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1000 Titel
  • A safe procedure? The unusual case of a fatal airway obstruction by silicone during the production process of a tracheostomal epithesis in a 13-year-old boy
1000 Autor/in
  1. Wittschieber, Daniel |
  2. Schulz, Ronald |
  3. Schmidt, Peter F. |
1000 Erscheinungsjahr 2021
1000 Publikationstyp
  1. Artikel |
1000 Online veröffentlicht
  • 2021-10-07
1000 Erschienen in
1000 Quellenangabe
  • 136(1):373-380
1000 Copyrightjahr
  • 2021
1000 Lizenz
1000 Verlagsversion
  • https://doi.org/10.1007/s00414-021-02720-x |
  • https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8813825/ |
1000 Publikationsstatus
1000 Sprache der Publikation
1000 Abstract/Summary
  • A tracheostomal epithesis is a plastic prosthesis that serves for sealing a tracheostoma and ensuring the position of the tracheostomy tube. The production of a tracheostomal epithesis requires an impression of the tracheostoma. To this end, silicone impression material is applied by an anaplastologist in and around the tracheostomal region, including the trachea. The blocked cuff of the tracheostomy tube serves to prevent aspiration of the material. We report on a 13-year-old boy who died during this procedure because the lower airways were obstructed with cured silicone. Forensic autopsy confirmed asphyctic suffocation as cause of death. Forensic physical investigation of the tracheostomy tube and its cuff revealed no structural or functional defects. Yet, the investigation results prove that the viscous silicone must have passed the cuff. To conclude, this case report demonstrates that the production of an impression of a tracheostoma is a procedure with a potentially lethal outcome. Hence, professional guidelines, including clear safety precautions, are urgently needed.
1000 Sacherschließung
lokal Malpractice
lokal Adolescent [MeSH]
lokal Silicones [MeSH]
lokal Trachea [MeSH]
lokal Humans [MeSH]
lokal Aspiration
lokal Tracheostomy/methods [MeSH]
lokal Asphyxia
lokal Male [MeSH]
lokal Tracheostoma
lokal Airway Obstruction/etiology [MeSH]
lokal Epithesis
lokal Case Report
1000 Liste der Beteiligten
  1. https://orcid.org/0000-0003-1344-7488|https://frl.publisso.de/adhoc/uri/U2NodWx6LCBSb25hbGQ=|https://frl.publisso.de/adhoc/uri/U2NobWlkdCwgUGV0ZXIgRi4=
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1000 Erstellt am 2023-05-09T11:56:55.162+0200
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1000 Zuletzt bearbeitet 2023-10-21T03:07:26.437+0200
1000 Objekt bearb. Sat Oct 21 03:07:26 CEST 2023
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