Tracheal rupture following cervical manipulation: late complication posttracheostomy.

This paper describes a tracheal rupture resulting from forceful cervical manipulation in a patient with healed tracheostomy performed 25 years earlier. It is hypothesized that the manipulation caused a tear in the anterior tracheal wall followed by recurrent abscesses and tracheocutaneous fistulas. Xerography revealed a ballooning out of the abscess cavity with the Valsalva maneuver. After intermittent full courses of oral antibiotics, surgical intervention was carried out with eventual complete resolution of symptoms. Since posttracheostomy scar tissue is more vulnerable than the extracranial vascular system, this first documented case of tracheal rupture should alert the public and the medical profession of yet another contraindication to forceful cervical manipulation.