Tracheostomy stomal seeding following tongue cancer resection: A case report

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Abstract
Background: The tracheostomy site seeding following oral cancer surgery is extremely rare and carries poor prognosis.Case Presentation: We present the case of the 62‐year‐old man with clinical T4bN2bM0 tongue squamous cell carcinoma (SCC). The tracheostomy was planned before cancer resection under general anesthesia, but oral intubation was not possible because of bleeding from tongue cancer. Thus, tracheostomy was performed under local anesthesia. He underwent a total glossectomy with segmental mandibulotomy, bilateral neck dissection with rectus abdominis muscle free flap reconstruction and postoperative radiotherapy. The pathological diagnosis was SCC (pT4bN0M0) with close margin. He underwent adjuvant radiotherapy of 66 Gy that targeted the primary tumor site and upper neck. The mass at the tracheostomy site from seeding was detected 4 months after surgery and treated with 60 Gy of radiotherapy. The patient was died from bleeding and airway obstruction about 7 months from detection of the seeding of tracheostomy site.Conclusion: Tracheostomy site seeding after temporally tracheostomy for oral cancer is very rare. The pathological mechanisms suspected the tumor seeding. The prognosis of the seeding of tracheostomy site was extremely poor. Possible method to prevent these includes awake tracheostomy without oral intubation for predicting bleeding from bulky tumor with trismus.

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