Airway obstruction caused by endotracheal tube cuff herniation during creation of tracheal stoma.

We report an unusual case of airway obstruction caused by herniation of endotracheal tube (ETT) cuff in a 62-year-old male who underwent surgery for hypopharyngeal carcinoma. During the procedure of creating a tracheal stoma, a new oral ETT was inserted by the surgical team to the lower portion of the trachea through the cut opening to replace the old for ventilation and prevention of soiling of the airway. Upon resumption of surgical manipulation, right endobronchial intubation was disclosed. The ETT cuff was therefore repositioned and reinflated, but airway obstruction persisted in spite of tube obstruction being ruled out by successfully passing a suction catheter through the ETT. After deflating the cuff the obstruction was resolved, and ventilation was eased. Thus the ETT was replaced with another new one and careful scrutiny made after the event revealed a herniating cuff due to manufacturing defect. It was conceivable that endobronchial intubation with over-inflation of the tube cuff may cause cuff herniation, particularly when surgical manipulation was active at the adjacency, in spite of the use of a modern tube with low-pressure high-volume cuff. Performing the "cuff deflation test" is the simple way to diagnose cuff herniation. Awareness of this condition, especially when anesthesiologists lose direct control of the airway during such procedures is important because undesirable complications can be prevented through quick decision and action.