Percutaneous tracheostomy in a patient with mandibulo-maxillary interfixation with modified approach for bronchoscopic guidance--case report.

Percutaneous tracheostomy has replaced the surgical approach in many intensive care unit patients. In this case report, we present the use of percutaneous tracheostomy on a patient with mandibulo-maxillary interfixation. A 19-year-old male with severe maxillofacial injuries underwent mandibulo-maxillary interfixation. Percutaneous tracheostomy was planned. Because of the mandibulo-maxillary interfixation, however, neither direct laryngoscopy nor the fiberoptic bronchoscopy through the existing preformed nasal endotracheal tube could be utilized. A modified approach utilizing the fiberoptic bronchoscopy to safely withdraw the endotracheal tube was used. The bronchoscope was introduced from the other nostril and used to inspect the withdrawal of the ETT from outside. Our case demonstrates the feasibility of percutaneous tracheostomy in the setting of mandibulo-maxillary interfixation. To our knowledge this is the first report of percutaneous tracheostomy in this indication.