Subglottic stenosis down to 5 mm with mature cicatrix.
3. Tracheal granulation tissue growing through the stents at the midway point of the stents.
5. Three metallic stents in place in the proximal trachea.
6. Distance from the true vocal cords to the proximal stent, 2 cm.
7. Distance from the proximal stent to the distal stent, 3.5 cm.
8. Distance from the distal stent to the carina, 8 cm.
9. Distal airway is clear.

PROCEDURES:
1. Rigid bronchoscopy with dilation.
2. Excision of granulation tissue tumor.
3. Application of mitomycin-C.
4. Endobronchial ultrasound.

TECHNIQUE IN DETAIL: After informed consent was obtained from the patient and her husband, she was brought to the operating theater after sequence induction was done. She had a Dedo laryngoscope placed. Her airways were inspected thoroughly with findings as described above. She was intermittently ventilated with an endotracheal tube placed through the Dedo scope. Her granulation tissue was biopsied and then removed with a microdebrider. Her proximal trachea was dilated with a combination of balloon, Bougie, and rigid scopes. She tolerated the procedure well, was extubated, and brought to the PACU.

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