Submandibular tissue obstruction of tracheostomy tube: Reversal with “chin sling”

We report on a 55-year-old woman with a tracheostomy who had unexplained respiratory failure from acute nocturnal shortness of breath. During the second day of admission, the patient noticed that her “second chin” folded over the tracheostomy on neck flexion, occluding her artificial airway. The patient jury-rigged a strap to retain the submental tissue from occluding the opening of the tracheostomy tube. She was subsequently free from obstructive symptoms with good oxygen saturation even with neck flexion. She was consequently discharged with a presumptive diagnosis of acute upper airway obstruction. We believe that this unusual complication of the tracheostomy tube may be more common than appreciated. Accordingly, patients with a tracheostomy should be evaluated through a full range of body and neck positions. Increases in body fat and tissue relaxation should be suspected as possible causes of occult occlusion of tracheostomy tubes. The application of a “chin sling” can reverse this unusual upper airway obstruction until definitive correction by surgical lipectomy is performed.