First case report
An 88-year-old patient with a history of esophageal squamous cell cancer presented with refractory dysphagia. The malignant esophageal stricture identified 18 cm from the incisors was dilated, and a fully covered Niti-S esophageal prosthesis of 80x18mm (Taewoong, Busan, South Korea) was subsequently placed across the stricture.
The day after the procedure, the patient developed inspiratory stridor and acute hypoxemic respiratory failure. X-rays of the neck showed that the stent was correctly placed. Orotracheal intubation was required on day 4. A flexible bronchoscopy showed that the vocal cords were paralyzed in paramedian position, with no evidence of locoregional edema or laryngeal injury, particularly cricoarytenoid edema or external tracheal compression. The stent was removed on day 6, and the patient was extubated on day 7. A second flexible bronchoscopy showed complete restoration of right vocal cord mobility and partial improvement on the left side. The respiratory outcome was favorable and oxygen therapy was stopped at day 10.
Second case report
A 58-year-old patient with a history of right upper lobectomy for stage IA primary lung adenocarcinoma presented with dyspnea and aphagia. A CT scan revealed a proximal esophageal mass extending to the lower trachea with no evidence of lung cancer recurrence. A flexible bronchoscopy showed tracheal stenosis due to an apparently malignant endotracheal mass combined with external airway compression. The vocal cords were normal. A silicone tracheal prosthesis of 15 × 80 mm (Trachéobronxane, Novatech, La Ciotat, France) was placed across the stricture during rigid bronchoscopy. At the same time, gastroscopy revealed severe extrinsic esophageal compression 23 cm after the incisors, and so an esophageal prosthesis was placed (Taewoong, Busan, South Korea). Tachypnea and dyspnea appeared immediately after extubation. Flexible bronchoscopy showed that the vocal cords were in paramedian position without tracheal prosthesis migration or laryngeal edema. The patient died 6 days following the placement of the prosthesis due to acute respiratory distress.