Malignant Seeding to the Trachea and Tracheostomy Site: A Case Report and Literature Review.

OBJECTIVE: Malignant seeding of the trachea after resection of head and neck cancer is a rare but clinically significant complication, most often associated with advanced-stage disease and nodal metastasis. We aim to present a case of malignant seeding to the trachea and provide a comprehensive literature review to identify patterns in presentation, management, and outcomes. METHODS: A literature search was performed to identify cases of malignant seeding to the trachea or tracheostomy site in patients with head and neck cancers. Inclusion required histological confirmation and sufficient clinical detail. RESULTS: We report a case of an 83-year-old woman with a history of mandibular squamous cell carcinoma (SCC) who underwent segmental mandibulectomy with free flap reconstruction and temporary tracheostomy. She presented 19 months later with progressive shortness of breath. Biopsy confirmed SCC at the prior tracheostomy site. Including our case, 28 cases were identified from the literature. SCC accounted for 92.9% of cases, with the oral cavity as the most common primary site (67.9%). Treatment for the tracheal seeding included surgical intervention with or without RT or chosen palliative care. At last follow-up, 60.7% of patients died from the tracheal malignancy, with 25.0% alive without disease. CONCLUSION: Malignant seeding to the trachea or tracheostomy site is relatively rare with a poor prognosis. Measures to prevent this occurrence include delaying tracheostomy until tumor resection, using separate sterile instruments when performing multiple surgeries, and providing prophylactic radiation to the stoma in high-risk patients.