Airway Burns and Pediatric Tracheostomy Decannulation: A Case Report

Decannulation in pediatric patients following airway burns is a complex clinical challenge with no universally accepted protocol. We report the case of a four-year-old female patient who sustained extensive facial burns when her clothing was ignited by a flammable incense solution. She required emergent intubation and, owing to concerns for prolonged airway compromise, underwent tracheostomy three days after presentation. Initial bronchoscopy revealed 97% subglottic stenosis. Subsequent evaluation demonstrated true vocal cord adhesion causing 99% glottic stenosis and complete subglottic obstruction from a tracheal granuloma. Following surgical lysis of vocal cord adhesion, triamcinolone injection, and bronchoscopic granuloma excision, a structured yet individualized decannulation protocol was initiated, incorporating serial endoscopic assessments, progressive capping trials, and polysomnography. This led to successful decannulation in the post-anesthesia care unit (PACU) with a post-decannulation fiberoptic laryngoscopy to confirm stable airway anatomy. Dynamic reassessment and tailored intervention, rather than strict adherence to fixed criteria, are essential to achieving safe decannulation in this high-risk population.