Surgical Reconstruction of Posterior Cricoid Injury Following Airway Management Resulting in Tracheoesophageal Fistula: A Case Report

Acquired tracheoesophageal fistula (TEF) in adults may arise from iatrogenic injury during airway management; in particular, hypopharyngeal-subglottic fistula (HSF) involving the cricoid is rare.We report a 61-year-old male who underwent repeated intubations and percutaneous tracheostomy for infective endocarditis.During recovery, aspiration led to the diagnosis of a high-level TEF with bilateral vocal fold paralysis (BVFP).Imaging 4 months after tracheostomy suggested posterior cricoid compromise, and surgery revealed fibrosis, loss of cricoid architecture, and a small posterior fistula.Open airway reconstruction using a laryngeal cleft-type multilayer closure with autologous graft achieved durable closure, preserved airway function, and enabled gradual decannulation without recurrence at 1 year.This case highlights that iatrogenic airway injuries can cause delayed posterior cricoid collapse with HSF and BVFP, and that multilayer reconstruction is an effective treatment in complex adult cases.