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Lesson of the month: management for aspiration of a silver nitrate pencil tip during tracheostomy care
  1. Simon Deshayes1,
  2. Romain Magnier1,
  3. Frédérick Rault2,
  4. Sylvain Teulier1,
  5. Helen Fouquet1,
  6. Emmanuel Bergot1,3,
  7. Aurélien Justet1,3
  1. 1 Service de Pneumologie et d'Oncologie Thoracique, CHU Caen, Caen, France
  2. 2 Service d'ORL et de chirurgie cervico-faciale, CHU Caen, Caen, France
  3. 3 ISTCT, UMR6030-CNRS-CEA-Université de Caen, Caen, France
  1. Correspondence to Dr Aurélien Justet, Pneumologie et Oncologie Thoracique, CHU Caen, Caen 14000, France; justet-a{at}


We present the cases of two laryngectomised patients who were treated for granulomas of the tracheostomy orifice with a silver nitrate pencil. During tracheostomy care, the tip broke off, was aspirated and fell into the bronchial tree. Necrotising ulcerative injuries of the right bronchial tree with clear delineation were found without lesions in the subsegmental division. To prevent the risk of secondary stenosis of the small airways induced by the spread of silver nitrate, we did not irrigate with saline solution as previously reported. Antibiotherapy and endoscopic monitoring were performed. Complete healing in 4–6 weeks was found without stenosis of the bronchial tree or bleeding.

  • bronchoscopy

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  • Contributors All authors contributed to the conception of the case reports. SD and RM wrote the first draft. All authors revised subsequent versions and AJ approved the final version.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.